Authors (including presenting author) :
Pang SCE
Affiliation :
(1) Department of Family Medicine and primary healthcare, Queen Mary Hospital, Hong Kong West Cluster
Introduction :
Osteoporosis is a common yet preventable medical condition that increases susceptibility to fragility fractures. The elderly, especially women are at the highest risk of developing osteoporosis. Among all fragility fractures, hip fracture is associated with the highest morbidity and mortality rate. Previous studies showed that the 1-year mortality rate after hip fracture was estimated to be around 20%. With the highest life expectancy globally, Hong Kong was predicted to be one of the regions with the highest increase in the incidence of hip fractures by 2050. The aging population would impose significant implications on the healthcare burden. Despite its significance, osteoporosis remains underdiagnosed and under-treated in Hong Kong. Patients are often diagnosed with osteoporosis only after they have had fragility fractures.
Currently, there is no government-led osteoporosis screening program in Hong Kong. Local experts had proposed that a universal osteoporosis screening program was cost-effective to reduce fragility fractures. Every man aged ≥70 years and woman aged ≥65 years was recommended to have Dual-energy X-ray absorptiometry (DXA) scan screening. However, no public funding is available to support the screening. The cost of a DXA scanning session was estimated to be around HK$500 in 2018.
According to the health belief model, individuals' risk perception can affect their health-related behaviours. Studies showed that individuals with higher perceived fracture risk were more likely to adopt bone-protective behaviours, such as undergoing DXA scans and taking anti-osteoporotic medications. Nevertheless, existing evidence dominated by Western countries found that at-risk individuals were often less aware of their fracture risk compared to individuals who were not at risk. Individuals with risk factors for osteoporotic fractures often underestimate their actual fracture risk. Whether at-risk population has lower awareness of their fracture risk is unknown in an Asian setting. Hence, this study aims to assess the relationship between fracture risk perception and calculated fracture risk among postmenopausal women in Hong Kong. The primary objective was to evaluate the discrepancy between the participants’ self-perceived fracture risk and the fracture risk calculated by FRAX. The secondary objective was to identify risk factors associated with underestimation of fracture risk.
Objectives :
We aimed to compare the participants’ self-perceived fracture risk (SPR) with fracture risk calculated by the Fracture Risk Assessment Tool (FRAX) and to identify factors associated with the underestimation of calculated risk.
Methodology :
Design: This is a cross-sectional study using questionnaires.
Subjects and main outcome measures: We collected demographic data and health information from postmenopausal Chinese women aged 50 to 90 in two general outpatient clinics. The participants estimated their 10-year osteoporotic fracture risk as
low (0-9%), moderate (10-19%) or high (≥ 20%), as referencing from previous studies. Their self-perceived fracture risk (SPR) was analysed with their calculated risk.
Result & Outcome :
Results:
In this study, we recruited 352 participants (age 67.5 ± 9.1 years). The proportion of fragility fracture and osteoporosis was 16% and 9%, respectively. Among those aged 65 or above, 66% had not undergone DXA scanning. 59% of the participants had low calculated fracture risk, while 27% and 14% had moderate and high calculated risk. Notably, 56% of high-risk participants underestimated their calculated risk. In our multivariate logistic regression model, we found that underestimation of fracture risk was statistically significantly associated with higher age (Odd ratio (OR)1.19, 95% Confidence Interval (CI): 1.12-1.26, p< 0.001) and lower body mass index (BMI) (OR 0.78, 95%CI: 0.63-0.95, p=0.02).
Conclusion:
Women with high calculated fracture risk tend to underestimate their risk, particularly those with higher age and lower BMI. Most at-risk individuals never had a DXA scan. These findings suggested osteoporosis health education should target at-risk individuals and include risk communication.
