DESCRIPTION OF MAJOR OSTEOPOROSIS RISK AND FRACTURING HIP RISK

BASED ON BMD T-SCORE WITH FRAX TOOLS IN WOMEN AGE ≥40 YEARS IN
JAMBI CITY IN 2018

Humaryanto; Torangdo Rendra Firnando

Abstract

Bone Mass Density (BMD) allocates the greatest contribution towards bone strength.
The Decrease in BMD will affect the strength of the bone and will become an
osteoporosis early predictors for the future. The Indonesian Osteoporosis Association
in 2007 showed that the prevalence of osteoporosis in Southeast Asia was estimated at
15.3%, meanwhile in Indonesia, the prevalence of osteoporosis reached 30.57%. This
research was gained by collecting 200 female respondents aged ≥ 40 years, which was
taken from Puskesmas Putri ayu, Puskesmas Rawa Sari and Puskesmas Koni. The
research design used was cross sectional design. Bone mineral density was measured
by bone densitometry. The data of the risk factor was obtained based on interview by
using the FRAX® tool. BMD features in 200 female respondents ≥ 40 years were
found as much as 61.5% osteopenia, 19% Osteoporosis and 18.5% normal. The risk
factors found were the history of fractures of 7% of respondents and 6.5% had risk
factors from consuming glucokorticoids. Based on the risk value of FRAX® tool, it
was found that 40% of respondents will have had a risk of ≥ 2.5% of having major
osteoporosis in the next 10 years, and 39.5% of respondents will have had a risk of
≥1% of having hip fracture in the next 10 years. Observing at the results of these
data, it is important to avoid the risk factors to prevent the possibility of major
osteoporosis and hip fractures

Keywords : Bone Mineral Density,Osteoporosis

INTRODUCTION
Osteoporosis is a hidden disease (silent
disease) without any special signs until the
patient experiences fractures due to minimal
trauma.1,2 It is stated as the most metabolic
bone abnormality that affects around 28.7%
of men and 32.3% of women in Indonesia.3
The prevalence of Osteoporosis increases
with age, especially age ≥ 40 years in both
men and women.4 Many factors influence
the existence of Osteoporosis. The
identification of Osteoporosis and the risk
fracture factors due to Osteoporosis is
important since the use of a BMD (bone
mass density) measuring device is still
considered to be less than optimal.5
The assessment of these risk factors is useful
in cost savings and to determine of therapy
to patients suspected of Osteoporosis. WHO
in collaboration with the University of
Sheffield has created a calculating device to
assess the risks an individual has and the
possibility of Osteoporotic fractures in the
next 10 years by looking at the data of one's
clinical risk factors. 5,7,7 The use of the
FRAX® tool is a widely used
recommendation although it has its own
shortcomings.5,7,8
Bone mineral density (DMT) is bone density
in the skeleton of the body.1 WHO uses
DMT measurements in diagnosing
Osteoporosis.2 WHO states Osteoporosis is
a condition where bone mineral density is
below -2.5 SD; while Osteopenia is a
condition where mineral density is -1 up to -
2.5 SD, and normal is if bone mineral
density is above -1 SD.3,4
Data released by the International
Osteoporosi Foundation (IOF) in 2013; it
has been predicted that by 2050 more than a
third of the total Indonesian population is at
risk of Osteoporosis over the age of 40
years, both in men and women. Research
conducted by the Indonesian Osteoporosis
Association in 2007 showed that the
prevalence of Osteoporosis in Southeast
Asia was estimated at 15.3% while in
Indonesia the prevalence of Osteoporosis
reached 30.57%. This shows that the
prevalence of Osteoporosis in Indonesia is
classified as high.4 According to
Tirtaraharja, in 2006 there were 23% of
women aged 50-80 years who had
Osteoporosis and 53% of women aged 70-
80 years had the same illness7. Therefore,
Osteoporosis will become a public health
problem in the future in Indonesia, including
in Jambi City, especially in elderly women.
RESEARCH METHODS
This research is a descriptive research with
cross sectional design to find out a
description of major Osteoporosis risk and
the risk of hip fracture based on the BMD T-
score with Frax tools and risk factors that
affect the occurrence of Osteoporosis and
hip fracture in the next 10 years. Research
conducted by the Indonesian Ministry of
Health Nutrition Research and Development
in 2005 in 16 regions in Indonesia (one of
which was Jambi Province) showed that the
prevalence of Osteopenia (early
Osteoporosis) reached a higher rate of
41.7%. The study also concluded that there
were at least 2 out of 5 people in Indonesia
at risk for Osteoporosis
This study will discuss more about the
picture of the risk of major Osteoporosis and
hip fracture based on Frax tools that use
DMT measurements with T score, and to
describe the risk factors in groups of women
aged ≥ 40 years in Puskesmas Rawa Sari,
Puskesmas Putri Ayu, and Puskesmas Koni.
RESULTS AND DISCUSSION
The respondents from this study were 200
women age ≥ 40 years. The age range of the
respondents in this study is between 40-69
years which was taken from Puskesmas
Koni, Rawa Sari and Putri Ayu.

