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| FRAX®使用不同部位BMD预测绝经后骨质疏松性椎体骨折的风险比较 |
| FRAX® using different bone mineral density in prediction of postmenopausal osteoporotic vertebral fracture |
| 投稿时间：2018-11-03 修订日期：2019-03-20 |
| DOI： |
| 中文关键词: 骨质疏松性椎体骨折 绝经后 FRAX® 骨密度 |
| 英文关键词:osteoporotic vertebral fracture, postmenopausal, FRAX®, bone mineral density |
| 基金项目:重庆市渝中区科技计划项目（20160126，20180147），重庆市人民医院医学科技创新基金项目（2016MSXM04） |
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| 中文摘要: |
| 摘要：目的 比较骨折风险评估工具（fracture risk assessment tool, FRAX?）使用不同部位骨密度（bone mineral density, BMD）预测绝经后女性骨质疏松性椎体骨折（osteoporotic vertebral fracture, OVF）风险的准确性。方法 回顾性研究我院2016年12月至2018年3月符合选择标准的287例患者，根据有无OVF分为骨折组和对照组。根据股骨颈（femoral neck, FN）与腰椎（lumbar spine, LS）BMD是否相差一个standard deviation（SD），分为BMD差异组和对照组。比较FRAX?使用不同部位BMD的骨折风险预测值。就诊时发生OVF与否为参考标准，绘制受试者工作特征 （receiver operating characteristic, ROC) 曲线，比较FNBMD, LSBMD, FRAX?, FRAX?-FNBMD, FRAX?-LSBMD预测OVF发生风险的准确性。 结果 OVF组共计86例患者，OVF组FNBMD, LSBMD均显著低于对照组（P < 0.05），FRAX?-LSBMD骨折风险评分显著高于FRAX?-FNBMD（P < 0.05）。BMD差异组共计39例患者，其中31例LSBMD低于FNBMD，24例OVF发生在低LSBMD组。FRAX?-LSBMD骨折风险评分显著高于FRAX?-FNBMD（P < 0.05）。FNBMD, LSBMD, FRAX?, FRAX?-FNBMD, FRAX?-LSBMD预测骨折风险的ROC曲线下面积分别为0.601，0.719，0.746，0.810，0.833。 结论 部分OVF患者存在FN-LSBMD差异，FRAX?较BMD更能综合的评估OVF风险，有效的识别高危人群。同时FRAX?-LSBMD评估OVF骨折风险的准确性可能优于FRAX?-FNBMD，尤其是FN-LSBMD存在明显差异的时候。 |
| 英文摘要: |
| Abstract: Objective To compare the accuracy of fracture risk assessment tool (FRAX?) using different bone mineral density (BMD) for prediction of postmenopausal osteoporotic vertebral fracture (OVF). Methods A total of 287 patients were eligible for and were retrospectively examined from December 2016 to March 2018. Patients were divided into OVF group and control group. Spine–femur discordance group was defined as >1 standard deviation (SD) of difference between the femoral neck (FN) and lumbar spine (LS) BMD. Vertebral fracture risk was calculated using FRAX? with FNBMD or LSBMD. Based on the baseline data and the occurrence of actual fracture, BMD, FRAX? (without or with FNBMD and LSBMD) scores were assessed for identifying OVF via receiver-operating characteristic (ROC) curves. Results 86 out of 287 patients developed OVF. The levels of T-score of FNBMD and LSBMD in OVF group were significantly lower than those in control group (P < 0.05). Values of FRAX?-LSBMD was significantly higher than those of FRAX?-FNBMD (P < 0.05). 39 patients demonstrated spine–femur discordance. 31 patients having discordance showed lower LSBMD compared to FNBMD. During the follow-up periods, 24 OVF occurred in the lower LSBMD group. Patients with actual vertebral fracture occurrences showed more apparently elevated estimated fracture risks when FRAX? using LSBMD instead of FNBMD (P < 0.05). AUCs of ROCs of FNBMD, LSBMD, FRAX?, FRAX?-FNBMD, FRAX?-LSBMD were 0.601, 0.719, 0.746, 0.810, 0.833, respectively. Conclusions A significant number of patients exhibit spine–femur discordance. Compare with BMD, FRAX? maybe can comprehensively and effectively identify the high-risk groups of osteoporosis. FRAX?-LSBMD may be more appropriate for estimation of OVF risk than FRAX?-FNBMD, especially patients with spine–femur BMD discordance. |
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