在存在死亡竞争风险的情况下进行骨折风险评估。

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Osteoporosis International Pub Date : 2024-11-01 Epub Date: 2024-08-15 DOI:10.1007/s00198-024-07224-z
Thach S Tran, Dana Bliuc, Robert D Blank, Jacqueline R Center, Tuan V Nguyen
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引用次数: 0

摘要

目的:确定在存在死亡竞争事件的情况下预测脆性骨折风险的最佳统计方法:我们使用了杜博骨质疏松症流行病学研究(Dubbo Osteoporosis Epidemiology Study)的真实数据,该研究对 3035 名老年参与者的骨骼健康和死亡率进行了监测。脆性骨折是通过放射学检查确定的。死亡率由国家登记处确认。我们考虑了四种预测骨折风险的统计模型:(i) 传统的 Cox 比例危险模型,(ii) 特定原因模型,(iii) Fine-Gray 子分布模型,以及 (iv) 多州模型。这些模型分别在开发子集(原始样本的 60%)和验证子集(40%)中进行了拟合和验证。通过辨别和校准分析评估了模型的性能:在中位数为 11.3 年(IQR:7.2,16.2)的随访期间,开发组群中有 628 人(34.5%)发生骨折,630 人(34.6%)在未发生骨折的情况下死亡。尽管传统模型倾向于高估骨折风险(校准大样本指数 = - 0.24; 95% CI: - 0.43, - 0.06),但各模型的区分度和 5 年预测性能均无明显差异。在10年风险预测方面,多州模型(大样本校准指数=- 0.05;95% CI:- 0.20,0.10)优于特异性病因模型(- 0.23;- 0.30,- 0.08)、Fine-Gray模型(- 0.31;- 0.46,- 0.16)和传统模型(- 0.54;- 0.70,- 0.39),后者明显高估了骨折风险:结论:调整死亡竞争风险对骨折的短期预测影响最小。然而,多态模型对长期骨折风险的预测最为准确,因此在对同样面临高死亡风险的老年人进行预测研究时应加以考虑。骨折风险评估可能会受到死亡这一竞争事件的影响。本研究利用真实世界的数据发现,在骨折风险评估中,多态模型优于目前的竞争风险方法。多态模型被认为是老年人预测研究的最佳统计方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Fracture risk assessment in the presence of competing risk of death.

Fracture risk assessment in the presence of competing risk of death.

Purpose: To identify the optimal statistical approach for predicting the risk of fragility fractures in the presence of competing event of death.

Methods: We used real-world data from the Dubbo Osteoporosis Epidemiology Study that has monitored 3035 elderly participants for bone health and mortality. Fragility fractures were ascertained radiologically. Mortality was confirmed by the State Registry. We considered four statistical models for predicting fracture risk: (i) conventional Cox's proportional hazard model, (ii) cause-specific model, (iii) Fine-Gray sub-distribution model, and (iv) multistate model. These models were fitted and validated in the development (60% of the original sample) and validation (40%) subsets, respectively. The model performance was assessed by discrimination and calibration analyses.

Results: During a median follow-up of 11.3 years (IQR: 7.2, 16.2), 628 individuals (34.5%) in the development cohort fractured, and 630 (34.6%) died without a fracture. Neither the discrimination nor the 5-year prediction performance was significantly different among the models, though the conventional model tended to overestimate fracture risk (calibration-in-the-large index =  - 0.24; 95% CI: - 0.43, - 0.06). For 10-year risk prediction, the multistate model (calibration-in-the-large index =  - 0.05; 95% CI: - 0.20, 0.10) outperformed the cause-specific (- 0.23; - 0.30, - 0.08), Fine-Gray (- 0.31; - 0.46, - 0.16), and conventional model (- 0.54; - 0.70, - 0.39) which significantly overestimated fracture risk.

Conclusion: Adjustment for competing risk of death has minimum impact on the short-term prediction of fracture. However, the multistate model yields the most accurate prediction of long-term fracture risk and should be considered for predictive research in the elderly, who are also at high mortality risk. Fracture risk assessment might be compromised by the competing event of death. This study, using real-world data found a multistate model was superior to the current competing risk methods in fracture risk assessment. A multistate model is considered an optimal statistical method for predictive research in the elderly.

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来源期刊
Osteoporosis International
Osteoporosis International 医学-内分泌学与代谢
CiteScore
8.10
自引率
10.00%
发文量
224
审稿时长
3 months
期刊介绍: An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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