NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, Australia, 3021,
Osteoporos Int. 2014 Jan;25(1):273-9. doi: 10.1007/s00198-013-2467-6. Epub 2013 Aug 2.
We examined whether low income was associated with an increased likelihood of treatment qualification for osteoporotic fracture probability determined by Canada FRAX in women aged ≥50 years. A significant negative linear association was observed between income and treatment qualification when FRAX included bone mineral density (BMD), which may have implications for clinical practice.
Lower income has been associated with increased fracture risk. We examined whether lower income in women was associated with an increased likelihood of treatment qualification determined by Canada FRAX®.
We calculated 10-year FRAX probabilities in 51,327 Canadian women aged ≥50 years undergoing baseline BMD measured by dual energy x-ray absorptiometry 1996-2001. FRAX probabilities for hip fracture ≥3% or major osteoporotic fracture (MOF) ≥20 % were used to define treatment qualification. Mean household income from Canada Census 2006 public use files was used to categorize the population into quintiles. Logistic regression analyses were used to model the association between income and treatment qualification.
Percentages of women who qualified for treatment based upon high hip fracture probability increased linearly with declining income quintile (all p trend <0.001), but this was partially explained by older age among lower income quintiles (p trend <0.001). Compared to the highest income quintile, women in the lowest income quintile had a greater likelihood of treatment qualification based upon high hip fracture probability determined with BMD (age-adjusted odds ratio [OR], 1.34; 95% confidence intervals (CI), 1.23-1.47) or high MOF fracture probability determined with BMD (age-adjusted OR, 1.31; 95% CI, 1.18-1.46). Differences were nonsignificant when FRAX was determined without BMD, implying that BMD differences may be the primary explanatory factor.
FRAX determined with BMD identifies a larger proportion of lower income women as qualifying for treatment than higher income women.
本研究旨在探讨加拿大 FRAX 预测的骨质疏松性骨折概率是否与低收入相关。
我们计算了 1996 年至 2001 年间 51327 名加拿大 50 岁以上女性的基线双能 X 线吸收法测量的骨密度（BMD）的 10 年 FRAX 概率。采用 FRAX 预测的髋部骨折概率≥3%或主要骨质疏松性骨折（MOF）概率≥20%定义为治疗资格。使用 2006 年加拿大人口普查公共使用文件中的家庭平均收入来将人群分为五等份。使用逻辑回归分析来建立收入与治疗资格之间的关联。
基于高髋部骨折概率，符合治疗标准的女性比例随着收入五分位数的降低呈线性增加（所有趋势 P<0.001），但这部分被较低收入五分位数中年龄较大的情况所解释（趋势 P<0.001）。与最高收入五分位数相比，基于 BMD 确定的高髋部骨折概率（年龄调整后的比值比[OR]，1.34；95%置信区间[CI]，1.23-1.47）或基于 BMD 确定的高 MOF 骨折概率（年龄调整后的 OR，1.31；95% CI，1.18-1.46），最低收入五分位数的女性更有可能获得治疗资格。当 FRAX 不包括 BMD 时，差异无统计学意义，这表明 BMD 差异可能是主要的解释因素。
BMD 确定的 FRAX 识别出更多的低收入女性符合治疗标准，而不是高收入女性。
