应用FRAX^(█)预测绝经后女性骨质疏松性椎体骨折的临床研究

A clinical study of FRAX^(█) in the prediction of postmenopausal osteoporotic vertebral fracture

目的比较骨折风险评估工具(fracture risk assessment tool,FRAX■)通过不同部位骨密度(bone mineral density,BMD)预测绝经后女性骨质疏松性椎体骨折(osteoporotic vertebral fracture,OVF)风险的准确性。方法回顾性研究2016年12月至2018年3月我院收治符合选择标准的287例患者,根据有无OVF分为骨折组和对照组。根据股骨颈(femoral neck,FN)与腰椎(lumbar spine,LS) BMD是否相差一个标准差(standard deviation,SD),分为BMD差异组和对照组。比较FRAX■使用不同部位BMD的骨折风险预测值。以就诊时发生OVF与否为参考标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,比较FNBMD、LSBMD、FRAX■、FRAX■-FNBMD、FRAX■-LSBMD预测OVF发生风险的准确性。结果 OVF组共计86例患者,OVF组FNBMD、LSBMD均显著低于对照组(P<0. 05),FRAX■-LSBMD骨折风险评分显著高于FRAX■-FNBMD(P<0. 05)。BMD差异组共计39例患者,其中31例LSBMD低于FNBMD,24例OVF发生在低LSBMD组。FRAX■-LSBMD骨折风险评分显著高于FRAX■-FNBMD(P<0. 05)。FNBMD、LSBMD、FRAX■、FRAX■-FNBMD、FRAX■-LSBMD预测骨折风险的ROC曲线下面积分别为0. 601、0. 719、0. 746、0. 810、0. 833。结论部分OVF患者存在FN-LSBMD差异,FRAX■较BMD更能综合的评估OVF风险,有效的识别高危人群。同时FRAX■-LSBMD评估OVF骨折风险的准确性可能优于FRAX■-FNBMD,尤其是FN-LSBMD存在明显差异的时候。

Objective To compare the accuracy of fracture risk assessment tool(FRAX■) using bone mineral density(BMD) of different sites for the prediction of postmenopausal osteoporotic vertebral fracture(OVF). Methods A total of 287 patients were eligible for the study and were retrospectively examined from December 2016 to March 2018. Patients were divided into OVF group and control group. Spine-femur BMD discordance group was defined as >1 standard deviation(SD) of difference between the femoral neck(FN) and lumbar spine(LS) BMD. Vertebral fracture risk was calculated using FRAX■with FNBMD or LSBMD. Based on the baseline data and the actual occurrence of fracture,BMD,FRAX■(without or with FNBMD and LSBMD) scores were assessed for identifying OVF via receiver-operating characteristic(ROC) curves. Results 86 out of 287 patients developed OVF. The levels of Tscore of FNBMD and LSBMD in OVF group were significantly lower than those in control group(P<0. 05). Values of FRAX■-LSBMD was significantly higher than those of FRAX■-FNBMD(P<0. 05). 39 patients demonstrated spine-femur BMD discordance. 31 patients having discordance showed lower LSBMD compared with FNBMD. During the follow-up periods,24 OVF occurred in the lower LSBMD group. Patients with actual vertebral fracture occurrences showed more apparently elevated estimated fracture risks when FRAX■using LSBMD instead of FNBMD(P < 0. 05). AUCs of ROCs of FNBMD,LSBMD,FRAX■,FRAX■-FNBMD,FRAX■-LSBMD were0. 601,0. 719,0. 746,0. 810 and 0. 833,respectively. Conclusion A significant number of patients exhibit spine-femur BMD discordance. Compare with BMD,FRAX■maybe can comprehensively and effectively identify the high-risk groups of OVF. FRAX■-LSBMD may be more appropriate for estimation of OVF risk than FRAX■-FNBMD,especially patients with spine-femur BMD discordance.