BMD、OSTA与FRAX^(■)预测绝经后女性骨质疏松性骨折风险的比较研究  

Comparative study of BMD,OSTA,and FRAX in the prediction of osteoporotic fracture risk in postmenopausal women

作　　者：左薇[1] 费琦[2] 杨雍[2] 王炳强[2] 林吉生[2] 赵凡[2] 孟茜[2] 彭晓霞[1] 

机构地区：[1]首都医科大学公共卫生学院流行病学与卫生统计学系 [2]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中国骨质疏松杂志》2015年第1期48-52,共5页Chinese Journal of Osteoporosis

摘　　要：目的比较BMD、OSTA与FRAX(不含BMD模型)预测绝经后女性骨质疏松性骨折风险的准确性,为选择适合我国绝经后女性骨质疏松性骨折风险工具提供研究依据。方法 2011年1月至2011年12月,以首都医科大学附属北京友谊医院就诊并接受DXA骨密度检查的绝经后女性为研究对象,连续纳入1497例,建立队列。基于基线数据,以就诊时发生骨质疏松性骨折与否为参考标准,绘制ROC曲线,比较BMD、OSTA及FRAX评分预测骨质疏松骨折发生风险的准确性。结果发生骨折组(n=343)患者的BMD,OSTA评分与FRAX评分均低于未发生骨折组(n=1154),且差异均有统计学意义。BMD、OSTA及FRAX评分(不使用骨密度的主要部位FRAX评分)预测骨折风险的ROC曲线下面积分别为0.654(95%CI:0.621-0.687),0.629(95%CI:0.595-0.663)和0.907(95%CI:0.888-0.926),最佳诊断截点值分别为-1.25,-1.90和3.65%。结论不使用骨密度的主要部位FRAX评分可用于我国绝经后女性的骨质疏松性骨折风险评估,但诊断截点值为3.65%,远低于WHO推荐的20%,其原因需要进一步研究。Objective To compare the accuracy of BM D,OSTA,and FRAX（ non-BM D model） on the prediction of osteoporotic fracture risk,and to provide a suitable tool of osteoporotic fractures for Chinese postmenopausal women.Me thods This cohort study assessed 1497 postmenopausal women who took BM D test in Beijing Friendship Hospital from January 2011 to December 2011.Based on the baseline data and the occurrence of actual fractures,ROC curves were drawn.The accuracy of BM D,OSTA,and FRAX（ non-BM D model） in the prediction of osteoporotic fracture risk was compared.Re sult Values of BM D,OSTA,and FRAX in fracture group（ n = 343） were lower than those in non-fracture group（ n = 1154）,and the difference was statistically significant.AUC areas of ROC curves of BM D,OSTA,and FRAX were 0.654（ 95% CI： 0.621- 0.687）,0.629（ 95% CI： 0.595- 0.663）,and 0.907（ 95% CI： 0.888- 0.926）,respectively.The best cutoff values were- 1.25,- 1.90,and3.65%,respectively.Conclusion FRAX without BM D values can be used for the prediction of osteoporotic fracture risk in Chinese postmenopausal women.However,the diagnosis cutoff value is 3.65%,which is far less than 20% of the WHO recommendation.Therefore,further study should be conducted to explore the reason.

关 键 词：绝经后女性 骨质疏松性骨折 骨密度 OSTA FRAX 

分 类 号：R591.1[医药卫生—内科学]