中国骨质疏松杂志

骨小梁评分结合骨密度用于骨质疏松诊疗及骨折风险预测

TBS combined with BMD for osteoporosis diagnosis and fracture risk prediction

DOI：10.3969/j.issn.1006-7108.2023.12.012

英文关键词:trabecular bone score bone mineral density osteoporosis fracture risk

基金项目:贵州省中医药管理局中医药、民族医药科学技术研究课题计划（QZYY-2018-056）

作者	单位
李黎唐魁韩王荣黄华陈静曾进海宋红*	北京积水潭医院贵州医院骨内科，贵州贵阳 550000

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中文摘要:

目的探讨骨小梁评分（trabecular bone score，TBS）结合骨密度（bone mineral density，BMD）用于骨质疏松诊治及骨折风险预测的可行性。方法收集2022年1月17日至2022年8月22日在我院使用GE Lunar双能X线骨密度仪检测的患者临床资料进行回顾性分析。观察50岁以下男性及绝经前女性不同骨量患者占比及BMD、TBS数据趋势，对比50岁以上男性及绝经后女性患者的脆性骨折组和非骨折组年龄、体质量指数（body mass index，BMI）、BMD、T值及TBS等影响因素的结果差异，根据 Logistic 回归分析BMD和TBS在骨折风险方面的预测性能，采用ROC曲线分析其对骨质疏松脆性骨折的风险预测。结果 50岁以下男性骨量正常占比97.06%，其中骨折中风险占比8.82%，骨折高风险占比8.82%，绝经前女性骨量正常占比96.26%，其中骨折中风险占比8.50%，骨折高风险占比2.38%。50岁以上男性脆性骨折66例，非骨折641例，其中两组之间年龄、BMI、BMD、T值及TBS差异均具有统计学意义（P＜0.01），绝经后女性患者脆性骨折283例，非骨折1794例，其中两组之间年龄、BMD、T值及TBS差异均具有统计学意义（P＜0.01），BMI差异无明显统计学意义（P=0.12）。BMD和TBS均为脆性骨折的独立预测指标，联合BMD和TBS预测骨折风险的AUC最大，为0.748。结论骨量正常的患者其也存在一定骨折风险，其中年龄、BMD、T值及TBS等因素起到了影响作用；BMD和TBS均为脆性骨折的独立预测指标，TBS在骨折风险评估方面能带来额外的诊断信息，从而提升诊断和预测性能。

英文摘要:

Objective To share the data analysis of bone trabecular score (TBS) combined with bone mineral density (BMD) in our hospital, and to explore the feasibility of TBS combined with BMD in the diagnosis and treatment of osteoporosis and the prediction of fracture risk. Methods Clinical data of patients who were examined with GE Lunar dual-energy X-ray absorptiometry in our hospital from January 17, 2022 to August 22, 2022 were collected and analyzed retrospectively. The proportion of men under 50 years old and premenopausal women with different bone mass and the data trends of BMD and TBS were observed. The results of age, BMI, BMD, T-value and TBS and other risk factors were compared between the fragility fracture group and the non-fracture group of men over 50 years old and postmenopausal women. Logistic regression was used to analyze the diagnostic performance of BMD and TBS. ROC curve was used to analyze the risk prediction of osteoporotic fractures. Results The normal bone mass of males under 50 years old accounted for 97.06%, among which the risk of fracture accounted for 8.82% and the high risk of fracture accounted for 8.82%. The normal bone mass of premenopausal females accounted for 96.26%, among which the risk of fracture accounted for 8.50% and the high risk of fracture accounted for 2.38%. There were 66 fragility fractures and 641 non-fracture cases in men over 50 years old, among which age, BMI, BMD, T-value, and TBS were statistically different between the two groups (P<0.01). There were 283 fragility fractures and 1794 non-fractures in postmenopausal women. There were significant differences in age, BMD, T-value and TBS between the two groups (P<0.01), but no significant differences in BMI between the two groups (P=0.12). Both BMD and TBS were independent predictors of fragility fractures. Combination of BMD and TBS had the largest AUC (0.748) in predicting fracture risk. Conclusion Patients with normal bone mass also have a certain risk of fracture. Age, BMD, T-value, and TBS play a role. Both BMD and TBS are independent predictors of fragility fractures. TBS brings additional diagnostic information in fracture risk assessment, thereby improving diagnostic and predictive performance.

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