FRAX■评估国内骨质疏松性骨折的应用现状分析

Analysis of the current status of FRAX■ application in evaluating osteoporotic fractures in China

骨折风险评估工具(FRAX■)于2008年发布,提供针对特定国家的算法,根据患者的临床危险因素(年龄、性别、身高、体重、脆性骨折史、父母髋部骨折史、目前是否抽烟、过量饮酒史、应用肾上腺皮质激素史、类风湿性关节炎病史以及其他继发性骨质疏松病史)及股骨、颈骨密度建立骨折预测模型,用于评估患者未来10年发生髋部骨折的概率和主要骨质疏松性骨折(椎体、髋部、前臂或肱骨近端)的概率。在FRAX■刚推出时,只有8个国家和地区的型号可供选择。随着FRAX■研究的不断深入,目前有71种型号可供66个国家使用,占世界人口的80%以上,并且在英国、美国、日本、瑞典等一些国家得到了广泛的应用。FRAX■最初干预阈值的界定基于9项大样本人群队列研究,其中8个队列均为高加索队列,另外一个队列来自日本人群。然而FRAX■在我国研究尚处于起步阶段,按照目前指南推荐的干预阈值,FRAX■可能低估了我国人群的骨折风险,尤其是主要骨质疏松性骨折风险。所以,一些学者开始尝试对FRAX■工具进行改良应用,探索适合我国国情的干预阈值。本文分析近年来FRAX■评估国内骨质疏松性骨折的应用现状及调整方案,从FRAX■评估髋部骨折和主要骨质疏松性骨折2个方面展开论述,使FRAX■在我国具有更好的适用性,以便更好地预测骨折风险,及时识别骨折高危人群并进行早期干预,减少骨折的发生。

The fracture risk assessment tool(FRAX■)was released in 2008 to provide country-specific algorithms.It was established on the basis of patient clinical risk factors(such as age,gender,height,weight,history of osteoporosis fracture,history of hip fracture in parents,history of smoking,history of excessive drinking,application history of adrenal cortical hormone,history of rheumatoid arthritis and other history of secondary osteoporosis and femoral neck bone mineral density)to assess the probability of hip fracture and major osteoporotic fracture(such as vertebral,hip,forearm or proximal humeral)in the next 10 years.When FRAX■ was launched,only eight national and regional models were available to choose from.At present,71 models are available for 66 countries.The number of users is more than 80%of the world population,and FRAX■ is widely used in the United Kingdom,the United States,Japan,Sweden and other countries.The initial intervention threshold of FRAX■ was defined on the basis of nine large population cohorts,eight of which were Caucasian and one from Japanese population.However,FRAX■ is rarely studied and applied in China and according to the intervention thresholds recommended by the current guidelines,FRAX■ may underestimate the risk of fractures in the Chinese population,especially major osteoporotic fractures.Therefore,some scholars are trying to improve the application of FRAX■ to explore intervention thresholds suitable for Chinese population.This paper analysed the application status and adjustment plan of FRAX■ in China in recent years through evaluation of hip fracture and major osteoporotic fracture with FRAX■ for its better applicability in China and to better predict fracture risk,identify people at high risk of fracture and early intervention in time and reduce the incidence of fractures.