Schwartz Elliott N, Steinberg Dee M
The Northern California Institute for Bone Health, Inc., 3100 Telegraph Avenue, Suite 3000, Oakland, CA 94609, USA.
Curr Osteoporos Rep. 2006 Dec;4(4):148-52. doi: 10.1007/s11914-996-0023-4.
Clinical decision rules (CDRs) are designed to help physicians practice better. A number of CDRs to assist in identifying women with low bone mass have been developed since the mid 1990s, including SCORE, OST (OSTA), OSIRIS, SOFSURF, NOF, ABONE, pBW, ORAI, and weight-only-EPIDOS (which we have termed WO-E). This review discusses these CDRs in terms of development and validation cohorts and their sensitivity and specificity. The sensitivities of the available CDRs exceed 80% and specificities are about 50%. After much analysis, it appears that most experts prefer OST for its simplicity and SCORE for its flexibility, but there is no consensus on what risk factors to use in the CDRs and what regions of interest (spine, total hip, femoral neck, or a combination) to test with dual-energy x-ray absorptiometry (DXA). Because of the lack of consensus, there are barriers to the clinical application of these CDRs. Agreement on a single CDR for worldwide use is required to optimally fulfill the objective of identifying low bone mass.
临床决策规则（CDRs）旨在帮助医生更好地开展诊疗工作。自20世纪90年代中期以来，已经开发了许多用于协助识别低骨量女性的CDRs，包括SCORE、OST（OSTA）、OSIRIS、SOFSURF、NOF、ABONE、pBW、ORAI以及仅体重-EPIDOS（我们称之为WO-E）。本综述从开发和验证队列以及它们的敏感性和特异性方面讨论了这些CDRs。现有CDRs的敏感性超过80%，特异性约为50%。经过大量分析，似乎大多数专家因其简单性而青睐OST，因其灵活性而青睐SCORE，但对于在CDRs中使用哪些风险因素以及用双能X线吸收法（DXA）检测哪些感兴趣区域（脊柱、全髋、股骨颈或组合）尚无共识。由于缺乏共识，这些CDRs在临床应用中存在障碍。需要就全球通用的单一CDR达成一致，以最佳地实现识别低骨量的目标。
