Judicious use of DXA-BMD in assessing fracture risk by using clinical risk factors in the Indian population.

FRAX scores were significantly higher in patients admitted with fragility fractures than controls and can be useful in choosing the right patients for bone density testing, thus using of an expensive test judiciously. PURPOSE: This study was planned to compare the FRAX scores for the risk for major osteoporotic fracture (FRAX-MOF) and hip fracture (FRAX-HF) in patients with fragility fractures (cases) and those admitted for other indications (controls) in the orthopedic ward in our institute. METHODS: Historical and anthropometric data were prospectively recorded from 500 consecutive patients admitted in the orthopedic ward in in Medanta, the Medicity, Gurgaon, India. The receiver operating characteristic (ROC) curves were constructed for FRAX-MOF and FRAX-HF and the area under the curve (AUC) was calculated between cases and controls. RESULTS: The FRAX-MOF was significantly high in cases as compared to controls (7.34 ± 4.41 versus 5.64 ± 4.3; p = 0.001). The FRAX-HF was also significantly high in cases as compared to controls (2.95 ± 3.13 versus 1.67 ± 2.21; p < 0.001). The areas under the curves were 0.627 for FRAX-MOF and 0.654 for FRAX-HF. For FRAX-MOF, a cutoff of 2 has a 90% sensitivity, but only 15% specificity; whereas a cutoff of 10.5 had a specificity of 90% to differentiate those with and without fractures, but only 23% sensitivity. For FRAX-HF, a cutoff 0.3 had about 90% sensitivity and 20% specificity, whereas a cutoff of 3.5 had 90% specificity and 25% specificity to differentiate cases and controls. CONCLUSIONS: This study compared the FRAX-MOF and FRAX-HF in patients with and without fragility fractures and derived cutoffs for practical clinical use of FRAX-MOF and FRAX-HF to optimize the use of DXA-BMD.

Association of polycystic ovary syndrome and Graves' disease: Is autoimmunity the link between the two diseases.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrinopathy of women of child-bearing age. Although some studies have suggested an association between PCOS and autoimmune thyroiditis, to our knowledge, only a few cases indicating association between PCOS and Graves' disease are reported. OBJECTIVE: We aim to describe this first case series of six women presenting with PCOS and Graves' disease together. MATERIALS AND METHODS: Women attending the endocrinology clinic at a tertiary care centre in north India and fulfilling the AE-PCOS criteria for diagnosis of PCOS were studied using a predefined proforma for any clinical, biochemical and imaging features of Graves' disease. RESULTS: The series consisted of six women with a mean age of 27.5 years and menarche as 12.6 years. All women were lean with mean BMI of 22.73 kg / m(2) and three out of six had waist circumference <80 cm. The mean FG score of subjects was 16.66 and average total testosterone was 77.02 ng / dl (25.0-119.64). All the patients had suppressed TSH, the average being 0.052 µIU/ml (0.01-0.15). Thyroid gland was enlarged in all clinically and on ultrasonography and imaging with (99m)Tc and/or RAIU revealed diffuse increased uptake. CONCLUSIONS: The association of a rare disorder like Graves' disease with a relatively common disorder like PCOS is unlikely to be because of a chance alone and may point to a common aetiopathogenic linkage leaving a scope for molecular characterization.