FRAX联合骨密度和骨代谢标志物评估甲状腺癌术后患者骨折风险的临床研究

A Clinical Study of FRAX Fracture Risk Assessment Tool Combined withBone Minera Density and Bone Metabolic Markers to Evaluate Fracture Risk in Postoperative Patients with Thyroid Cancer

目的探讨骨密度和骨代谢标志物联合骨折风险评估工具(fracture risk assessment tool,FRAX)评估甲状腺癌术后患者骨折风险。方法我院2018年6月至2020年12月期间,门诊和住院的年龄超过40岁的甲状腺癌术后患者286例,其中男57例,女229例,年龄40~78岁,平均年龄57.3±19.9岁。获取患者的骨密度(DXA)、骨代谢标志物(BTM)结果、基本信息并计算患者FRAX骨折风险评估系数。以髋部骨折风险系数≥3%或任何重要的骨质疏松骨折风险系数≥20%作为高风险截断值。结果(1)BTM高转换组骨质疏松(T值≤-2.5)比例:66/174=37.9%;低转换组骨质疏松(T值≤-2.5)比例:21/112=18.8%。(2)BTM高转换组骨量减少(-2.5<T<-1)比例:82/174=47.2%;低转换组骨量减少(-2.5<T<-1)比例:29/112=25.9%;(3)BTM高转换组骨密度正常(T≥-1)比例:26/174=14.9%;低转换组骨密度正常(T≥-1)比例:20/112=17.9%;(4)BTM高转换组FRAX高风险比例:72/174=41.4%;低转换组FRAX高风险比例:29/112=25.9%;(5)DXA骨质疏松组FRAX高风险比例:57/87=65.6%;(6)DXA骨量减少组FRAX高风险比例:37/137=27.0%;(7)DXA骨量正常组FRAX高风险比例:8/137=5.8%。结论对于年龄大于40岁的甲状腺癌术后激素替代治疗患者,采用DXA、BTM联合FRAX对患者进行骨折风险综合评估,预测骨质疏松及骨折风险准确性更高。

Objective To explore bone mineral density and bone metabolic markers combined with FRAX(fracture risk assessment tool,FRAX)fracture risk assessment tool to evaluate the risk of fracture in postoperative patients with thyroid cancer.Methods From June,2018 to December,2020,there were 286 outpatients and inpatients over 40 years old with postoperative hormone replacement for thyroid cancer in our hospital.Bone mineral density(DXA),bone metabolic markers(BTM)and basic information of these patients were obtained and the risk assessment coefficient of FRAX fracture was calculated.The risk factor of hip fracture≥3%or the risk factor of any important osteoporotic fracture≥20%were applied as the high-risk cutoff values.Results(1)The proportion of osteoporosis(T value≤-2.5)in BTM high conversion group was 66/174=37.9%,and that in low conversion group(T value≤-2.5mm)was 21/112,=18.8%.(2)The proportion of bone mass reduction(-2.5<T<-1)in BTM high conversion group was 82/174=47.2%,and low conversion group(-2.5<T<-1)was 55/112=49.1%.(3)The proportion of normal bone mineral density(T≥-1)in BTM high conversion group was 26/174=14.9%,and low conversion group(T≥-1)was 36/112=32.1%.(4)High risk ratio of FRAX in BTM high conversion group was 72/174=41.4%,and FRAX high risk ratio in low conversion group was 29/112=25.9%.(5)High risk ratio of FRAX in DXA osteoporosis group was 57/87=65.6%.(6)High risk ratio of FRAX in DXA bone mass reduction group was 37/137=27.0%.(7)The high risk ratio of FRAX in the group with normal DXA bone mass was:8/137=5.8%.Conclusion For patients older than 40 years old who received postoperative hormone replacement therapy for thyroid cancer,DXA and BTM combined with FRAX fracture risk assessment can be used to comprehensively evaluate the patients,and the prediction of osteoporosis and fracture risk is more accurate.