WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S102RX, UK.
Osteoporos Int. 2011 Mar;22(3):809-16. doi: 10.1007/s00198-010-1524-7. Epub 2011 Jan 13.
We examined the effect of glucocorticoid dose on FRAX® derived fracture probabilities in a UK setting. A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.
The WHO fracture risk assessment (FRAX) tool estimates 10-year probability of fracture based upon multiple clinical risk factors and an optional femoral neck BMD measurement. Ever (past and current) use of systemic glucocorticoids is a dichotomous risk factor (yes/no) and does not therefore take account of the dose of glucocorticoids. The aim of this work was to estimate the adjustment for fracture probability based upon the dose of glucocorticoids.
Dose responses for fracture risk during exposure to glucocorticoids were taken from the General Practice Research Database and used to adjust the relative risks for glucocorticoids in FRAX. In addition to fracture risk, a dose response for the death hazard was estimated and both variables were used to populate the FRAX model for the UK.
The exposure to glucocorticoids was found to significantly affect fracture probability. The following rule was formulated. For low-dose exposure (< 2.5 mg daily of prednisolone or equivalent), the probability of a major fracture is decreased by about 20% depending on age. For medium doses (2.5-7.5 mg daily), the unadjusted FRAX value can be used. For high doses (> 7.5 mg daily), probabilities can be upward revised by about 15%. Conversion factors were also determined for the adjustment of hip fracture probability.
A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.
我们研究了糖皮质激素剂量对英国 FRAX®衍生骨折概率的影响。通过了解糖皮质激素的剂量，可以对传统 FRAX 估计的髋部骨折和主要骨质疏松性骨折概率进行相对简单的调整，从而调节风险评估。
世界卫生组织（WHO）骨折风险评估（FRAX）工具根据多个临床危险因素和可选的股骨颈 BMD 测量值，估计 10 年骨折概率。曾经（过去和现在）使用全身性糖皮质激素是一个二分风险因素（是/否），因此不考虑糖皮质激素的剂量。这项工作的目的是根据糖皮质激素的剂量估计骨折概率的调整。
从一般实践研究数据库中获取糖皮质激素暴露时骨折风险的剂量反应，并将其用于调整 FRAX 中糖皮质激素的相对风险。除了骨折风险外，还估计了死亡风险的剂量反应，并将这两个变量用于填充英国 FRAX 模型。
发现糖皮质激素暴露显著影响骨折概率。制定了以下规则：对于低剂量暴露（<2.5mg 每日泼尼松龙或等效物），根据年龄，主要骨折的概率降低约 20%。对于中等剂量（2.5-7.5mg 每日），可以使用未经调整的 FRAX 值。对于高剂量（>7.5mg 每日），概率可以向上修正约 15%。还确定了调整髋部骨折概率的转换因子。
通过了解糖皮质激素的剂量，可以对传统 FRAX 估计的髋部骨折和主要骨质疏松性骨折概率进行相对简单的调整，从而调节风险评估。
