Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fra...Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.展开更多
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of b...The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.展开更多
AIM: To assess:(1) Whether the World Health Organization fracture risk assessment tool(FRAX) can be used for monitoring osteoporosis patients receiving treatment as well as its clinical implications; and(2) The relati...AIM: To assess:(1) Whether the World Health Organization fracture risk assessment tool(FRAX) can be used for monitoring osteoporosis patients receiving treatment as well as its clinical implications; and(2) The relation between fracture incidence and post-treatment FRAX.METHODS: Five hundred and seventy-nine osteoporotic women known to be adherent to the prescribed osteoporosis medication, had dual-energy X-ray absorptiometry scan and fracture probability calculated at baseline, 2 and 5-year of osteoporosis treatment. Those patients who responded to treatment and did not sustain a new low trauma fracture during the first 2 years, continued their treatment and were re-assessed 3-year later. The patient subgroup who did not achieve an improvement in their bone mineral density(BMD)or sustain any fracture within the first 2-year, had their osteoporosis treatment changed. Outcome measures included BMD and FRAX assessment calculated 3-year after commencing new osteoporosis treatment. RESULTS: There was a significant negative correlation between 10-year probability of major osteoporotic and hip fractures and BMD at the total proximal femur at 2-year of treatment(R =-0.449 and-0.479 respectively), and at 5-year(R =-0.489 and-0.594 respectively). At both 2 years and 5 years of treatment, the 10-year fracture probability showed significant correlation with the incidence of fracture(P < 0.01). On comparing fracture probability, there was a significant difference(P < 0.05) between the responders and non-responders to osteoporosis treatment.CONCLUSION: In women currently or previously treated for osteoporosis, the FRAX tool can be used to predict fracture probability. Osteoporosis treatment does not annul prediction of fractures. FRAX tool may be of value in guiding clinicians towards the need for continuation or withdrawal of treatment.展开更多
AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic...AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD.Each item in text was paired with a photograph that illustrated the written content,which was in the 2 main local languages.The final product had 21 items and was named the pictorial autism assessment schedule(PAAS).Performance of PAAS was tested on a clinical sample of 18-48 mo old children,diagnosis na?ve,presenting with developmental deficits.Mothers completed PAAS checklist.Based on clinical diagnosis,which was taken as the gold standard,children were later grouped into ASD(Group 1) and non-ASD developmental disorders(Group 2).Mothers of a control sample of typically developing children also completed PAAS(Group 3).RESULTS A total of 105 children(Group 1-45,Group 2-30,Group 3-30) participated in the study.Mean age of Group 1 and Group 2 were 36 and 40 mo respectively.Majority were male in all 3 groups.Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%,specificity 60.7%,positive predictive value(PPV) 78.4%,negative predictive value(NPV) 77.2%,likelihood ratio(LR+) 2.26,and LR-0.18.Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%,specificity 93.3%,PPV 95.2%,NPV 84.0%,LR+ 13.3 and LR- 0.12.The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder.A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSION PAAS is an effective tool in screening for ASD.Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.展开更多
目的探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值。方法回顾性分析750名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因...目的探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值。方法回顾性分析750名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因素,并随访收集10年内是否新发骨折,计算年龄及体质量指数(body mass index,BMI),用FRAX工具计算10年内骨质疏松引起主要部位骨折(脊柱、前臂、肩部骨折)概率(the 10-year probability of major osteoporotic fractures,PMOF)和10年内髋骨骨折概率(the 10-year probability of hip osteoporotic fractures,PHF)。分析FRAX预测值与年龄、BMI、股骨颈BMD的相关性,建立二分类Logistic回归方程研究10年内新发骨折的显著危险因素,并建立模型得到预测值,以10年内是否新发骨折为标准绘制受试者工作曲线(receiver operating characteristic curve,ROC),计算FRAX预测值、BMD及模型预测值曲线下面积(area under curve,AUC),以AUC评估FRAX工具的预测价值。结果研究对象平均年龄为(62.49±6.59)岁,平均体质量为(63.03±9.63)kg,平均身高为(156.11±5.10)cm,平均股骨颈BMD(T值)为-1.12±0.95。危险因素与FRAX预测值的相关性分析显示,除吸烟和饮酒外,余危险因素与PMOF的差异均有统计学意义(P<0.05);除饮酒和风湿性关节炎外,余危险因素与PHF的差异均有统计学意义(P<0.05)。年龄、BMI和股骨颈BMD与FRAX评分的相关性分析显示,年龄与PMOF和PHF呈正相关,差异有统计学意义(P<0.05),而BMI、股骨颈BMD与PMOF和PHF均呈负相关,差异有统计学意义(P<0.05)。以10年内是否新发骨折为因变量生成Logistic回归方程评估危险因素,得出骨折史、吸烟、股骨颈BMD、体重、身高对女性骨折风险的影响较大并得到预测模型。ROC曲线分析PMOF、PHF、股骨颈BMD和回归模型预测10年内骨折的AUC分别为0.616、0.600、0.573和0.670(P<0.05),但诊断能力较低。结论FRAX可应用于北京地区绝经后女性骨折风险评估,但预测准确性有待提高。绝经后女性如果有骨折史,应尽早行FRAX及DXA评估,并尽快得到医疗建议。展开更多
目的分析亚洲人骨质疏松(osteporsis,OP)自我筛查工具(osteoporosis self-assessment tool for Asian,OSTA)指数与骨密度(bone mineral density,BMD)的相关性,并探讨跟骨定量超声(quantitative ultrasound,QUS)测定BMD对中老年男性OP的...目的分析亚洲人骨质疏松(osteporsis,OP)自我筛查工具(osteoporosis self-assessment tool for Asian,OSTA)指数与骨密度(bone mineral density,BMD)的相关性,并探讨跟骨定量超声(quantitative ultrasound,QUS)测定BMD对中老年男性OP的诊断价值。方法对893例45岁以上男性研究对象行QUS-BMD检查,记录跟骨QUS-BMD及QUS-T值,测量身高、体重,计算OSTA指数,其中255例研究对象同时行双能X线(dual-energy Xray absorptionmetry,DXA)BMD测定,按OSTA分层标准将受试者分为OP高、中、低风险组。比较各组间跟骨QUS-BMD、QUS-T以及各部位DXA-BMD的差异,分析OSTA指数与髋部、腰椎DXA-BMD的相关性。根据WHO的OP诊断金标准(骨质疏松:T值≤-2.5,骨量减少:-2.5<T值<-1,骨量正常:T值≥-1)将受试者分为OP组、骨量减少组和骨量正常组,评价跟骨QUS-T值对OP的诊断价值。结果 DXA-BMD测定者中,OP者71例(27.8%),骨量减少者143例(56.1%),骨量正常者41例(16.1%)。OSTA分层高、中、低不同OP风险组中,股骨颈、全髋和全腰椎BMD逐渐升高,高危组明显低于中危组和低危组(P<0.05),而中、低危组间的差异无统计学意义(P>0.05)。OP风险高、中、低危3组中OP患病例数分别为37例(48.7%)、17例(17.5%)和17例(20.7%),高危组中OP患病例数显著高于中、低危组(P<0.05)。Spearman相关分析示OSTA指数与股骨颈、全髋及全腰椎BMD呈显著正相关(P<0.05),相应的相关系数分别为0.448、0.439和0.141。跟骨QUS-BMD和QUS-T值在不同OP风险组间的差异无统计学意义(P>0.05)。跟骨QUS-T值诊断OP的曲线下面积为0.753,最佳截断值为-1.3,相应的灵敏度和特异度分别为77.5%和61.4%。结论随着OSTA指数升高,OP风险降低,股骨颈、全髋及全腰椎的BMD升高,OSTA指数与各部位DXA-BMD成线性正相关。OSTA指数和跟骨QUST值对诊断中老年男性OP症筛查具有一定的价值。展开更多
