应用FRAX预测女性骨质疏松性骨折风险的对比研究

目的应用FRAX对比女性前臂骨密度和股骨颈骨密度进行骨质疏松性骨折的风险预测。方法对行骨密度检查的女性作回顾性分析,其中行前臂骨密度检查10 519例,行股骨颈骨密度检查1 280例。根据FRAX指定的危险因子,记录研究对象的年龄、身高、体重、既往骨折史、父母髋部骨折史、吸烟史、饮酒史、长期使用类固醇激素史、类风湿性关节炎及其他继发性骨质疏松症史、前臂和股骨颈的骨密度值或T值。以每10岁年龄段分组,分别运用前臂骨密度T值及股骨颈骨密度计算FRAX评分。应用SPSS 19.0统计分析软件,两组间计量数据比较使用t检验,不符合t检验条件时使用非参数秩和检验。P0.05为差异有统计学意义。结果前臂骨密度低于股骨颈骨密度。40～50岁组骨密度T值前臂要高于股骨颈,60～80岁组骨密度T值前臂低于股骨颈,除80岁组外,其他各组差异均有统计学意义(P0.05)。40岁组前臂骨质疏松检出率低于股骨颈骨质疏松检出率;50～80岁组前臂骨质疏松检出率较高(P0.05)。40～50岁组预测主要部位骨折风险前臂要低于股骨颈;70岁组预测主要部位骨折风险系数前臂要高于股骨颈(P0.05)。40～50岁组预测髋部骨折风险前臂低于股骨颈;70岁组预测髋部骨折风险系数前臂高于股骨颈(P0.05)。结论前臂骨密度可以用于FRAX进行骨折风险的预测,但各年龄段的评估概率会与股骨颈有一定差距,还需进行深入细致更准确的研究。

Comparative study of predicting osteoporotic fracture risk in women using FRAX

Objective To compare the FRAX estimated osteoporotic fracture risk in females using forearm bone mineral density and femoral neck bone density. Methods A retrospective analysis of 10 519 cases of forearm and 1 280 cases of femoral neck bone density was performed. According to the risk factors specified by FRAX, the study subjects'' age, height, weight, previous fracture history, history of parent hip fractures, smoking history, drinking history, long-term use of steroid hormones, rheumatoid arthritis, other secondary osteoporosis, and bone mineral density (BMD) or T-score of the forearm and femoral neck were recorded. Each group was divided into ten-year age groups and the FRAX score was calculated using the T-score of forearm bone density and femoral neck bone density. SPSS 19.0 statistical analysis software was used to compare the measurement data between the two groups using the t-test. Non-parametric rank sum tests were used when the t-test conditions were not met. P<0.05 was considered statistically significant. Results Bone density of forearm was lower than that of the femoral neck. Forearm bone mineral density in the 40-50-year-old group was higher than that of the femoral neck, and the T-score in the 60-80-year-old group was lower than that of the femoral neck, except for the 80-year-old group (P<0.05). The detection rate of osteoporosis at forearm in the 40-year-old group was lower than that of femoral neck; the detection rate of osteoporosis at forearm in the 50-80-year-old group was higher (P<0.05). In the 40-50-year-old group, the predicted risk of major osteoporotic fracture using forearm data was lower than that of femoral neck; in the 70-year-old group, the predicted risk of major osteoporotic fracture using forearm data was higher than that of femoral neck (P<0.05). In the 40-50-year-old group, the predicted risk of hip fracture was lower using forearm data compared with using femoral neck data; in the 70-year-old group, the predicted risk of hip fracture was higher using forearm data than femoral neck data (P<0.05). Conclusion Forearm bone mineral density can be used to predict fracture risk using FRAX. However, in each age group there is certain gap between the probability estimated using forearm and femoral neck bone density, thus further detailed and accurate research is needed.