OSTA对65岁及以上老人骨质疏松的筛查价值

Sreening value of OSTA for osteoporosis in the elderly aged 65 years and above

目的评估亚洲骨质疏松自我评估工具(Osteoporosis Self-assessment Tool for Asians,OSTA)指数对老年人骨质疏松的筛查价值。方法通过对上海市某社区签约建立健康档案的65岁及以上老年人进行问卷调查,测量身高、体重、骨密度等,并对调查结果采用性别、年龄分层分析处理,用ROC曲线评估OSTA指数预测骨质疏松的筛查价值。结果本次研究共调查5 832名65岁及以上老人,骨质疏松患病率30.37%。不同性别、年龄组的骨质疏松占比差异均有统计学意义(P<0.001)。不同性别、年龄组的OSTA高风险占比差异也均有统计学意义(P<0.001)。65~<70岁组和70~<80岁组的骨密度分级与OSTA风险分级的秩相关系数均>0(P<0.05)。以骨密度T值为金标准,OSTA指数评估骨质疏松的ROC曲线面积为0.460~0.570;女性65~<70岁的老年人OSTA筛查骨质疏松的灵敏度为0.902,特异度为0.093;男性65~<70岁的则分别是1.000和0.096;女性80岁及以上老年人OSTA筛查骨质疏松的灵敏度为0.125,而特异度为0.854。不同性别、年龄组和骨密度分级的OSTA指数值比较差异均有统计学意义(P<0.001)。结论 OSTA指数作为重要的骨质疏松筛查评估工具,在社区老年人群骨质疏松诊断中的筛查价值不高;在对老年人群采用OSTA指数评估骨质疏松筛查时,需要按年龄段和性别重新设置分级标准。

Objective To evaluate the value of Osteoporosis Self-assessment Tool for Asians （OSTA） index in the screening of osteoporosis. Methods A questionnaire survey was conducted among the elderly aged 65 years and above and signed up for establishing health records in a community in Shanghai. Their height, body weight and bone mineral denstity were meansured, and the surveyed results were stratifiedly analyzed according to gender and age groups. Receiver operating characteristic （ROC） curve was used for evaluating the screening value of OSTA index in the prediction of osteoporosis. Results A total of 5,832 elderly persons aged 65 years and above were investigated in this study, and the prevalence rate of osteoporosis was 30.37%. There were statistically significant differences in the prevalence of osteoporosis as well as in the OSTA high risk grade among different gender and age groups （both P〈0.001）. The rank correlation coefficients of bone mineral density grading and OSTA risk grading in the age groups of 65-〈70 years and 70-〈80 years were all greater than 0 （P〈0.05）. With T value of bone mineral density as the gold standard, the areas of ROC curve of osteoporosis evaluated by OSTA index were between 0.460 and 0.570. The sensitivity and specificity of OSTA to screen osteoporosis in the females of the age group of 65-〈70 years were 0.902 and 0.093 respectively, and those in the males of the age group of 65-〈70 years were 1.000 and 0.096 respectively. The sensitivity and specificity of OSTA to screen osteoporosis in the females of the age group of 80 years and above were 0.125 and 0.854 respectively. There were statistically significant differences in the OSTA index among different gender and age groups and bone mineral density grading （P〈0.001）. Conclusions OSTA index is considered as an important tool for screening and assessment of osteoporosis, but its screening value in diagnosing osteoporosis in the community elderly is not high. The grading standard should be reset based on age and gender groups when OSTA index is used for screening osteoporosis in the elderly.