维持性血液透析绝经后女性患者骨质疏松筛查的初步研究

Preliminary study on osteoporosis screening among postmenopausal patients with maintenance hemodialysis

目的初步探讨亚洲人骨质疏松自我筛查工具(Osteoporosis Self-assessment Tool for Asians,OSTA)指数及骨折风险预测工具(Fracture Risk Assessment Tool,FRAX)量表在预测维持性血液透析(maintenance hemodialysis,MHD)绝经后女性患者骨质疏松筛查中的作用。方法收集2017年8月-2018年10月四川大学华西医院肾脏内科血液透析中心36例绝经后女性MHD患者年龄、身高、体重等一般资料,计算OSTA指数及FRAX量表(含或不含骨密度的模型)的10年髋部骨折风险及主要骨质疏松骨折风险。同期应用双能X线骨密度仪(dual energy Xray absorptiometry,DXA)对其髋部及腰椎进行骨密度检测。以DXA骨密度测定T值≤.2.5为界,分析OSTA指数与FRAX量表在预测绝经后女性MHD患者骨质疏松中的作用。结果36例患者DXA骨密度结果示T值≤.2.5的患者比例为50.0%(18/36),有骨折史的患者占30.6%(11/36)。绝经后女性MHD患者骨密度值与FRAX(不含骨密度值的模型)呈负相关,与OSTA指数呈正相关。OSTA预测骨质疏松的灵敏度为94.4%,特异度为61.1%;FRAX(不含骨密度值的模型)预测骨质疏松的灵敏度为88.9%,特异度为50.0%。FRAX量表中含骨密度模型与不含骨密度模型对骨折风险的评分结果相似。结论绝经后女性MHD患者骨质疏松的风险较高,骨折史的比例也较高。OSTA指数及FRAX量表均能较好地预测其骨质疏松情况。FRAX的两种模型对MHD患者骨折风险预测具有相似的临床价值,提示在临床工作中,对于缺乏DXA的基层医院及透析中心,可采用OSTA及FRAX量表对MHD患者骨质疏松进行初步筛查。

Objective To preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD). Methods Thirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department,West China Hospital of Sichuan University were selected. Relevant data such as age,height,and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤?2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed. Results The DXA BMD of the 36 patients showed that 50.0%(18/36) had a T value≤?2.5,and 30.6%(11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values),and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%,respectively;and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%,respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis. Conclusions Postmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients,and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work,for primary hospitals and dialysis centers lacking DXA,preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.