骨折风险评估工具FRAX^(■)评分判定上海社区老年人群实际骨质疏松性椎体骨折(OVF)效用的研究

Validation of osteoporotic fracture risk assessment tool FRAX^(■) in identifying osteoporotic vertebral fractures(OVF) of community-dwelling elderly people in Shanghai

目的探讨骨折风险评估工具FRAX?评价社区老年人群实际骨质疏松性椎体骨折(osteoporotic vertebral fracture,OVF)的效用。方法按年龄分布进行分层抽样,入组上海5个社区60岁以上老人2 809例,所有研究对象测量身高、体重,并行问卷调差,选择中国模式FRAX?评分,计算出每位患者未来10年内发生主要部位骨质疏松性骨折(major osteoporotic fracture,MOF)的概率,并同时进行胸腰椎侧位X线摄片,按Genant半定量法进行分度。结果老年女性中,椎体骨折组的年龄、既往骨折史比例、FRAX?MOF值均显著高于非骨折组(P<0.001);老年男性中,椎体骨折组既往骨折史、长期饮酒比例、类风湿关节炎比例和FRAXMOF值均高于非骨折组(P<0.01或P<0.05)。老年女性椎体骨折率随FRAX?MOF值增高而升高,组间差异有统计学意义(P<0.001);老年男性椎体骨折率随FRAX?MOF值增长而升高,但到Q4组下降(P=0.035)。FRAX?MOF值评价老年女性椎体骨折、中重度椎体骨折、多发骨折的敏感性和特异性分别为81.9%和53.9%,91.7%和56.8%,64.7%和65.5%(P<0.001)。FRAX?MOF值评价老年男性椎体骨折和中重度椎体骨折的敏感性和特异性分别为67.8%和45.9%(P<0.001),69.2%和53.6%(P=0.003),无法判定是否为多发骨折。结论对于判定社区老年女性患者椎体骨折,尤其是中重度椎体骨折,FRAX?是一项简便有效的工具。

Objective To investigate the validation of fracture risk assessment tool FRAX?in identifying osteoporotic vertebral fracture(OVF) in community-dwelling elderly people in Shanghai.Methods Stratified sampling was performed according to the age distribution of the population in communities in Shanghai. Totally 2809 elderly aged over 60 years from 5 communities were enrolled.Questionnaires and clinical physical examination(height and weight)were recorded. The estimated 10-year absolute risks of major osteoporotic fractures(MOF) were calculated with the FRAX?algorithms for China. OVF were ascertained from X-radiographs of thoracic and lumbar spine.The results were assessed according to the semi-quantitative technique of Genant. Results In females,age,proportion of previous fracture history and FRAX?MOF value of OVF group were higher than that of non-OVF group(P<0.001). In males,the proportion of previous fracture history,alcohol intake,rheumatoid arthritis and FRAX?MOF value of OVF group were higher than that of non-fracture group(P<0.05 or P<0.01).The prevalence of OVF increased with the rising of FRAX?MOF value according to the quartile groups(Q1 to Q4) in females(P<0.001). The prevalence of OVF increased with the rising of FRAX?MOF value according to the quartile groups(Q1 to Q3)and declined in Q4 in males(P=0.035). The sensitivity and specificity for FRAX?MOF to identify OVF was 81.9% and 53.9%,to identify moderate-severe OVF was91.7% and 56.8%,and to identify multiple OVF was 64.7% and 65.5% in females(P<0.001);the sensitivity and specificity for FRAX?MOF to identify OVF was 67.8% and 45.9%(P<0.001),and to identify moderate-severe OVF was 69.2% and 53.6% in males(P=0.003).Conclusions FRAX?may be a simple and effective tool for identifying the risk of OVF,especially for moderate-severe OVF in community-dwelling elderly women.