应用FRAX工具评价莆田地区中老年骨质疏松骨折风险的临床研究

Evaluating the risk of osteoporosis fractures in middle-aged and elderly patients in Putian by FRAX

目的通过应用骨折风险评估工具(FRAX)及检测股骨颈骨密度(BMD)方法对本院3881例中老年人进行研究,探讨FRAX工具与由检测股骨颈骨密度分析其未来10年内发生主要骨折风险概率(PMOF)及10年内髋骨骨折概率(PHF)的关系。方法选取2017年1月至12月在莆田市第一医院门诊、病房以及体检的人员进行回顾性分析,均接受双能X线骨密度仪(美国Hologic,DiscoverA)检测股骨颈BMD的3881例检查人员作为研究对象,其中男性1218例,女性2663例,平均年龄(61.5±12.6)岁,按每十岁为一个年龄段,分别为40~49岁、50~59岁、60~69岁、70~79岁和≥80岁5个组,采用"中国"模式FRAX软件分析,系统自动生成PMOF及PHF,BMD用T值表示,T<-1.0为BMD异常(骨量低下和骨质疏松),T≥-1为BMD正常组。应用SPSS25.0软件进行数据分析,P<0.05为差异有统计学意义。结果3881例参与者中BMD异常组1954例(51%),BMD正常组1927例(49%)。BMD异常组与正常组比较,年龄较高、体重较轻、身高变矮较多及体质量指数(BMI)较低(P<0.001),应用FRAX工具在有或无录入骨密度值的情况下,BMD异常组PMOF及PHF(%)均显著高于正常组(P<0.001);FRAX与骨密度测定值的相关分析得出FRAX预测的PMOF与股骨颈骨密度T值之间呈显著负相关,不同年龄段中,40~49、50~59、60~69、70~79岁组及≥80岁的BMD异常发生率分别为28.9%,40.1%,53.9%,68.2%,76.2%,平均为50.3%。随着年龄的增大,PMOF显著升高,组间差异具有统计学意义(P<0.001)。有或无录入BMD值的情况下,骨密度异常组在不同年龄段PMOF及PHF(%)也均显著高于正常组(P<0.001)。结论在有或无录入股骨颈骨密度值情况下应用FRAX评估工具得出,所有参与者的未来10年内发生主要骨折风险的概率均随年龄增大而增高,因此建议把FRAX作为一项骨质疏松基本的筛查工具在我国缺乏骨密度测定仪时推广应用,但骨质疏松骨折的发生概率较国外低,有待进一步研究。

Objective To study 3881 middle-aged and elderly patients in our hospital by using fracture risk assessment tool( FRAX), and to explore and analyze the relationship between the risk of major fracture( PMOF) and hip fracture probability( PHF) in the next 10 years and FRAX in condition of having been detecting femoral neck bone mineral density( BMD). Methods From Jan. to Dec. 2017,3881 cases in the First Hospital of Putian were retrospectively analyzed,in whom 1218 were males,2663 were females,they all were detected femoral neck BMD by dual-energy X-ray absorptiometry( DXA).According to the ages,they were devided into five groups,40-49,50-59,60-69,70-79 years old and over 80 year old respectively. The data were analysed using the model of "China" FRAX software. Results Among the 3881 participants,there were 1954 cases( 51%) were included in the abnormal BMD group and 1927 cases( 49%) in the normal BMD group. Compared with the normal BMD group,the abnormal BMD group had higher age,lower weight,more height loss and lower body mass index( BMI)( P< 0. 001). In the conditions with or without a BMD when using the FRAX tool,the PMOF and PHF(%) in the abnormal BMD group were significantly higher than those in the normal group( P<0. 001) with FRAX.The relationship between PMOF predicted by FRAX and femoral neck bone mineral density was significantly negative correlation.In different age groups,40-49,50-59,60-69,and 70-79 and over 80 year old groups,abnormal BMD rates were 28. 9%,40. 1%,53. 9%,68. 2%,and 76. 2%,with an average of 50. 3%,along with the increase of age,a significant rise in PMOF,and differences between groups with a statistical significance( P <0. 001).With or without BMD values,PMOF and PHF(%) in the abnormal BMD group were significantly higher than that of in the normal BMD group( P< 0. 001). Conclusion With or without inputting femoral neck BMD value and the application of FRAX,all participants in the next 10 years the main fracture risk probability increases along with the age increased. It is recommended that the FRAX as a basic osteoporosis screening tool can be popularized in our country by the lack of DXA. The probability of osteoporosis fracture in our country is lower than those in abroad,this needs further research.