目的比较亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)和体质量指数(body mass index,BMI)对骨质疏松症的预测效果。方法使用双能X线吸收检测仪(dual energy X-ray absorptiometry,DXA)测定50岁以...目的比较亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)和体质量指数(body mass index,BMI)对骨质疏松症的预测效果。方法使用双能X线吸收检测仪(dual energy X-ray absorptiometry,DXA)测定50岁以上体检者5 745人(男性2 094人,女性3 651人)的骨密度(bone mineral density,BMD)值,计算OSTA指数和BMI,分别评价两者对骨质疏松症的预测效果。结果股骨颈BMD均随年龄增长而逐渐下降。OSTA指数预测股骨颈骨质疏松的受试者工作特征(receiver operating characteristic,ROC)曲线下面积女性为0.817,男性为0.797,最佳诊断切点为-1.75(女)和-1.70(男)。BMI预测男性股骨颈骨质疏松的曲线下面积(area under curves,AUC)为0.736,与OSTA指数比较,差异无统计学意义(P>0.05),最佳诊断切点为22.9 kg/m^2。女性OSTA预测股骨颈和腰椎骨质疏松的ROC曲线下面积均高于BMI(P<0.05)。结论 OSTA和BMI可用于50岁以上人群骨质疏松症筛查,女性更适合应用OSTA指数。建议OSTA最佳干预界值为-1.7,BMI预测骨质疏松的最佳切点男性为23 kg/m^2,女性为21 kg/m^2。展开更多
目的探讨女性人群中手握力与亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)指数组合确定骨量减少及骨质疏松症(osteoporosis,OP)的作用。方法选取上海瑞金医院313名年龄20~85岁的女性患者进行横断面...目的探讨女性人群中手握力与亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)指数组合确定骨量减少及骨质疏松症(osteoporosis,OP)的作用。方法选取上海瑞金医院313名年龄20~85岁的女性患者进行横断面研究。询问饮酒及吸烟史、疾病史、生活史和骨折史,测量身高、体质量、腰围、臀围、握力和身体脂肪含量并计算OSTA指数。测定生化指标(肝肾功能、电解质、血脂、空腹血糖、餐后血糖、糖化血红蛋白)。双能X线吸收检测法(dual energy x-ray absorptiometry,DXA)检测腰椎和股骨近端骨密度(bone mineral density,BMD)。结果绝经后女性握力与L1-4 BMD(r=0.329,P=0.000)、L2-4 BMD(r=0.329,P=0.000)、股骨颈BMD(r=0.313,P=0.000)和全髋BMD(r=0.343,P=0.000)呈正相关,且不受年龄影响。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示握力筛查骨量减少/OP阈值为22.8 kg(敏感度为70.7%,特异度为56.1%,曲线下面积=0.674),握力联合OSTA指数≤-1筛查骨量减少/OP的阈值为20.45 kg(敏感度为81%,特异度为31%,曲线下面积=0.810)。结论握力与OSTA指数结合使用可能成为反映骨丢失和女性骨量减少及OP的筛查方法。展开更多
文摘Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.
文摘The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
文摘AIM: To assess:(1) Whether the World Health Organization fracture risk assessment tool(FRAX) can be used for monitoring osteoporosis patients receiving treatment as well as its clinical implications; and(2) The relation between fracture incidence and post-treatment FRAX.METHODS: Five hundred and seventy-nine osteoporotic women known to be adherent to the prescribed osteoporosis medication, had dual-energy X-ray absorptiometry scan and fracture probability calculated at baseline, 2 and 5-year of osteoporosis treatment. Those patients who responded to treatment and did not sustain a new low trauma fracture during the first 2 years, continued their treatment and were re-assessed 3-year later. The patient subgroup who did not achieve an improvement in their bone mineral density(BMD)or sustain any fracture within the first 2-year, had their osteoporosis treatment changed. Outcome measures included BMD and FRAX assessment calculated 3-year after commencing new osteoporosis treatment. RESULTS: There was a significant negative correlation between 10-year probability of major osteoporotic and hip fractures and BMD at the total proximal femur at 2-year of treatment(R =-0.449 and-0.479 respectively), and at 5-year(R =-0.489 and-0.594 respectively). At both 2 years and 5 years of treatment, the 10-year fracture probability showed significant correlation with the incidence of fracture(P < 0.01). On comparing fracture probability, there was a significant difference(P < 0.05) between the responders and non-responders to osteoporosis treatment.CONCLUSION: In women currently or previously treated for osteoporosis, the FRAX tool can be used to predict fracture probability. Osteoporosis treatment does not annul prediction of fractures. FRAX tool may be of value in guiding clinicians towards the need for continuation or withdrawal of treatment.
