老年骨质疏松性脊柱骨折患者出院后再发骨折风险的预测模型构建

Construction of a Predictive Model for the Risk of Recurrent Fractures in Elderly Patients with Osteoporotic Spinal Fractures after Discharge

目的:构建老年骨质疏松性脊柱骨折患者出院后再发骨折的风险预测模型。方法:回顾性分析2020年12月—2023年5月梁山县人民医院收治的150例老年骨质疏松性脊柱骨折患者临床资料,根据出院后1年内是否再发骨折将其分为再发骨折组(n=44)和非再发骨折组(n=106)。使用Logistic回归分析确定患者出院后再发骨折的影响因素,构建风险预测模型。采用受试者工作特征曲线与Hosmer-Lemeshow检验评价该模型的预测效能。结果:随访1年后,有44例患者再次发生骨折,发生率为29.33%。回归分析结果显示,年龄70~80岁、女性、骨密度低、25-羟基维生素D3低、首次骨折椎体数≥2个、出院后未规律锻炼、出院后未规律服用抗骨质疏松药是老年骨质疏松性脊柱骨折患者出院后再发骨折的独立影响因素。预测模型曲线下面积为0.869,约登指数为0.429,灵敏度为0.846,特异度为0.583。结论:年龄大、女性、骨密度低、25-羟基维生素D3低、首次骨折椎体数≥2个、出院后未规律锻炼、出院后未规律服用抗骨质疏松药可能会提高老年骨质疏松性脊柱骨折患者再发骨折的风险,临床上应对上述因素加以注意。具有较好的预测效能。

Objective:To establish a risk prediction model for elderly patients with osteoporotic spinal fracture after discharge.Methods:Clinical data of 150 elderly patients with osteoporotic spinal fracture admitted to Liangshan County People’s Hospital from December 2020 to May 2023 were retrospectively analysed.They were divided into a recurrent fracture group(n=44)and a non-recurrent fracture group(n=106)according to whether they had recurrent fracture within one year after discharge.regression analysis was used to determine the factors affecting the recurrence of fractures after discharge,the risk prediction model was constructed.The predictive efficiency of the model was evaluated by using the receiver operating characteristic curve and Hosmer-Lemeshow test.Results:After 1 year of follow-up,44 patients had fracture again,the incidence was 29.33%.Logistic regression analysis showed that age 70 to 80 years old,female,low bone mineral density,low 25-hydroxyvitamin D3,≥2 vertebral bodies with thefirst fracture,lack of regular exercise after discharge and lack of regular use of anti-osteoporosis drugs after discharge were independent influencing factors for recurrent fractures in elderly patients with osteoporotic spinal fractures after discharge(P<0.05).The predictive model area under the curve was 0.869,the Jorden index was 0.429,the sensitivity was 0.846,the specificity was 0.583.Conclusion:Older age,female,low bone mineral density,low 25-hydroxyvitamin D3,≥2 vertebrae fractured for thefirst time,lack of regular exercise after discharge and lack of regular use of anti-osteoporosis drugs after discharge may increase the risk of recurrent fracture in elderly patients with osteoporotic spinal fractures.Clinical attention should be paid to the above factors.