基于骨折风险评估工具(FRAX■)的上海地区中老年人骨质疏松性骨折发生风险研究  

Osteoporotic Fracture Risk Prediction Value of Fracture Risk Assessment Tool(FRAX?)in Middle-aged and Elderly People in Shanghai

作　　者：赵啸 章振林[2] ZHAO Xiao;ZHANG Zhenlin(Department of Endocrinology,Shanghai Changning Tianshan Traditional Chinese Medicine Hospital,Shanghai 200051,China;Department of Osteoporosis and Osteopathy/Bone Metabolism and Genetics Laboratory,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海市长宁区天山中医医院内分泌科,上海市200051 [2]上海交通大学附属第六人民医院骨质疏松和骨病专科骨代谢病和遗传研究室,上海市200233

出　　处：《中国全科医学》2020年第19期2429-2434,共6页Chinese General Practice

基　　金：上海市科委项目(16411954500);上海市长宁区天山中医医院PI团队建设项目。

摘　　要：背景骨质疏松性骨折是老年患者致残和致死的主要原因之一,早期预测和尽早干预是防治的重要环节。WHO推荐的骨折风险评估工具(FRAX■)用于评估患者未来10年主要骨质疏松性骨折概率(MOFP)和髋部骨质疏松性骨折概率(HOFP),危险因素的确定基于欧洲、北美、亚洲、澳大利亚等多个独立大样本前瞻性研究和大样本荟萃分析,具有一定代表性。但上海地区的骨质疏松性骨折发生率及影响因素的大样本流行病学研究正在进行中,FRAX■预测结果能否准确预估上海地区中老年人群的骨折风险尚有待进一步证实。目的利用FRAX■中国版本预测上海地区中老年人的骨质疏松性骨折发生风险。方法选取2013年1-10月在上海交通大学附属第六人民医院骨质疏松和骨病专科就诊的中老年人1 520例,年龄45~90岁,平均年龄(65.5±9.6)岁。采用FRAX■中国版本计算中老年人的10年MOFP和HOFP,以10年MOFP≥20%和10年HOFP≥3%为骨质疏松性骨折高危人群。结果男性中老年人的10年MOFP中位值为2.10%(1.10%),高危者占比为0.13%(1/749),10年HOFP中位值为0.60%(0.70%),高危者占比为2.94%(22/749);女性中老年人的10年MOFP中位值为3.60%(2.80%),高危者占比为0.13%(1/771),10年HOFP中位值为0.80%(1.50%),高危者占比为11.28%(87/771)。女性中老年人10年MOFP、10年HOFP及10年HOFP高危者占比高于男性(P<0.05),但男性和女性中老年人10年MOFP高危者占比无统计学差异(P>0.05)。考虑不同年龄段:男性10年MOFP,50~59岁者低于60~69、70~79、80~90岁者(P<0.05);男性10年HOFP,50~59岁者低于60~69、70~79、80~90岁者,60~69岁者低于70~79、80~90岁者(P<0.05);女性10年MOFP和HOFP,45~49、50~59、60~69、70~79、80~90岁者依次升高(P<0.05)。考虑不同BMI分段:男性10年MOFP,BMI≥28.0 kg/m^2者低于BMI<18.5、18.5~23.9、24.0~27.9 kg/m^2者(P<0.05);男性10年HOPF,BMI<18.5、18.5~23.9、24.0~27.9、≥28.0 kg/m^2者依次降低(P<0.05);女性10Background Osteoporotic fractures are one of the main causes of disability and death in elderly patient,and early prediction and timely intervention are important links of prevention and treatment.The Fracture Risk Assessment Tool(FRAX?)recommended by WHO is used to assess the 10-year major osteoporotic fracture probability(MOFP)and hip osteoporotic fracture probability(HOFP).The fracture-related risk factors have been identified based on a number of independent large-sample prospective population studies and meta-analysis of large-sample studies in Europe,North America,Asia,Australia,etc,so they are representative.However,as large-scale epidemiological studies on the incidence of osteoporotic fractures and their influencing factors in Shanghai are ongoing,whether FRAX?predictions can accurately assess fracture risk in middle-aged and elderly people in Shanghai remains to be confirmed by further research.Objective To predict the risk of osteoporotic fractures in middle-aged and elderly people in Shanghai using the Chinese version of FRAX?.Methods Participants were 1520 middle-aged and elderly Chinese people〔mean age was(65.5±9.6)years,range between 45 and 90〕recruited from Department of Osteoporosis and Osteopathy,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January to October 2013.The Chinese version of FRAX?was used to calculate the 10-year MOFP and HOFP.The diagnostic criterion for high-risk of osteoporosis fracture was defined as 10-year MOFP≥20%or 10-year HOFP≥3%.Results Compared with men,women had higher median 10-year MOFP〔3.60%(2.80%)vs 2.10%(1.10%)〕,higher median 10-year HOFP〔0.80%(1.50%)vs 0.60%(0.70%)〕,and higher percentage of cases at high-risk for 10-year HOFP〔11.28%(87/771)vs 2.94%(22/749)〕(P<0.05).But the percentage of cases at high-risk for 10-year MOFP in women was similar to that of men〔0.13%(1/771)vs 0.13%(1/749)〕(P>0.05).Age-specific analysis showed that in men,the 10-year MOFP in age group of 50-59 was lower than that of age groups

关 键 词：骨质疏松性骨折 髋骨折 骨折风险评估工具 中老年 上海 

分 类 号：R683[医药卫生—骨科学]