Nguyen Tuan V, Center Jacqueline R, Pocock Nicholas A, Eisman John A
Bone and Mineral Research Program, Garvan Institute of Medical Research, 384 Victoria Street, 2010, Darlinghurst, NSW, Australia.
Osteoporos Int. 2004 Jan;15(1):49-55. doi: 10.1007/s00198-003-1511-3. Epub 2003 Oct 30.
Bone mineral density (BMD) is the primary predictor of fracture, and is utilised in the definition of osteoporosis. Mass screening for osteoporosis is, however, currently not recommended. The primary objective of this study was to develop, validate and assess a simple, non-invasive scoring system to identify women at high risk of fracture. Using baseline data of the Dubbo Osteoporosis Epidemiology Study, a sample of 1256 women aged 60 or above was randomly divided into a development cohort (n=846) and a validation cohort (n=410). Low BMD was evaluated by DXA, with respect to 2.0 or 2.5 SD below the mean for young normal women at the femoral neck and lumbar spine. A logistic regression model was used to derive a predictive score, "DOEScore", in the development cohort, and the performance of this score was then assessed in the validation cohort. Incident fractures over 9395 person-years (median of follow-up duration: 8.4 years) were identified by X-ray records. Approximately 57% and 40% of women (in both cohorts) had T-scores less than -2.0 and greater than -2.5, respectively. Only age, body weight, and previous fracture were significantly related to BMD at both the femoral neck and lumbar spine. These three variables were used in the development of the DOEScore. When applied to the validation cohort, the sensitivity and specificity of DOEScore were 0.82 and 0.52, respectively, for selecting women with T-scores less than -2.5; the area under the receiver operating characteristic (ROC) curve was 0.75. These goodness-of-fit indices were comparable to, or better than, those obtained by the FOSTA, SOFSURF and ORAI score systems. However, neither the DOEScore nor other score systems reliably identify women with incident fractures; for DOEScore, the sensitivity and specificity were 0.52 and 0.49, respectively, with an area under the ROC curve of 0.48. Clinical risk scores can be used to identify women likely to have low BMD (albeit with low specificity), but they are not a useful tool to identify women who will have a fracture.
骨密度（BMD）是骨折的主要预测指标，用于骨质疏松症的定义。然而，目前不建议对骨质疏松症进行大规模筛查。本研究的主要目的是开发、验证和评估一种简单的非侵入性评分系统，以识别骨折高危女性。利用达博骨质疏松症流行病学研究的基线数据，将1256名60岁及以上的女性样本随机分为一个开发队列（n = 846）和一个验证队列（n = 410）。通过双能X线吸收法（DXA）评估低骨密度，以低于年轻正常女性股骨颈和腰椎平均值2.0或2.5个标准差为标准。在开发队列中使用逻辑回归模型得出一个预测分数“DOEScore”，然后在验证队列中评估该分数的性能。通过X线记录识别出9395人年（随访持续时间中位数：8.4年）内的新发骨折。在两个队列中，分别约有57%和40%的女性T值小于-2.0和大于-2.5。仅年龄、体重和既往骨折与股骨颈和腰椎的骨密度显著相关。这三个变量用于开发DOEScore。应用于验证队列时，对于选择T值小于-2.5的女性，DOEScore的敏感性和特异性分别为0.82和0.
