骨质疏松症患者脆性骨折危险因素分析及骨折风险评估模型的建立  

Analysis of risk factors for fragility fractures and establishment of a fracture risk assessment model in patients with osteoporosis

作　　者：吴芷若 黄水金 霍亚南[2] 熊昌辉 邓颖[2] 钟彦嘉 王晨秀[2] 林安华[2] WU Zhi-ruo;HUANG Shui-jin;HUO Ya-nan;XIONG Chang-hui;DENG Ying;ZHONG Yan-jia;WANG Chen-xiu;LIN An-hua(Department of Chronic Diseases,Yingtan City Center for Disease Control and Prevention,Yingtan,Jiangxi 335000,China;Department of Endocrinology and Osteoporosis,Jiangxi Provincial People's Hospital,The First Affiliated Hospital of Nanchang Medical College,Nanchang 330000,China)

机构地区：[1]江西省鹰潭市疾病预防控制中心慢病科,江西鹰潭335000 [2]江西省人民医院(南昌医学院第一附属医院)内分泌骨质疏松与骨病科,南昌330000

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2024年第4期308-317,共10页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家重点研发计划专项(2021YFC2501701,2021YFC2501703);江西省重点研发计划项目(20202BBGL73021);江西省卫健委普通科技项目(20200318);江西省医学领先学科建设项目-老年医学(骨质疏松)。

摘　　要：目的探索骨质疏松症患者发生脆性骨折的影响因素,并构建骨折风险评估模型。方法纳入912例骨质疏松症患者,分为骨折组595例,无骨折组317例。通过医院电子病历信息系统和骨质疏松患者数据管理平台查阅患者病历资料,获得临床特征、骨密度、实验指标和生活方式等38个变量。对比骨折组与无骨折组的差异,通过Logistic回归分析脆性骨折的影响因素,并建立回归模型。采用Bootstrap法内部验证模型、绘制模型校准曲线及列线图。结果与无骨折组比较,骨折组的年龄更大、碱性磷酸酶(alkaline phosphatase,ALP)更高,有跌倒史和有父母髋部骨折史的发生率更高,运动和日照时间更少,腰椎、股骨颈、全髋骨密度(bone mineral density,BMD)更低,(P<0.05)。Logistic回归分析发现:年龄(OR=1.050,95%CI:1.023~1.078)、过去一年跌倒史(OR=5.738,95%CI:3.119~10.558)、父母髋部骨折史(OR=2.521,95%CI:1.021~6.224)、ALP(OR=1.010,95%CI:1.003~1.017)是发生脆性骨折的独立危险因素,腰椎BMD(OR=0.061,95%CI:0.009~0.396)是保护性因素。利用年龄、过去一年跌倒史、父母髋部骨折史、ALP等4个脆性骨折影响因素建立评估模型,C指数为0.785,拟合优度检验结果P>0.05,提示模型具有较好的校准度与区分度。结论骨质疏松症患者的年龄、过去一年跌倒史、父母髋部骨折史、ALP是骨质疏松症患者发生脆性骨折的危险因素,腰椎BMD是保护因素。研究建立的模型中包含的4个变量均是简单、易获得的指标,无需进行双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检测即可判断骨质疏松症患者的脆性骨折风险,在各级别医疗机构都有一定推广价值。Objective To explore the influencing factors of fragility fractures in patients with osteoporosis and construct a fracture risk assessment model.Methods Totally 912 patients with osteoporosis were included and divided into a fracture group of 595 cases and a non-fracture group of 317 cases.Through the hospital electronic medical record information system and the osteoporosis patient data management platform,38 variables were obtained,including clinical characteristics,bone mineral density,experimental indicators,and lifestyle.The differences between the fracture group and the non-fracture group were compared,and the influencing factors of fragility fractures were analyzed through logistic regression,and a regression model was established.The model was internally validated,the model calibration curve and column chart were drawn by Bootstrap method.Results Compared with the non-fracture group,the fracture group had older age,higher alkaline phosphatase(ALP)level,higher incidence of falls and parental hip fractures,less exercise and sunshine time,and lower bone mineral density(BMD)at lumbar spine,femoral neck,and total hip(all P<0.05).Logistic regression analysis found that age(OR=1.050,95%CI:1.023-1.078),a history of falls in the past year(OR=5.738,95%CI:3.119-10.558),parental history of hip fractures(OR=2.521,95%CI:1.021-6.224),and ALP(OR=1.010,95%CI:1.003-1.017)were independent risk factors for fragility fractures in osteoporosis patients,and lumbar BMD values(OR=0.061,95%CI:0.009-0.396)were protective factors.An assessment model was established using four factors that affect brittle fractures:age,a history of falls in the past year,parental history of hip fractures,and ALP.The C-index was 0.785,and the goodness of fit test result was P>0.05,indicating that the model had good calibration and discrimination.Conclusion Age,a history of falls in the past year,parental history of hip fractures,and ALP are risk factors for fragility fractures in patients with osteoporosis,while lumbar BMD is a protective factor.The fo

关 键 词：骨质疏松症 脆性骨折 骨密度 

分 类 号：R683[医药卫生—骨科学]