Espallargues M, Sampietro-Colom L, Estrada M D, Solà M, del Rio L, Setoain J, Granados A
Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain.
Osteoporos Int. 2001;12(10):811-22. doi: 10.1007/s001980170031.
Available evidence suggests that fracture prediction with bone densitometry may improve when used on people at high risk of osteoporotic fractures. The objectives of this literature review were: (1) to identify risk factors for fracture that are associated with the development of a low bone mass for both men and women; (2) to describe and assess the relationship between these factors and the risk of fracture; and (3) to classify them according to the strength of their association with fracture incidence. Studies were identified from MEDLINE (1982-1997), HealthSTAR (1975-1997) and The Cochrane Library (1997) databases. Pre-stated inclusion criteria (original analytic studies assessing risk factors for osteoporotic fractures in men and women) and methodologic quality were assessed by two independent investigators. Information on the study design and analysis, characteristics of participants, exposure (risk factor) and outcome measures (relative risk and odds ratios for fracture incidence), control for potential confounding factors and risk estimates was extracted using a standardized protocol. Qualitative and meta-analytic techniques were used for data synthesis. As a result, risk factors were classified into three groups according to their strength of association with fracture: high risk (RR > or = 2), moderate risk (1 < RR < 2) and no risk or protective (RR < or = 1). Of approximately 80 risk factors identified from 94 cohort and 72 case-control studies, 15% were classified in the high-risk group, including low body weight, loss of weight, physical inactivity, the consumption of corticosteroids or anticonvulsants, primary hyperparathyroidism, diabetes mellitus type 1, anorexia nervosa, gastrectomy, pernicious anemia, and aging (> 70-80 years). Eighteen percent and 8% of risk factors were classified in the moderate and no risk group respectively, whereas 60% showed either a lack of scientific evidence confirming their association with fracture or contradictory results. An efficient strategy for bone densitometry provision may thus be its selective use in those individuals who present with several strong or moderate risk factors for fracture related to bone mass loss.
现有证据表明，对骨质疏松性骨折高危人群使用骨密度测定法进行骨折预测，其效果可能会更好。本综述的目的是：（1）确定与男性和女性低骨量发生相关的骨折危险因素；（2）描述和评估这些因素与骨折风险之间的关系；（3）根据它们与骨折发生率的关联强度对其进行分类。研究是从MEDLINE（1982 - 1997年）、HealthSTAR（1975 - 1997年）和Cochrane图书馆（1997年）数据库中检索到的。由两名独立研究人员评估预先设定的纳入标准（评估男性和女性骨质疏松性骨折危险因素的原始分析研究）和方法学质量。使用标准化方案提取有关研究设计与分析、参与者特征、暴露因素（危险因素）和结局指标（骨折发生率的相对风险和比值比）、对潜在混杂因素的控制以及风险估计的信息。采用定性和荟萃分析技术进行数据合成。结果，根据危险因素与骨折的关联强度，将其分为三组：高风险（RR≥2）、中度风险（1＜RR＜2）和无风险或具有保护作用（RR≤1）。从94项队列研究和72项病例对照研究中确定的约80个危险因素中，15%被归类为高风险组，包括体重过低、体重减轻、身体活动不足、使用皮质类固醇或抗惊厥药、原发性甲状旁腺功能亢进、1型糖尿病、神经性厌食症、胃切除术、恶性贫血以及年龄增长（＞70 - 80岁）。分别有18%和8%的危险因素被归类为中度风险组和无风险组，而60%的危险因素要么缺乏证实其与骨折相关的科学证据，要么结果相互矛盾。因此，骨密度测定的有效策略可能是在那些存在与骨量丢失相关的多个强或中度骨折危险因素的个体中选择性使用。
