Tao Bei, Liu Jian-min, Li Xiao-ying, Wang Ji-guang, Wang Wei-qing, Ning Guang
Department of Endocrine and Metabolic Diseases, Shanghai Rui-jin Hospital, Jiaotong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
J Bone Miner Metab. 2008;26(1):60-5. doi: 10.1007/s00774-007-0798-0. Epub 2008 Jan 10.
This cross-sectional study aims to assess the effectiveness of a simple, noninvasive scoring system, the Osteoporosis Self-Assessment Tool for Asians (OSTA), and quantitative bone ultrasound (QUS) in assessing nonvertebral fracture risk in Chinese postmenopausal women. A group of 513 community-dwelling women including 271 postmenopausal individuals participated in this study. Speed of sound (SOS m/s) at the radius, phalanx, and tibia were assessed by using the Omnisense prototype (Sunlight Ltd., Israel). Body height and weight were measured, and body mass index (BMI) and OSTA indices were calculated. Self-reported fractures were identified using a structured questionnaire. Phalanx SOS was significantly lower among postmenopausal women with a history of nonvertebral fracture occurred after menopause than those without (3755 m/s vs. 3841 m/s, P = 0.017, adjusted for age and weight), with an AUC of 0.66. The AUC of the OSTA for predicting nonvertebral fracture occurred after menopause was 0.64. SOS at the radius, phalanx, and tibia showed a positive correlation with OSTA index (r = 0.376-0.401, P < 0.001). The prevalence of nonvertebral fractures also increased significantly with the decreasing order of OSTA index (chi2 = 5.432, P = 0.02). The OSTA values of <or=-1 and phalanx QUS T-score of <or=-1.95 can differentiate postmenopausal nonvertebral fracture with sensitivity of 75% and 81%, respectively, and specificity of 48% and 40%, respectively. Combining OSTA and phalanx QUS yielded a sensitivity of 83% and a specificity of 84% to detect postmenopausal nonvertebral fracture, with an AUC of 0.64. We conclude that OSTA and phalanx QUS are simple and effective clinical tools for identifying postmenopausal women at increased risk of nonvertebral fractures and can thereby facilitate the appropriate and more cost-effective use of bone densitometry to prevent osteoporotic fractures in developing countries.
这项横断面研究旨在评估一种简单、无创的评分系统——亚洲人骨质疏松自我评估工具（OSTA）以及定量骨超声（QUS）在中国绝经后女性非椎体骨折风险评估中的有效性。一组513名居住在社区的女性，其中包括271名绝经后个体参与了本研究。使用Omnisense原型机（以色列阳光有限公司）评估桡骨、指骨和胫骨处的声速（SOS，单位为m/s）。测量身高和体重，并计算体重指数（BMI）和OSTA指数。通过结构化问卷确定自我报告的骨折情况。绝经后发生非椎体骨折的绝经后女性的指骨SOS显著低于未发生骨折的女性（3755 m/s对3841 m/s，P = 0.017，经年龄和体重校正），曲线下面积（AUC）为0.66。OSTA预测绝经后发生非椎体骨折的AUC为0.64。桡骨、指骨和胫骨处的SOS与OSTA指数呈正相关（r = 0.376 - 0.401，P < 0.001）。非椎体骨折的患病率也随着OSTA指数的降低而显著增加（χ2 = 5.432，P = 0.02）。OSTA值≤ -1且指骨QUS T值≤ -1.95可分别以75%和81%的敏感度以及48%和40%的特异度区分绝经后非椎体骨折。联合使用OSTA和指骨QUS检测绝经后非椎体骨折的敏感度为83%，特异度为84%，AUC为0.64。我们得出结论，OSTA和指骨QUS是识别绝经后非椎体骨折风险增加女性的简单有效的临床工具，从而有助于在发展中国家更合理且更具成本效益地使用骨密度测定法来预防骨质疏松性骨折。
