Nguyen N D, Frost S A, Center J R, Eisman J A, Nguyen T V
Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, 384 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.
Osteoporos Int. 2007 Aug;18(8):1109-17. doi: 10.1007/s00198-007-0362-8. Epub 2007 Mar 17.
Until now there has been no published prognostic tool available for predicting of hip fracture to primary care settings. We have developed a nomogram for predicting the absolute risk of hip fracture for any individual by using clinical factors, including age, prior fracture and fall, in addition to BMD that was based on a 15-year follow-up cohort study.
Bone mineral density or clinical risk factors alone are useful but limited tools for the identification of individuals with high-risk of hip fracture. It is hypothesized that the combination of clinical risk factors and BMD can improve the accuracy of fracture prediction. This study was aimed at developing a nomogram which combines these factors for predicting 5-year and 10-year risk of hip fracture for an individual.
The study, designed as a epidemiologic, community-based prospective study, included 1,208 women and 740 men aged 60+ years with median duration of follow-up of 13 years (inter-quartile range, IQR: 6-14) for both women and men, yielding 10,523 and 7,586 person-years of observation, respectively. Main outcome measures were incidence of hip fractures and risk factors were femoral neck bone mineral density (FNBMD), prior fracture, history of fall, postural sway and quadriceps strength. Femoral neck BMD was measured by DXA (GE-LUNAR Corp, Madison, Wisconsin, USA). Cox's proportional hazards model was used to estimate the risk of fracture for individuals, and a nomogram was constructed for predicting hip fracture risk.
Between 1989 and 2004, 127 individuals (96 women) sustained a hip fracture. Advancing age, low femoral neck BMD, prior fracture and history of falls were independent predictors of hip fracture. The area under the receiver operating characteristic curve for the model was 0.85 for both sexes. A nomogram was constructed for predicting hip fracture risk for an individual. Among those aged 75 or older with BMD T-scores < or = -2.5, the risk of hip fracture in men was comparable to or higher than in women; however, in younger age groups, the risk was higher in women than in men.
The combination of BMD and non-invasive clinical risk factors in a nomogram could be useful for identifying high-risk individuals for intervention to reduce the risk of hip fracture.
到目前为止，还没有已发表的可用于初级保健机构预测髋部骨折的预后工具。我们通过一项为期15年的随访队列研究，利用包括年龄、既往骨折和跌倒情况等临床因素以及骨密度，开发了一种列线图，用于预测任何个体髋部骨折的绝对风险。
单独的骨密度或临床风险因素是有用的，但对于识别髋部骨折高危个体来说是有限的工具。据推测，临床风险因素和骨密度的结合可以提高骨折预测的准确性。本研究旨在开发一种结合这些因素的列线图，用于预测个体5年和10年的髋部骨折风险。
该研究设计为一项基于社区的流行病学前瞻性研究，纳入了1208名女性和740名60岁及以上男性，女性和男性的中位随访时间均为13年（四分位间距，IQR：6 - 14），分别产生了10523和7586人年的观察数据。主要结局指标是髋部骨折的发生率，风险因素包括股骨颈骨密度（FNBMD）、既往骨折、跌倒史、姿势摇摆和股四头肌力量。股骨颈骨密度通过双能X线吸收法（DXA，美国威斯康星州麦迪逊市GE - LUNAR公司）测量。采用Cox比例风险模型估计个体骨折风险，并构建列线图以预测髋部骨折风险。
在1989年至2004年期间，127人（96名女性）发生了髋部骨折。年龄增长、股骨颈骨密度低、既往骨折和跌倒史是髋部骨折的独立预测因素。该模型的受试者工作特征曲线下面积在两性中均为0.85。构建了一个用于预测个体髋部骨折风险的列线图。在75岁及以上且骨密度T值≤ - 2.5的人群中，男性髋部骨折风险与女性相当或更高；然而，在较年轻年龄组中，女性风险高于男性。
列线图中骨密度和非侵入性临床风险因素的结合可能有助于识别高危个体，以便进行干预以降低髋部骨折风险。