The sample of this study was all women

aged above or equal to 40 years who met the
criteria of exclusion and inclusion. The
number of samples in this study were 200
respondents. The measurement of Bone
Mineral Density was using Bone
Densitometry (T-Score), BMI was measured
from their height using microtoa, and body
weight was measured by using digital scales.
BMI is calculated based on body weight in
kilograms divided by height in meters
squared (kg / m2). The measurement results
are input into Frax tools by outputting of the
major osteoporosis and hip fracture risk
values in each respondent.
1. Univariate Analysis
Based on the results of the study, it was
found that 101 respondents (50.5%) had
obesity nutritional status. The DMT values
in 200 respondents showed that the most
Osteopenia found in 125 respondents
(61.5%), followed by Osteoporosi in 38
respondents (19%) and 37 respondents
(18.5%) is at normal category.
Table 1. Distribution of Research variables

Variabel Category n %

Underweight 5 2,5

BMI Normal 94 47

Obesity 101 50,5

Ever 14 7
Previous Fractur History
Never 186 93
Yes 13 6,5
Consumed Glucocorticoids
No 187 93,5

Normal 37 18,5

DMT Osteopenia 125 61,5

Osteoporosis 38 19

The risk factors found based on interviews

with respondents; it was found in 14
respondents (7%) had a previous history of
 fracture and 186 respondents (93%) did not
have a previous fracture history. It was also
found that 13 respondents (6.5%) consumed 2. Bivariat Analysis
glucocorticoids and 187 respondents
(93.5%) claimed they did not consume a. BMD
glucocorticoids.
Grafik 1. Percentage of risk for major osteoporosis and
hip fracture Based on the research data, it can be seen
from 200 respondents, there were 101
respondents with obesity nutritional status,
18 respondents among them had
osteoporosis, 80 respondents had osteopenia,
and 3 normal respondents, we could also see
respondents with underweight nutritional
status; 2 respondents had Osteoporosis.
Osteoporosis was higher as seen from 14
respondents who had experienced a fracture,
8 respondents were experiencing
Osteoporosis and 6 had Osteopenia. A risk
factor for consuming glucocorticoids was
also seen from 13 respondents who
consumed glucokorticoids, 9 of them had
From the results of FRAX® tool
Osteoporosis, while 4 respondents had
calculations based on risk factors and BMD
Osteopenia.
T-Score values, it was obtained that 80
(40%) respondents had a risk of ≥ 2.5%
experiencing major Osteoporosis in the next
10 years, while 120 (60%) respondents had
as much risk as < 2.5% to experience Major
Osteoporosis in the next 10 years and 79
(39.5%) respondents have a risk of ≥1%
experiencing Hip fractures in the next 10
years, while 121 (60.5%) respondents have a
risk of <1% to experience hip fracture in the
next 10 years.
Table 2. Variable distribution of research with BMD

