Institute of Clinical Research, University of Southern Denmark, Odense University Hospital, DK-Odense C, Denmark.
J Bone Miner Res. 2013 Aug;28(8):1701-17. doi: 10.1002/jbmr.1956.
A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power. We searched PubMed, Embase, and Cochrane databases for papers and evaluated these with respect to methodological quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist. A total of 48 tools were identified; 20 had been externally validated, however, only six tools had been tested more than once in a population-based setting with acceptable methodological quality. None of the tools performed consistently better than the others and simple tools (i.e., the Osteoporosis Self-assessment Tool [OST], Osteoporosis Risk Assessment Instrument [ORAI], and Garvan Fracture Risk Calculator [Garvan]) often did as well or better than more complex tools (i.e., Simple Calculated Risk Estimation Score [SCORE], WHO Fracture Risk Assessment Tool [FRAX], and Qfracture). No studies determined the effectiveness of tools in selecting patients for therapy and thus improving fracture outcomes. High-quality studies in randomized design with population-based cohorts with different case mixes are needed.
已经开发了大量的风险评估工具。远非所有工具都经过了外部研究的验证，更多的工具缺乏方法学和透明的证据，而且很少有工具被纳入国家指南。因此，我们进行了系统评价，以提供现有的、有效的和可靠的骨质疏松性骨折预测风险评估工具的概述。此外，我们还旨在确定每种工具的性能是否足以实际使用，最后，还检查工具的复杂性是否影响其判别能力。我们在 PubMed、Embase 和 Cochrane 数据库中搜索了论文，并使用诊断准确性研究的质量评估工具（QUADAS）检查表评估了这些论文的方法学质量。总共确定了 48 种工具；其中 20 种已经过外部验证，但是，只有 6 种工具在具有可接受的方法学质量的基于人群的环境中进行了不止一次的测试。没有一种工具的表现始终优于其他工具，简单的工具（即骨质疏松症自我评估工具[OST]、骨质疏松症风险评估工具[ORAI]和加文骨折风险计算器[Garvan]）通常与更复杂的工具（即简单计算风险估计评分[SCORE]、世界卫生组织骨折风险评估工具[FRAX]和 Qfracture）一样好或更好。没有研究确定工具在选择接受治疗的患者以改善骨折结局方面的有效性。需要进行高质量的随机设计研究，纳入具有不同病例组合的人群队列。
