Dargent-Molina P, Piault S, Bréart G
INSERM (Institut National de la Santé et de la Recherche Médicale), 16 avenue Paul Vaillant-Couturier, Unité 149, 94 807, Villejuif Cedex, France.
Osteoporos Int. 2003 Dec;14(12):969-77. doi: 10.1007/s00198-003-1506-0. Epub 2003 Sep 30.
Decision to treat with an anti-osteoporotic drug should be based on individual fracture risk evaluation. We compared the discriminant value of four different screening strategies to identify elderly women with a risk of hip fracture greater than 20 per 1000 woman-years: (1) BMD screening alone, (2) quantitative ultrasound (QUS) screening alone, (3) QUS triage followed by BMD assessment for women with medium-low QUS parameters, and (4) selective BMD screening based on weight followed by clinical evaluation for women with medium-low BMD. The study population included 5910 women aged 75 years or older who participated to the EPIDOS (Epidemiologie de l'Ostéoporose) prospective study. Over an average of 3.7 (+/-0.8) years of follow-up, 231 women suffered a hip fracture, which corresponds to an average risk of 10.6 per 1000 woman-years. All strategies allow us to clearly distinguish a group at high risk of hip fracture (i.e. >20 per 1000 woman-years) from a group at low risk (i.e. below the average risk in the cohort). QUS screening alone has a very low sensitivity (15%). The strategy using QUS as a method of triage and that combining selective BMD and clinical assessment have a sensitivity equivalent to systematic BMD screening (around 35%), with less than 50% BMD examinations. The high-risk women identified by these two strategies are not the same. A simple algorithm combining QUS, BMD, and clinical risk assessment allows an increased number of high-risk women to be identified (21%), and thus improves the sensitivity (53%). With this combined strategy, women in the high-risk group have one chance in ten of having a hip fracture over the next 4 years, whereas women in the low risk group have only one chance in 40.
是否使用抗骨质疏松药物进行治疗应基于个体骨折风险评估。我们比较了四种不同筛查策略在识别髋部骨折风险高于每1000妇女年20例的老年女性方面的判别价值：（1）仅进行骨密度（BMD）筛查；（2）仅进行定量超声（QUS）筛查；（3）对QUS参数为中低水平的女性，先进行QUS分诊，然后进行BMD评估；（4）对体重较轻的女性进行选择性BMD筛查，然后对BMD为中低水平的女性进行临床评估。研究人群包括5910名75岁及以上参与EPIDOS（骨质疏松症流行病学）前瞻性研究的女性。在平均3.7（±0.8）年的随访期间，231名女性发生了髋部骨折，相当于每1000妇女年的平均风险为10.6例。所有策略都能使我们清楚地区分髋部骨折高风险组（即每1000妇女年>20例）和低风险组（即低于队列中的平均风险）。仅QUS筛查的敏感性非常低（15%）。使用QUS作为分诊方法的策略以及结合选择性BMD和临床评估的策略，其敏感性与系统性BMD筛查相当（约35%），且BMD检查次数不到50%。通过这两种策略识别出的高风险女性并不相同。一种结合QUS、BMD和临床风险评估的简单算法能够识别出更多的高风险女性（21%），从而提高了敏感性（53%）。采用这种联合策略，高风险组的女性在未来4年内发生髋部骨折的几率为十分之一，而低风险组的女性只有四十分之一的几率。