BMD %
Variabel Kategori osteoporosis osteopenia normal
n % n % n %
Underweight 2 1 0 0 3 1,5
BMI Normal 18 9 45 22,5 31 15,5
Obesity 18 9 80 40 3 1,5
Never 8 4 6 3 0 0
Previous Fractur History Ever 15 59,5 18,5
30 119 37
Consumed Yes 9 4,5 4 2 0 0
Glucocorticoids No 29 14,5 121 60,5 37 18,5
 with a fracture history had a higher risk of
Osteoporosis as seen from 14 respondents
b. Risk of Major Osteoporosis and Hip who had experienced a fracture; 8
Fractures respondents had Osteoporosis and 6 had
Osteopenia. The risk of Osteoporotic
Based on the results of the research data, fracture was greater in patients who had
respondents with obesity nutritional status experienced a previous fracture than people
had a greater risk of Osteoporosis in the next who had never experienced fracture. The
10 years (73 respondents), and had a greater risk of consuming glucocorticoids was also
risk of hip fracture in the next 10 years (73 seen from 13 respondents who took
respondents). It was also shown that the glucokorticoids, 9 of them had Osteoporosis,
respondents with Osteoporosis BMD had a while 4 respondents had Osteopenia.
greater risk of mayor Osteoporosis and hip According to several studies, the risk of
fracture; as seen as in 38 respondents. From fracture of the femur, forearm and shoulder
the data above, it was also seen the has doubled in patients who take
respondents who had a history of fractures glucocorticoids.
in 14 respondents. They were all at risk for
major osteoporosis and hip fracture. From the results of the research data, it was
also seen respondents with obesity
nutritional status; (28%) had a greater risk of
Osteoporosi (≥ 2.5%) in the next 10 years
Resiko
Osteoporosis Resiko Hip Fraktur
Variabel Kategori
Mayor
≥ 2,5 % < 2,5 % ≥1% <1%
Underweight 3 2 3 2
BMI Normal 4 90 3 91
Obesity 73 28 73 28
Ever 14 0 13 1
Previous Fractur History Never 66 120 66 119
Yes 13 0 12 1
Consumed Glucocorticoids No 67 120 67 119
Normal 7 30 6 31
BMD Osteopenia 35 90 35 90
Osteoporosis 38 0 38 0
and had a greater risk of hip fracture (≥1%)
in the next 10 years. It was also seen that
CONCLUSIONS AND respondents with Osteoporosis DMT had a
RECOMMENDATIONS greater risk of major Osteoporosis and hip
fracture by 38 respondents. From the data
A total of 101 respondents (50.5%) had above it was also seen respondents who had
obesity nutritional status. The BMD value a history of fractures; 14 respondents were
showed that Osteopenia mostly found, in all at risk for major Osteoporosis and hip
125 respondents (61.5%). Of the 101 fracture. While respondents who consumed
respondents with obesity nutritional status, glucocorticoids (13 respondents) all also had
9% of them had Osteoporosis, 40% had a greater risk of Osteoporosis major and hip
Osteopenia, 1.5% were normal. Respondents fracture.
Women with a mild risk based on the
calculation of FRAX® tool are advised to
arrange a nutritional diet and regular
exercise. This is because women and men
aged ≥40 years have a risk of bone loss. A
series of Osteoporosis prevention measures
are recommended to avoid the occurrence of
Osteoporosis fractures which have an effect
on the mortality and morbidity of patients.
These precautions include taking good
calcium and vitamin D, exercising and
preventing of falls, and also avoiding
smoking and drinking alcohol. While for
women at severe risk based on FRAX® tool
calculations, it is recommended to carry out
bone density checks by using DXA. But this
has problems since the availability of DXA
tools as the gold standard for osteoporosis
diagnosis is still minimal in Indonesia.
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