The Added Value of SARC-F to Prescreening Using FRAX for Hip Fracture Prevention in Older Community Adults

  • Yi Su
    Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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  • Jean W. Woo
    Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China

    Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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  • Timothy C.Y. Kwok
    Address correspondence to Timothy C.Y. Kwok, MD, Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
    Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China

    Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Published:October 09, 2018DOI:



      To examine the potential added value of a simple 5-item questionnaire for sarcopenia screening (SARC-F) to the Fracture Risk Assessment Tool (FRAX) for hip fracture risk prediction, in order to identify at-risk older adults for screening with dual-energy x-ray absorptiometry (DXA).


      A prospective cohort study.

      Setting and participants

      Two thousand Chinese men and 2000 Chinese women aged 65 years or older were recruited from local communities and were prospectively followed up for about 10 years.


      Areal bone mineral density (BMD) of hip and lumbar spine were measured by DXA at baseline. Ten-year FRAX probability of hip fracture was calculated using the baseline risk factors. Information from the baseline questionnaire was extracted to calculate a modified SARC-F score. The independent predictive values of SARC-F and FRAX questionnaire were evaluated using multivariate survival analysis. The added predictive values of SARC-F to FRAX for pre-DXA screening were examined.


      During the follow-up, 63 (3.2%) men and 69 (3.5%) women had at least 1 incident hip fracture. SARC-F had an independent value of FRAX for hip fracture risk prediction, with an adjusted hazard ratio [95% confidence interval (CI)] of 1.24 (1.02, 1.52) and 1.15 (0.99, 1.13) in men and women, respectively. Compared with using FRAX, using SARC-F in conjunction with FRAX made the sensitivity for prediction rise from 58.7% to 76.2% in men and from 69.6% to 78.3% in women, with a nondecreased area under receiver operating characteristic curve of 0.67. Prescreening using FRAX in conjunction with SARC-F could save more than half of the DXA assessment than with no prescreening.


      SARC-F is associated with a modest increase in hip fracture risk, especially in men. Conjoint evaluation for sarcopenia in addition to FRAX screening may help identify older adults at higher risk of hip fracture for more intensive screening and/or preventive interventions.


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