Department of Medicine, United Christian Hospital, Hong Kong, China.
Osteoporos Int. 2012 Mar;23(3):871-8. doi: 10.1007/s00198-011-1647-5. Epub 2011 May 12.
We followed 2,266 postmenopausal Chinese women for 4.5 years to determine which model best predicts osteoporotic fracture. A model that contains ethnic-specific risk factors, some of which reflect frailty, performed as well as or better than the well-established FRAX model.
Clinical risk assessment, with or without T-score, can predict fractures in Chinese postmenopausal women although it is unknown which combination of clinical risk factors is most effective. This prospective study sought to compare the accuracy for fracture prediction using various models including FRAX, our ethnic-specific clinical risk factors (CRF) and other simple models.
This study is part of the Hong Kong Osteoporosis Study. A total of 2,266 treatment naïve postmenopausal women underwent clinical risk factor and bone mineral density assessment. Subjects were followed up for outcome of major osteoporotic fracture and receiver operating characteristic (ROC) curves for different models were compared. The percentage of subjects in different quartiles of risk according to various models who actually fractured was also compared.
The mean age at baseline was 62.1 ± 8.5 years and mean follow-up time was 4.5 ± 2.8 years. A total of 106 new major osteoporotic fractures were reported, of which 21 were hip fractures. Ethnic-specific CRF with T-score performed better than FRAX with T-score (based on both Chinese normative and National Health and Nutrition Examination Survey (NHANES) databases) in terms of AUC comparison for prediction of major osteoporotic fracture. The two models were similar in hip fracture prediction. The ethnic-specific CRF model had a 10% higher sensitivity than FRAX at a specificity of 0.8 or above.
CRF related to frailty and differences in lifestyle between populations are likely to be important in fracture prediction. Further work is required to determine which and how CRF can be applied to develop a fracture prediction model in our population.
本研究旨在探讨何种临床危险因素模型对预测中国绝经后女性骨质疏松性骨折的准确性最高。
本研究是香港骨质疏松研究的一部分，共纳入 2266 例未经治疗的绝经后女性，评估其临床危险因素和骨密度。随访主要骨质疏松性骨折的发生情况，比较 FRAX 评分、我们的种族特异性临床危险因素（CRF）和其他简单模型的预测准确性。
基线时平均年龄为 62.1±8.5 岁，平均随访时间为 4.5±2.8 年。共发生 106 例新发主要骨质疏松性骨折，其中 21 例为髋部骨折。在预测主要骨质疏松性骨折方面，基于中国和美国国家健康和营养调查（NHANES）数据库的 T 评分，种族特异性 CRF 优于 FRAX 评分（AUC 比较）。两种模型在预测髋部骨折方面相似。在特异性为 0.8 或以上时，种族特异性 CRF 模型的敏感性比 FRAX 高 10%。
与人群差异相关的脆弱性和生活方式相关的 CRF 可能对骨折预测很重要。需要进一步研究确定哪些和如何应用 CRF 来开发适合我们人群的骨折预测模型。
