分解和简化骨折风险评估工具

IF 3.4 Q2 ENDOCRINOLOGY & METABOLISM
JBMR Plus Pub Date : 2024-03-23 DOI:10.1093/jbmrpl/ziae039
Chia-Chun Li, I. Liu, Tien-Tsai Cheng, Fu-Wen Liang, Zih‐Jie Sun, Yin-Fan Chang, Chin-Sung Chang, Yi-Ching Yang, Tsung-Hsueh Lu, Li-Chieh Kuo, Chih-Hsing Wu
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引用次数: 0

摘要

骨折风险评估工具(FRAX®)是一种广泛使用的针对特定国家的计算器,用于识别骨折高危人群;其分数由 12 个变量计算得出,但其制定方法并未公开披露。我们的目的是利用一个全国性的社区调查数据库作为参考模块,对 FRAX® 进行分解和简化,从而为任何国家的骨质疏松性骨折社区筛查创建一个本地评估工具。参与者(n = 16 384:主要为女性(75%);平均年龄 = 64.8 岁)来自台湾骨质疏松症调查,这是一个 2008-2011 年收集的全国性横断面社区调查数据库。我们还从健康问卷中确定了 11 项其他临床风险因素。我们使用移动式 DXA 车通过双能 X 射线吸收仪评估了骨质密度(BMD),并使用 FRAX® 计算了 10 年骨折风险评分,包括主要骨质疏松性骨折(MOF)和髋部骨折(HF)风险评分。平均股骨颈 BMD 为 0.7 ± 0.1 g/cm2,T 评分为 -1.9 ± 1.2,MOF 为 8.9 ± 7.1%,HF 为 3.2 ± 4.7%。在使用多重线性回归对 FRAX® 进行分解后,当包括 BMD 时,MOF 的调整 R2 值为 0.9206,HF 为 0.9376;当不包括 BMD 时,MOF 为 0.9538,HF 为 0.9554。在对性别和年龄进行分层分析后,FRAX® 对女性和年轻人的预测效果优于男性和老年人。根据本研究人群的决策树分析,排除股骨颈 BMD 后,年龄、性别和既往骨折成为简化 FRAX® 的三个主要临床风险因素。包含三个主要临床风险因素的简化版国别 FRAX® 的调整 R2 值为:MOF 为 0.8210,HF 为 0.8528。经过分解后,即使没有股骨颈 BMD,新的简化模块也能直接估算出 10 年骨折风险,因此适用于社区或临床骨质疏松性骨折风险筛查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Decomposing and simplifying fracture risk assessment tool
The Fracture Risk Assessment tool (FRAX®) is a widely utilized country-specific calculator for identifying individuals with high fracture risk; its score is calculated from 12 variables, but its formulation is not publicly disclosed. We aimed to decompose and simplify the FRAX® by utilizing a nationwide community survey database as a reference module for creating a local assessment tool for osteoporotic fracture community screening in any country. Participants (n = 16 384: predominantly women (75%); mean age = 64.8 years) were enrolled from the Taiwan OsteoPorosis Survey, a nationwide cross-sectional community survey database collected from 2008–2011. We identified 11 other clinical risk factors from the health questionnaires. Bone mineral density (BMD) was assessed via dual-energy X-ray absorptiometry in a mobile DXA vehicle, and 10-year fracture risk scores, including major osteoporotic fracture (MOF) and hip fracture (HF) risk scores, were calculated using the FRAX®. The mean femoral neck BMD was 0.7 ± 0.1 g/cm2, the T-score was -1.9 ± 1.2, the MOF was 8.9 ± 7.1%, and the HF was 3.2 ± 4.7%. Following FRAX® decomposition with multiple linear regression, the adjusted R2 values were 0.9206 for MOF and 0.9376 for HF when BMD was included and 0.9538 for MOF and 0.9554 for HF when BMD was excluded. The FRAX® demonstrated better prediction for women and younger individuals than for men and elderly individuals after sex and age stratification analysis. Excluding femoral neck BMD, age, sex, and previous fractures emerged as three primary clinical risk factors for simplified FRAX® according to the decision tree analysis in this study population. The adjusted R2 values for the simplified country-specific FRAX® incorporating three premier clinical risk factors were 0.8210 for MOF and 0.8528 for HF. After decomposition, the newly simplified module provides a straightforward formulation for estimating 10-year fracture risk, even without femoral neck BMD, making it suitable for community or clinical osteoporotic fracture risk screening.
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来源期刊
JBMR Plus
JBMR Plus Medicine-Orthopedics and Sports Medicine
CiteScore
5.80
自引率
2.60%
发文量
103
审稿时长
8 weeks
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