Department of Medicine/Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy at Göteborg University, Arvid Wallgrens backe, Göteborg, Sweden.
BMC Musculoskelet Disord. 2010 Mar 24;11:55. doi: 10.1186/1471-2474-11-55.
One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women.
In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique.
Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD <or= -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age >or=80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score <or=-3.5 SD.
In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.
四分之一的瑞典女性患有髋部骨折，导致发病率和死亡率均较高。我们希望对一个四项临床风险评分进行再验证，并评估一种便携式跟骨骨密度（BMD）技术，以评估老年女性的髋部和脆性骨折风险。
在一项基于人群的前瞻性队列研究中，我们使用基线问卷中的临床危险因素和跟骨 BMD 来预测骨折预防计划中女性两年内髋部和脆性骨折的结果。通过便携式双能 X 线激光吸收法（DXL）测量跟骨跟骨 BMD，并与使用固定双能 X 线吸收法（DXA）技术测量的髋部 BMD 进行比较。
在 285 名女性中，有 7 名女性发生髋部骨折，14 名女性发生脆性骨折/（髋部、桡骨、肱骨和骨盆）；60%的人跟骨 BMD≤-2.5 SD。四项 FRAMO（骨折和死亡率）指数结合了临床危险因素，包括年龄≥80 岁、体重<60 公斤、既往脆性骨折和站立能力受损。有 2-4 项危险因素的女性髋部骨折的比值比（OR）为 5.9，脆性骨折的 OR 为 4.4。高危组髋部骨折的年风险为 2.8%，而低危组的年风险为 0.5%（69%）。跟骨 BMD 每降低 1 SD，髋部骨折的 OR 为 3.1，脆性骨折的 OR 为 2.6。对于 30 名接受 DXA 评估的参与者，平均髋部 BMD 在-2.5 SD 水平对应于跟骨较低的 BMD。7 例髋部骨折中有 5 例发生在高危组 32 名女性中，这些女性的 FRAMO 指数高+既往脆性骨折+跟骨 T 评分≤-3.5 SD。
在后续研究中，我们使用简单的四项风险模型确定了髋部和脆性骨折的高危人群。骨折风险的增加也与跟骨骨密度的降低有关，跟骨骨密度是通过移动 DXL 技术测量的。高 FRAMO 指数、既往脆性骨折和极低的 BMD 相结合，将高危组限制在 11%，其中大多数髋部骨折发生（71%）。这些实用的筛选方法最终可以通过将预防资源集中用于高骨折风险女性，来降低髋部骨折的发生率。
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