文摘目的比较新型北京友谊医院绝经后妇女骨质疏松筛查工具(Beijing Friendship Hospital osteoporosis self-assessment tool,BFH-OST)和亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)对绝经后妇女骨质疏松风险的预测作用。方法随机选取2021年1月至2022年11月就诊于民航总医院的115例绝经后妇女,以双能X射线吸收法(dual energy X-ray absorptiometry,DXA)为诊断标准,通过受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析BFH-OST、OSTA的诊断效能。结果BFH-OST和OSTA均与DXA诊断骨质疏松存在明显相关性(P<0.01),BFH-OST的曲线下面积(area under the curve,AUC)为0.819,截断值≤12.2,敏感度为81.25%,特异性为75.90%;OSTA的AUC为0.809,截断值≤–1.2,敏感度为81.25%,特异性72.29%。BFH-OST和OSTA的ROC曲线比较,差异有统计学意义(P<0.05)。结论BFH-OST和OSTA对绝经后妇女骨质疏松风险均有预测作用,BFH-OST的诊断效能优于OSTA。
文摘AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD.Each item in text was paired with a photograph that illustrated the written content,which was in the 2 main local languages.The final product had 21 items and was named the pictorial autism assessment schedule(PAAS).Performance of PAAS was tested on a clinical sample of 18-48 mo old children,diagnosis na?ve,presenting with developmental deficits.Mothers completed PAAS checklist.Based on clinical diagnosis,which was taken as the gold standard,children were later grouped into ASD(Group 1) and non-ASD developmental disorders(Group 2).Mothers of a control sample of typically developing children also completed PAAS(Group 3).RESULTS A total of 105 children(Group 1-45,Group 2-30,Group 3-30) participated in the study.Mean age of Group 1 and Group 2 were 36 and 40 mo respectively.Majority were male in all 3 groups.Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%,specificity 60.7%,positive predictive value(PPV) 78.4%,negative predictive value(NPV) 77.2%,likelihood ratio(LR+) 2.26,and LR-0.18.Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%,specificity 93.3%,PPV 95.2%,NPV 84.0%,LR+ 13.3 and LR- 0.12.The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder.A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSION PAAS is an effective tool in screening for ASD.Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.
文摘目的探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值。方法回顾性分析750名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因素,并随访收集10年内是否新发骨折,计算年龄及体质量指数(body mass index,BMI),用FRAX工具计算10年内骨质疏松引起主要部位骨折(脊柱、前臂、肩部骨折)概率(the 10-year probability of major osteoporotic fractures,PMOF)和10年内髋骨骨折概率(the 10-year probability of hip osteoporotic fractures,PHF)。分析FRAX预测值与年龄、BMI、股骨颈BMD的相关性,建立二分类Logistic回归方程研究10年内新发骨折的显著危险因素,并建立模型得到预测值,以10年内是否新发骨折为标准绘制受试者工作曲线(receiver operating characteristic curve,ROC),计算FRAX预测值、BMD及模型预测值曲线下面积(area under curve,AUC),以AUC评估FRAX工具的预测价值。结果研究对象平均年龄为(62.49±6.59)岁,平均体质量为(63.03±9.63)kg,平均身高为(156.11±5.10)cm,平均股骨颈BMD(T值)为-1.12±0.95。危险因素与FRAX预测值的相关性分析显示,除吸烟和饮酒外,余危险因素与PMOF的差异均有统计学意义(P<0.05);除饮酒和风湿性关节炎外,余危险因素与PHF的差异均有统计学意义(P<0.05)。年龄、BMI和股骨颈BMD与FRAX评分的相关性分析显示,年龄与PMOF和PHF呈正相关,差异有统计学意义(P<0.05),而BMI、股骨颈BMD与PMOF和PHF均呈负相关,差异有统计学意义(P<0.05)。以10年内是否新发骨折为因变量生成Logistic回归方程评估危险因素,得出骨折史、吸烟、股骨颈BMD、体重、身高对女性骨折风险的影响较大并得到预测模型。ROC曲线分析PMOF、PHF、股骨颈BMD和回归模型预测10年内骨折的AUC分别为0.616、0.600、0.573和0.670(P<0.05),但诊断能力较低。结论FRAX可应用于北京地区绝经后女性骨折风险评估,但预测准确性有待提高。绝经后女性如果有骨折史,应尽早行FRAX及DXA评估,并尽快得到医疗建议。
文摘目的比较亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)和体质量指数(body mass index,BMI)对骨质疏松症的预测效果。方法使用双能X线吸收检测仪(dual energy X-ray absorptiometry,DXA)测定50岁以上体检者5 745人(男性2 094人,女性3 651人)的骨密度(bone mineral density,BMD)值,计算OSTA指数和BMI,分别评价两者对骨质疏松症的预测效果。结果股骨颈BMD均随年龄增长而逐渐下降。OSTA指数预测股骨颈骨质疏松的受试者工作特征(receiver operating characteristic,ROC)曲线下面积女性为0.817,男性为0.797,最佳诊断切点为-1.75(女)和-1.70(男)。BMI预测男性股骨颈骨质疏松的曲线下面积(area under curves,AUC)为0.736,与OSTA指数比较,差异无统计学意义(P>0.05),最佳诊断切点为22.9 kg/m^2。女性OSTA预测股骨颈和腰椎骨质疏松的ROC曲线下面积均高于BMI(P<0.05)。结论 OSTA和BMI可用于50岁以上人群骨质疏松症筛查,女性更适合应用OSTA指数。建议OSTA最佳干预界值为-1.7,BMI预测骨质疏松的最佳切点男性为23 kg/m^2,女性为21 kg/m^2。
