摘要
目的 通过比较不输入骨密度(BMD)T值的骨折风险评估工具(FRAX)评分与BMD T值能否得出相一致的治疗建议,以股骨颈T值为金标准确定FRAX评分最佳干预阈值,探讨单纯应用FRAX对巴州地区中老年人骨折风险的预测价值。方法 选取2020年1月1日至2022年12月31日在新疆巴音郭楞蒙古自治州人民医院住院患者505例,根据病历记录患者的一般资料,通过FRAX计算10年内主要骨质疏松性骨折概率(MOF)及10年内髋关节骨折概率(HF),用双能X线吸收法(DXA)骨密度仪检查腰椎L_(1~4)及左侧股骨颈、大粗隆、粗隆间、髋关节的BMD,检测血钙、25羟维生素D、骨钙素、甲状旁腺激素(PTH),采取Kappa检验比较FRAX评分和BMD T值给出干预建议的一致性,绘制FRAX评分预测骨质疏松的ROC曲线,计算其截断值(cut-off)。结果 患者平均年龄(65.80±11.49)岁,男232例、女273例,女性≥60岁组FRAX评分最高,为2.40(1.20,3.80)分,男性45~59岁组评分最低,为0.30(0.20,0.40)分。FRAX与BMD T值对中老年患者骨质疏松治疗建议的一致性Kappa为0.630(P<0.001),FRAX工具截断值为3.75,最大约登指数为0.619,敏感度与特异度分别为0.685、0.933。结论 由FRAX评分与BMD T值给出的骨质疏松干预建议一致性较好,在巴州地区,FRAX工具预测中老年人群骨质疏松的最佳干预阈值为3.75%(不输入BMD)。
Objective To compare whether the fracture risk assessment tool(FRAX)score(FRAX/-)and bone mineral density(BMD)T value,which do not include bone mineral density values,can provide consistent treatment recommendations.The optimal intervention threshold for FRAX score is determined using the femoral neck T value as the gold standard,and to explore the predictive value of the application of FRAX alone on the fracture risk of middle-aged and elderly people in the Bazhou region.Methods A total of 505 patients hospitalized in the People’s Hospital of Bayingol Mongolian Autonomous Prefecture from January 1,2020 to December 31,2022 were selected.According to the general information of patients recorded in the medical records,the probability of major osteoporotic fracture(MOF)in 10 years and the probability of hip fracture(HF)in 10 years were calculated by FRAX.The bone mineral density of the lumbar spine L_(1-4),left femoral neck,greater trochanter,intertrochanter,and hip joint was measured by dual-energy X-ray absorptiometry(DXA).The blood calcium,25 Hydroxyvitamin D,osteocalcin,and parathyroid hormone(PTH)were tested.The Kappa test was used to compare the consistency of the FRAX score and bone mineral density value to give intervention recommendations,draw the receiver operating characteristic(ROC)of the FRAX score to predict osteoporosis and calculate its cut-off value.Results The average age of the patients was(65.80±11.49),with 232 males and 273 females.The FRAX score was the highest in the female≥60-year-old group 2.40(1.20,3.80),and the lowest in the male 45-59-year-old group 0.30(0.20,0.40).The consistency of FRAX and BMD T values for the treatment of osteoporosis in middle-aged and elderly patients was Kappa=0.630(P<0.001),the FRAX tool cut-off value was 3.75,the maximum Youden index was 0.619,and the sensitivity and specificity were 0.685 and 0.933,respectively.Conclusion The consistency of intervention recommendations for osteoporosis based on the FRAX score and BMD T value is better.In the Bazhou region,the optimal intervention threshold for predicting osteoporosis in the middle-aged and elderly population using the FRAX tool is 3.75%(without inputting BMD).
作者
韩海滨
张娟
刘冬
陈立
HAN Haibin;ZHANG Juan;LIU Dong;CHEN Li(Department of Geriatrics,the People’s Hospital of Bayingol Mongolian Autonomous Prefecture,Xinjiang,Korla 841000,China)
出处
《中国医药科学》
2023年第21期183-186,共4页
China Medicine And Pharmacy
基金
新疆巴音郭楞蒙古自治州人民医院面上基金项目(BY202010)。
关键词
骨折风险评估工具
巴州地区
中老年人
骨质疏松
Fracture risk assessment tool
Bazhou region
Middle-aged and elderly people
Osteoporosis
作者简介
通讯作者:刘冬。
