骨折风险评估工具筛查北京地区绝经后骨质疏松症的有效性研究  

Effectiveness of fracture risk assessment tool for screening postmenopausal osteoporosis in Beijing:a cross-sectional study

作　　者：易祖玲[1] 安宁 林吉生[1] 李嘉仪 范子寒 费琦[1] YI Zuling;AN Ning;LIN Jisheng;LI Jiayi;FAN Zihan;FEI Qi(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050 [2]首都医科大学附属北京友谊医院超声医学科,北京100050

出　　处：《中华骨与关节外科杂志》2025年第4期344-349,共6页Chinese Journal of Bone and Joint Surgery

基　　金：北京市卫生健康科技成果和适宜技术推广项目(BHTPP202007)。

摘　　要：目的:评估骨折风险评估工具(FRAX)筛查北京地区绝经后骨质疏松症(PMO)的有效性,并确定绝经后女性人群规避双能X射线吸收法(DXA)的理想阈值,为PMO的二级预防提供便捷、有效的筛查手段。方法:运用横断面研究方式,选取2021年1月至2022年12月于首都医科大学附属北京友谊医院进行健康体检的绝经后女性作为研究对象,开展DXA骨密度检查以及问卷调查。依据世界卫生组织(WHO)诊断标准,将骨密度T值≤-2.5 SD定义为骨质疏松症(OP),进而计算该标准下PMO的患病率。通过受试者操作特征(ROC)曲线分析FRAX髋部骨折风险(FRAX-HF)及FRAX严重骨质疏松性骨折风险(FRAX-MOF)预测PMO的敏感度、特异度及ROC曲线下面积(AUC),明确相应工具的最佳截断值。结果:本研究共纳入550名受试者,PMO的患病率为34.5%(190/550),分为PMO组190名和非PMO组360名。两组受试者在年龄、身高、体重、既往骨折史及骨密度(腰椎L1~4、左侧股骨颈、髋部总体)方面的差异均存在统计学意义(P均<0.05)。FRAX-HF筛查PMO的敏感度为59.47%、特异度为67.50%、AUC值为0.701,具备中等预测价值;FRAX-MOF筛查PMO的敏感度为84.74%、特异度为38.33%、AUC值为0.673,具备低预测价值。结论:PMO患病率状况不可忽视,相较于FRAX-MOF,FRAX-HF可能是识别北京地区PMO更为有效的工具。Objective:To evaluate the effectiveness of the Fracture Risk Assessment Tool(FRAX)for screening postmenopausal osteoporosis(PMO)in Beijing and to establish an optimal threshold for postmenopausal women to avoid unnecessary dual-energy X-ray absorptiometry(DXA)scans,thereby providing a convenient and effective screening method for the secondary prevention of PMO.Methods:In this cross-sectional study,postmenopausal women who underwent health examinations at Beijing Friendship Hospital,Capital Medical University from January 2021 to December 2022,were enrolled.All participants underwent bone mineral density(BMD)testing via DXA and completed a questionnaire.According to World Health Organization(WHO)diagnostic criteria,osteoporosis was defined as a BMD T-score≤-2.5 SD,and the prevalence of PMO was calculated accordingly.The sensitivity,specificity,and area under the ROC curve(AUC)of FRAX hip fracture risk(FRAX-HF)and FRAX major osteoporosis risk(FRAX-MOF)in predicting PMO were analyzed by receiver operating characteristic(ROC)curves to determine the optimal cutoff value of the tool.Results:A total of 550 participants were included,with the PMO prevalence of 34.5%(190/550).Participants were divided into two groups:the PMO grou p(n=190)and the non-PMO group(n=360).Significant differences were observed between the two groups in age,height,weight,history of previous fractures,and BMD measurements(lumbar spine L 1-4,left femoral neck,and total hip)(all P<0.05).The FRAX-HF demonstrated a sensitivity of 59.47%,specificity of 67.50%,and an AUC value of 0.701,indicating moderate predictive accuracy.In contrast,the FRAX-MOF showed a sensitivity of 84.74%,specificity of 38.33%,and an AUC value of 0.673,indicating low predictive performance.Conclusions:The prevalence of PMO is significant and cannot be ignored.Compared to FRAX-MOF,FRAX-HF may serve as a more effective screening tool for PMO in Beijing.

关 键 词：绝经后骨质疏松症 骨密度 骨折风险评估工具 

分 类 号：R683[医药卫生—骨科学]