Analysis of influencing factors and predictive value of initial fracture in postmenopausal osteoporosis patients

Objective To investigate the factors affecting initial fracture (IF) in postmenopausal osteoporosis (PMOP).Methods The clinical data of PMOP patients who visited the department of orthopedics and endocrinology of Xi'an Central Hospital from January 2018 to December 2023 were retrospectively collected, and patients were divided into the IF group and non-fracture (NF) group based on their fracture history. Logistic regression was used to analyze the factors influencing the occurrence of IF in PMOP patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to explore the predictive value of relevant indicators.Results A total of 370 PMOP patients were included, with 256 in the IF group and 114 in the NF group. The incidence of IF was 69.19%. Logistic regression analysis showed that higher Johns Hopkins Fall Risk Assessment Tool (JHFRAT) scores [OR=1.339, 95%CI(1.151, 1.557)], higher neutrophil-to-lymphocyte ratio (NLR) [OR=2.163, 95%CI(1.105, 4.237)], and elevated alkaline phosphatase (ALP) levels [OR=1.014, 95%CI(1.004, 1.024)] were risk factors for IF in PMOP patients. In contrast, living in an urban area [OR=0.333, 95%CI(0.113, 0.984)], higher bone mineral density (BMD) [OR=0.609, 95%CI(0.395, 0.937)], higher systemic immune-inflammation index (SII) [OR=0.998, 95%CI(0.997, 0.999)], and higher uric acid (UA) levels [OR=0.992, 95%CI(0.987, 0.997)] were protective factors. ROC curve analysis showed that the AUC for the combined three indicators (JHFRAT score + NLR + SII) was 0.834 [95% CI (0.792, 0.876)].Conclusion In PMOP patients, higher JHFRAT scores, NLR, and ALP levels, as well as lower BMD, SII, and UA levels, increase the risk of IF. The combination of JHFRAT score, NLR, and SII has high predictive value for IF.