FRAX模型评估中国老年2型糖尿病患者骨折风险的价值  

Value of FRAX model in assessing fracture risk of Chinese elderly adults with type 2 diabetes

作　　者：谢壮丽[1] 杨军[1] 宣淼[1] 计佩芳[1] 李颖[1] XIE Zhuangli;YANG Jun;XUAN Miao;JI Peifang;LI Ying(Department of Endocrinology and Metabolism,Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院内分泌代谢科,上海200065

出　　处：《外科研究与新技术》2021年第1期9-13,共5页Surgical Research and New Technique

摘　　要：目的应用FRAX模型评估老年2型糖尿病和非糖尿病患者的骨折风险,明确FRAX模型评估中国大陆老年2型糖尿病亚群的骨折风险的有效性。方法随机选取2型糖尿病老年患者267例,对照组(非糖尿病患者)359例,进行调查问卷、骨密度测量、FRAX分值计算。应用二分类变量回归方法分析FRAX高骨折风险的相关因素。结果2型糖尿病组体质指数、腰臀比、吸烟比例、饮酒比例均高于对照组(P<0.001)。2型糖尿病组股骨颈和腰椎骨矿含量、骨密度T值、Z值均高于对照组。2型糖尿病组应用FRAX-BMI模型预估10年主要骨质疏松性骨折(MOF)和髋部骨折(HF)风险均低于对照组[(4.27±2.84)%对(5.14±2.92)%,P<0.001;(1.42±1.54)%对(1.83±2.23)%,(P<0.001)]。应用FRAX-BMD模型评估2型糖尿病组MOF风险低于对照组[(5.28±4.41)%对(6.30±5.10)%,(P<0.001)]。回归分析显示股骨颈骨密度T值,吸烟,髋部骨折家族史和糖皮质激素应用与髋部骨折高风险有关。股骨颈骨密度T值,吸烟,髋部骨折家族史和既往脆性骨折史与MOF高风险有关。是否罹患2型糖尿病不是FRAX模型预估高骨折风险的相关因素。结论中国2型糖尿病老年患者应用FRAX模型预估10年骨折风险低于非糖尿病人群预估结果,提示FRAX模型并不完全适合中国人群。Objective To assess the fracture risk of elderly patients with and without type 2 diabetes mellitus(T2DM)by FRAX model,and to ascertain the validity of this model in assessing the fracture risk of elderly patients with T2DM in the mainland of China.Methods A total of 267 T2DM and 359 non-diabetic(control)patients were randomly selected,completed a questionnaire survey,underwent bone mineral density measurement,and were assessed by FRAX model.Binary regression analysis was used to evaluate the risk factors for high-risk fracture predicted by FRAX model.Results The body mass index(BMI),waist-hip ratio,and the proportions of smoking and drinking were all higher in the T2DM group than those in the control group(P<0.001).The bone mineral content,T value,and Z value of femoral neck(FN)and lumbar vertebra(L)in the T2DM group were also high.The T2DM group showed lower risks of 10-year major osteoporotic fracture(MOF)and hip fracture(HF)by FRAX-BMI model than the control group[(4.27±2.84)%vs.(5.14±2.92)%,P<0.001,and(1.42±1.54)%vs.(1.83±2.23)%,P<0.001].The T2DM group also showed a lower risk of MOF by FRAX-BMD model than the control group[(5.28±4.41)%vs.(6.30±5.10)%,P<0.001].Regression analysis results showed that the T score of FN,smoking,family history of hip fracture,and glucocorticoid use were associated with high-risk HF.The T score of FN,smoking,family history of HF,and history of brittle fracture were associated with high-risk MOF.T2DM was not associated with high-risk fracture predicted by the FRAX model.Conclusion The FRAX model predicts a lower 10-year fracture risk in elderly Chinese patients with T2DM than in non-diabetic patients,indicating that the model is not well suited for the Chinese population.

关 键 词：2型糖尿病 骨折风险 骨密度 FRAX 

分 类 号：R656[医药卫生—外科学]