Piscitelli P, Brandi M, Cawston H, Gauthier A, Kanis J A, Compston J, Borgström F, Cooper C, McCloskey E
I.O.S., Southern Italy Hospital Institute, Centro Direzionale, Isola E3, Palazzo Avalon, Naples, 80143, Italy,
Calcif Tissue Int. 2014 Nov;95(5):419-27. doi: 10.1007/s00223-014-9910-3. Epub 2014 Sep 9.
The article describes the adaptation of a model to estimate the burden of postmenopausal osteoporosis in women aged 50 years and over in Italy between 2010 and 2020. For this purpose, a validated postmenopausal osteoporosis disease model developed for Sweden was adapted to Italy. For each year of the study, the 'incident cohort' (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and deaths. Fracture by site (hip, clinical vertebral, non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected fracture site-specific risk of death and subsequent fractures. Model inputs specific to Italy included population size and life tables from 1970 to 2020, incidence of hip fracture and BMD by age in the general population (mean and standard deviation). The model estimated that the number of postmenopausal osteoporotic women would increase from 3.3 million to 3.7 million between 2010 and 2020 (+14.3%). Assuming unchanged incidence rates by age group over time, the model predicted the overall number of osteoporotic fractures to increase from 285.0 to 335.8 thousand fractures between 2010 and 2020 (+17.8%). The estimated expected increases in hip, vertebral and non-hip non-vertebral fractures were 22.3, 17.2 and 16.3%, respectively. Due to demographic changes, the burden of fractures is expected to increase markedly by 2020.
本文描述了一种模型的调整，该模型用于估算2010年至2020年间意大利50岁及以上女性绝经后骨质疏松症的负担。为此，将一个为瑞典开发并经验证的绝经后骨质疏松症疾病模型调整至意大利使用。对于研究的每一年，确定“发病队列”（首次发生骨质疏松性骨折的女性），并使其通过一个以1年为周期的马尔可夫模型，直至2020年。健康状态基于骨折和死亡的数量。针对每种健康状态追踪按部位（髋部、临床椎体、非髋部非椎体）划分的骨折情况。转移概率反映了特定骨折部位的死亡风险和后续骨折风险。意大利特有的模型输入包括1970年至2020年的人口规模和生命表、一般人群中按年龄划分的髋部骨折发病率和骨密度（均值和标准差）。该模型估计，2010年至2020年间，绝经后骨质疏松症女性的数量将从330万增加至370万（增长14.3%）。假设各年龄组的发病率随时间保持不变，该模型预测，2010年至2020年间骨质疏松性骨折的总数将从28.5万增加至33.58万例（增长17.8%）。估计髋部、椎体和非髋部非椎体骨折的预期增加分别为22.3%、17.2%和16.3%。由于人口结构变化，预计到2020年骨折负担将显著增加。
