国内外骨质疏松症社区筛查工具述评

Review of screening tools on osteoporosis in community at home and abroad

骨质疏松症是威胁各国居民健康的重要公共卫生问题,给社会造成重大的经济和健康损失。多个国家地区研制出了若干种社区筛查工具,在多个人群中得以运用。本综述通过对各种筛查工具的来源、应用方法、优缺点和临床应用进行逐一介绍,为骨质疏松症的社区筛查工作者提供参考和依据。运用PubMed、EMbase及知网、中国学术期刊全文数据库、万方数据库,以"社区(community)""骨质疏松(osteoporosis)""筛查(screening)"和"工具(tool)"为关键词,检索2015-01-01-2019-12-31相关文献。共检索到中文文献1205篇,英文文献126篇。纳入标准:原发性骨质疏松症、成人及社区筛查的相关研究。排除标准:继发性、绝经后和特发性骨质疏松症以及基因筛查等相关研究。最终34篇文献纳入分析。结果表明,亚洲骨质疏松症简易自测工具(OSTA)计算简便,适合筛查大样本人群;骨质疏松危险评估工具(ORAI)灵敏度较高,容易出现较高的假阳性;骨质疏松评估简易评分法(SCORE)和骨质疏松预筛选风险评估(OPERA)的特异度较高,适合筛检阴性人群;男性骨质疏松症风险评估(MORES)法对男性的筛查效果较好;Garvan nomogram法在女性中筛查效果较好;骨质疏松危险指数(OSIRIS)灵敏度和特异度均较好,但国内研究较少。1min快速测试问卷中,父母髋部骨折、腹泻史及身高降低是更具有意义的风险预测因子。骨折风险评价工具(FRAX)是预测患者发生骨折风险的软件,国内运用较为广泛,但存在诸多局限。定量超声骨密度法携带方便、操作简便,但重复性差。骨代谢指标可诊断和预测骨质疏松症,但需要结合实验室诊断技术。综上所述,不同的筛查工具和方法各有优缺点,应将多种筛查工具进行联合应用,以提高筛查的灵敏度和特异度。

Osteoporosis is an important public health problem which threatens the health of residents in all countries,and causes great economic and health loss to the society.A number of community screening tools have been developed in many countries and regions,and have been used in many populations.This paper introduced the sources,application methods,advantages,disadvantages and clinical applications of various screening tools one by one,so as to provide reference and basis for community screening."Community","osteoporosis","screening"and"tool"as the theme words,PubMed,EMbase,CNKI and Wan Fang database were used to search for the literatures from Jan 1st 2015 to Dec 31st 2019.A total of 1205 Chinese and 126 English literatures were retrieved.Finally,34 literature were included in the analysis of primary osteoporosis,adult and community screening and excluded of secondary,postmenopausal,idiopathic osteoporosis and gene screening.The results show that osteoporosis self-assessment tool for Asian(OSTA)is calculated simply and suitable for large sample population screening.Osteoporosis risk assessment instrument(ORAI)have higher sensitivity,but is easy to appear false positive.Simple calculated of osteoporosis risk estimation(SCORE)and osteoporosis prescreening risk assessment(OPERA)have higher specificity,and are suitable for screening negative people.Male osteoporosis risk estimation score(MORES)have better screening effect for men,while Garvan nomogram method for women.The osteoporosis index of risk(OSIRIS)have better sensitivity and specificity,while there are few domestic studies.In One Minute Quick Test questionnaire,parents’hip fracture,diarrhea history and height decrease are more significant risk predictors.Fracture Risk Assessment Tool(FRAX)is a software to predict the risk of fracture in patients,widely used in domestic,but has many limitations.Quantitative ultrasound bone densitometer is easy to carry and operate,but have poor repetitiveness.Bone metabolism indicators could diagnose and predict osteoporosis,but need to combine the laboratory techniques.In summary,different screening tools and methods have their own advantages and disadvantages,so it should be combined use to improve the sensitivity and specificity.