髋部几何力学结合骨折风险预测简易工具预测中老年妇女的骨折风险

Combination of hip geometry mechanics and fracture risk assessment tool to predict fracture risk in middle-aged and elderly women

背景:髋部几何力学是基于双能X射线吸收测定法扫描的图像上进行分析髋部结构(皮质厚薄)的力学研究,可以更好地弥补骨密度的偏差。骨折风险预测简易工具(FRAX)可以将骨折概率与多种临床危险因子以及股骨颈的骨密度相结合,预测10年内髋骨骨折概率和10年内主要骨质疏松性骨折(脊椎、前臂、髋骨或肩部骨折)概率。目的:分析中老年妇女髋部几何力学以及FRAX~@工具与骨折的相关性,探讨两者结合对中老年妇女脆性骨折风险预测的临床意义。方法:回顾性研究1089名中老年女性受试者,根据调查问卷分既往有骨折组225例和无骨折864例,双能X射线骨密度仪检测骨密度,HSA软件分析髋部几何力学参数:骨横截面积、横截面转动惯量、截面弯曲模量、皮质厚度和屈曲应力比数值;FRAX~@工具计算未来10年主要部位骨折率和髋部骨折率。研究获得福建省中医药研究院伦理委员会审批。结果与结论:①骨折组的年龄明显高于无骨折组;②2组髋部几何力学参数比较:无骨折组的腰椎骨密度、股骨颈骨密度、骨横截面积、横截面转动惯量、皮质厚度、截面弯曲模量均明显高于骨折组,而屈曲应力比低于骨折组,经Logistic回归分析,显示皮质厚度是骨折的保护因素(OR=0.000,95%CI:0.000-0.000);③不同年龄段FRAX计算分析,骨折组的未来10年主要部位骨折率、髋部骨折率均明显高于无骨折组;④结果说明,髋部几何力学与骨折发生有明显关联性,股骨颈皮质厚度是骨折发生的保护因素,FRAX~@分析对预测骨折发生具有临床指导价值,两者结合可以更好地预测骨质疏松性骨折的发生。

BACKGROUND:Hip geometric mechanics indicates a mechanical study of hip structure(cortical thickness)based on dual energy X-ray absorptiometry images,which is a better compensation for the deviation of bone density.The fracture risk assessment tool(FRAX)can combine fracture probability with multiple clinical risk factors and bone density of the femoral neck to predict the probability of hip fracture within 10 years and the probability of major osteoporotic fractures(spine,forearm,hip or shoulder fracture).OBJECTIVE:To analyze the hip geometry mechanics and the correlation between the FRAX@tool and fractures in middle-aged and elderly women,and to explore the clinical significance of the combination method to predict the risk of fragility fracture in middle-aged and elderly women.METHODS:A retrospective study of 1089 middle-aged female subjects was conducted.According to the questionnaire,there were 225 cases of fractures and 864 cases of non-fractures.Bone mineral density was measured using a dual-energy X-ray absorptiometry,and hip geometrical parameters were analyzed using HSA software:cross-sectional area(CSA),cross-sectional moment of inertia(CSMI),cross-sectional modulus(Z),cortical bone thickness(Cort)and the buckling ratio(BR)value.The FRAX@tool was used to calculate the fracture rate at the main site and hip fracture rate over the next 10 years.The study was approved by the Ethics Committee of Fujian Institute of Traditional Chinese Medicine.RESULTS AND CONCLUSION:The age of the fracture group was significantly higher than that of the non-fracture group.The hip geometrical parameters of the two groups were compared:lumbar vertebra bone density,femoral neck bone density,CSA,CSMI,Cort,Z were significantly higher in the non-fracture group than the fracture group,while BR was lower in the non-fracture group than the fracture group.Logistic regression analysis of hip geometry mechanics indicated that Cort was a possible protective factor for fracture(odds ratio=0.000,95%confidence interval:0.000-0.000).FRAX calculation and analysis of different age groups indicated that the fracture rate at the main site and hip fracture rate of the fracture group were significantly higher than those of the non-fracture group in the next 10 years.In conclude,there is a significant correlation between hip geometric mechanics and fracture.The Cort of the femoral neck is a possible protective factor for fracture,and FRAX@has a clinical guiding value for predicting fracture.The combination of the two can better predict osteoporotic fracture.