宁波市城区中老年人骨质疏松症患者骨折风险评价工具评估干预阈值探索  

Study on the intervention thresholds based on FRAX data among the middle-aged and the elderly in urban areas of Ningbo

作　　者：王俊[1,2] 王雪君 方贞 

机构地区：[1]宁波市江东区明楼街道社区卫生服务中心,浙江宁波315040 [2]宁波市江东区疾病预防控制中心 [3]宁波市江东区东柳街道社区卫生服务中心

出　　处：《中国预防医学杂志》2017年第7期512-516,共5页Chinese Preventive Medicine

基　　金：宁波市科技计划项目(2014C50061)

摘　　要：目的对宁波市城区中老年人估值风险评估工具(fracture risk assessment tool,FRAX)评估数据分析,探索国内FRAX评估骨折风险干预阈值。方法根据444例到宁波市东柳街道社区卫生服务中心体检的40~89岁居民的FRAX评估风险及骨密度(bone mineral density,BMD),采用不同方法探索FRAX干预阈值。以受试者工作特征曲线(reveiver operating characteristic curve,ROC)评估上述3种策略干预阈值。结果本次研究对象FRAX主要骨折风险为(5.00±3.55)%,髋部骨折风险为(1.55±2.21)%。策略1以既往有骨折史、无其他临床危险因素的女性FRAX评估骨折风险为阈值,40~89岁主要骨折风险阈值为2.60%~13.00%,髋部骨折风险阈值为0.40%~5.60%。策略2以FRAX评估概率的77.70%(1-既往骨折率22.30%)百分位数为阈值则主要骨折风险阈值为6.70%、髋部骨折风险阈值为2.30%。策略3以FRAX评估概率的60.59%(1-骨质疏松症检出率39.41%)百分位数为阈值则主要骨折风险阈值为4.70%、髋部骨折风险阈值为1.40%。策略1评估出的需干预数量最少,且各年龄段需干预比例差异无统计学意义(χ~2=2.650,P=0.104)。策略2和策略3需干预对象比例在高年龄组明显增加。策略1和策略2灵敏度很低、特异度较高,策略3灵敏度稍高、特异度较低。策略1中主要骨折风险阈值约登指数为0.086,髋部骨折风险阈值约登指数为0.089;策略2中两个约登指数分别为0.157和0.222;策略3分别为0.239和0.241。三种干预策略的AUC均不高,其中策略3的AUC稍高于另两种干预策略。结论不同干预策略得出FRAX评估干预阈值各有优缺点,需结合各地实际情况加以运用,并有待进一步研究确认。Objective Explore the intervention thresholds based on FRAX in Chinese urban middle-aged and elderly. Methods Based on the data of osteoporotic fracture probability by FRAX and the bone mineral den- sity （BMD） of 444 individuals aged 40-89 years who received physical examination in the center, several differ ent strategies were used to explore the FRAX based intervention thresholds which were then assessed through Youden index and the area under curve （AUC） . Results The FRAX-based 10 year major osteoporosis frac- ture probability without BMD was （5.00～3.55）%, the FRAX-based 10 years hip osteoporosis fracture prob- ability without BMD was （1.55～ 2.21 ）%. In strategy 1, the FRAX based fracture probability without BMI） of women with prior fragility fracture but no other clinical risk factors （CRFs） was taken as intervention thresholds, the 10 year main fracture probability thresholds rose from 2.60% at the age of 40 to 13.00% at the age of 89, the 10 year hip fracture probability rose from 0.40% to 5.60%. In strategy 2, the 77.70% （1-22.30%, 22.30% was the rate of prior osteoporotic fracture） percentiles FRAX-based 10 years major osteoporosis fracture probability of 6.70% and hip osteoporosis fracture probability of 2.30% were taken as the intervention thresholds. In strategy 3, the 60.59% （1-39.41%, 39.41% was the percentage of those examined with osteoporosis） percentiles FRAX-based 10 years major osteoporosis fracture probability of 4.70% and hip osteoporosis fracture probability of 1.40% were taken as the intervention thresholds. The total number of person needed to be intervened was the least by strategy 1 and there was no significant difference in age groups （x^2 =2. 650, P=0. 104）, while the percentage of people needed to be intervened increased in older age group by strategy 2 and strategy 3. The sensitivities of strategy 1 and strategy 2 were low but the specifieities were high. The sensi tivity of strategy 3 was a little higher but the specificity was lower. The Youde

关 键 词：FRAX 骨质疏松症 干预阈值 骨密度 骨折风险 

分 类 号：R580[医药卫生—内分泌] R683[医药卫生—内科学]