FRAX在新疆2型糖尿病患者群骨折风险预测中的适用性评价

Applicability evaluation of FRAX in fracture risk prediction for patients with type 2 diabetes mellitus in Xinjiang

目的探讨骨折风险评估工具在新疆2型糖尿病(type 2 diabetes mellitus,T2DM)人群骨折风险预测中的适用性评价。方法研究对象为1008例T2DM住院患者,记录患者的年龄、性别、民族、糖尿病病程、体质量指数(body mass index,BMI)、HbA1c、Ca、25(OH)D、骨密度(bone mineral density,BMD)值、股骨颈T值等指标,以及FRAX中的各种危险因素。分为FRAX评分(FRAX/-)(无骨密度值)和股骨颈骨密度T值(BMD T值),(FRAX/-)组髋骨骨折概率(probability of hip fracture,PHF)≥3%或主要骨质疏松性骨折概率(probability of a major osteoporotic fracture,PMOF)≥20%、(BMD T值)组T值≤-2.5为治疗切点,若给出相同的治疗建议为相同组,否则为不同组。在两组进行一致性分析以评价FRAX在特定人群中的适用性。结果随着年龄增加,发生骨质疏松性骨折风险增加,而较高的BMD值可以降低骨质疏松性骨折风险,性别之间差异也有统计学意义(P<0.01)。相同组有961例患者,不同组有47例,一致率达95.3%(961/1008)。其中,年龄、性别、股骨颈T值的差异均有统计学意义(P<0.01)。与不同组相比,相同组年龄小,股骨颈T值、BMD值高。FRAX与股骨颈骨密度T值评估骨折是否需要治疗进行一致性分析,Kappa值=0.69,P<0.001。10年内PHF和PMOF的受试者工作特征曲线的曲线下面积分别为0.91(P<0.01)和0.898(P<0.01)。结论(FRAX/-)和(BMD T值)存在较好的一致性,FRAX软件可以较为准确地评估和预测新疆地区T2DM人群的骨折风险概率,同时给出较准确的干预治疗建议,FRAX作为一项初筛工具在我国2型糖尿病人群中可以推广应用。

Objective To evaluate the applicability of fracture risk assessment tools in fracture risk prediction of patients with type 2 diabetes mellitus(T2DM)in Xinjiang.Methods The study included 1008 T2DM hospitalized patients.Age,gender,nationality,duration of diabetes,BMI,HbA1c,Ca,25(OH)D,bone mineral density(BMD)values,femoral neck T values,as well as the various risk factors in FRAX were recorded.Patients were divided into FRAX score group(FRAX/-,without BMD)and BMD T value group(with T value of femoral neck bone mineral density).The cutoff point of treatment in FRAX/-group was PHF≥3%or PMOF≥20%,and in BMD T value group was T value≤-2.5.Those who received same treatment recommendation were in the same group.Those who received different treatment recommendation were in the different group.Consistency analysis was carried out between the two groups to evaluate the applicability of FRAX in the specific population.Results With the increase of age,the risk of osteoporotic fracture increased.Higher BMD value reduced the risk of osteoporotic fractures.The fracture risk between different genders was also statistically significant(P<0.01).There were 961 patients in the same group and 47 in different groups.The consensus rate was 95.3%(961/1008).Among them,the differences in age,gender,and femoral neck T values were statistically significant(P<0.01).The age was younger,and the femoral neck T value and BMD value were higher in the same group than in the different group.Consistency using FRAX or femoral neck bone mineral density T values for the treatment decision showed that the Kappa value was 0.69(P<0.001).The area under the ROC curve of 10-year PHF and PMOF was 0.91(P<0.01)and 0.898(P<0.01),respectively.Conclusion FRAX/-and BMD T value have good consistency.The FRAX software can be used to accurately estimate and predict the fracture risk probability of T2DM population in Xinjiang.It provides accurate intervention recommendation.As a primary screening tool,FRAX can be promoted and applied in type 2 diabetes patients in China.