Kanis J A, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman J A, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg M-A, La Croix A, McCloskey E, Mellstrom D, Melton L J, Pols H, Reeve J, Sanders K, Schott A-M, Silman A, Torgerson D, van Staa T, Watts N B, Yoshimura N
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
Osteoporos Int. 2007 Aug;18(8):1033-46. doi: 10.1007/s00198-007-0343-y. Epub 2007 Feb 24.
BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. INTRODUCTION AND HYPOTHESES: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD.
Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score).
CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts.
The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.
骨密度（BMD）和临床风险因素可预测髋部及其他骨质疏松性骨折。临床风险因素与骨密度相结合，比单独使用二者具有更高的特异性和敏感性。引言与假设：开发一种基于临床风险因素（有或无骨密度）的风险评估工具。
对9项基于人群的研究进行分析，这些研究在基线时记录了骨密度和临床风险因素。针对髋部骨折和其他骨质疏松性骨折，分别建立了包含和不包含髋部骨密度的泊松回归模型。骨折风险以风险梯度（GR，风险比/风险评分标准差变化）表示。
仅临床风险因素在50岁时预测髋部骨折的风险梯度为2.1/标准差，且随年龄增长而降低。单独使用骨密度时风险梯度更高（3.7/标准差），临床风险因素与骨密度联合使用时进一步提高（4.2/标准差）。对于其他骨质疏松性骨折，风险梯度低于髋部骨折。仅临床风险因素在50岁时的风险梯度为1.4/标准差，与骨密度单独使用时相当（风险梯度 = 1.4/标准差），联合使用时未显著增加（风险梯度 = 1.4/标准差）。在11个独立的基于人群的队列中验证了有或无骨密度时临床风险因素的性能特征。
所开发的模型为在男性和女性中综合使用经过验证的临床风险因素以辅助骨折风险预测提供了基础。
