El Maghraoui Abdellah, Sadni Siham, Jbili Nabil, Rezqi Asmaa, Mounach Aziza, Ghozlani Imad
Rheumatology department, Military Hospital Mohammed V, PO Box: 1018, Rabat, Morocco.
BMC Musculoskelet Disord. 2014 Nov 4;15:365. doi: 10.1186/1471-2474-15-365.
A Moroccan model for the FRAX tool to determine the absolute risk of osteoporotic fracture at 10 years has been established recently. The study aimed to assess the discriminative capacity of FRAX in identifying women with prevalent asymptomatic vertebral fractures (VFs).
We enrolled in this cross-sectional study 908 post-menopausal women with a mean age of 60.9 years ± 7.7 (50 to 91) with no prior known diagnosis of osteoporosis. Subjects were recruited from asymptomatic women selected from the general population. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genantsemiquantitative (SQ) approach and morphometry. We calculated the absolute risk of major fracture and hip fracture with and without bone mineral density (BMD)using the FRAX website.The overall discriminative value of the different risk scores was assessed by calculating the areas under the ROC curve (AUC).
VFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF. The group of women with VFs had a statistically significant higher FRAX scores for major and hip fractures with and without BMD, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. The AUC ROC of FRAX for major fracture without BMD was 0.757 (CI 95%; 0.718-0.797) and 0.736 (CI 95%; 0.695-0.777) with BMD, being 0.756 (CI 95%; 0.716-0.796) and 0.747 (CI 95%; 0.709-0.785), respectively for FRAX hip fracture without and with BMD. The AUC ROC of lumbar spine T-score and femoral neck T-score were 0.660 (CI 95%; 0.611-0.708) and 0.707 (CI 95%; 0.664-0.751) respectively.
In asymptomatic post-menopausal women, the FRAX risk for major fracture without BMD had a better discriminative capacity in identifying the women with prevalent VFs than lumbar spine and femoral neck T-scores suggesting its usefulness in identifying women in whom VFA could be indicated.
最近建立了一种摩洛哥版的FRAX工具模型，用于确定10年内骨质疏松性骨折的绝对风险。本研究旨在评估FRAX在识别患有无症状椎体骨折（VF）的女性方面的鉴别能力。
我们纳入了这项横断面研究中的908名绝经后女性，她们的平均年龄为60.9岁±7.7岁（50至91岁），之前没有已知的骨质疏松症诊断。研究对象从从普通人群中选取的无症状女性中招募。使用GE医疗的Lunar Prodigy骨密度仪获得腰椎和股骨近端的侧位VFA图像及扫描结果。VF采用Genant半定量（SQ）方法和形态测量法相结合的方式进行定义。我们通过FRAX网站计算了有和没有骨密度（BMD）情况下的主要骨折和髋部骨折的绝对风险。通过计算ROC曲线下面积（AUC）评估不同风险评分的总体鉴别价值。
VFA图像显示，179名参与者（19.7%）至少有一处2/3级VF。有VF的女性组在有和没有BMD情况下，主要骨折和髋部骨折的FRAX评分在统计学上显著更高，且体重、身高、腰椎和髋部BMD及T值低于没有VFA识别出VF的女性。无BMD时FRAX对主要骨折的AUC ROC为0.757（95%CI；0.718 - 0.797），有BMD时为0.736（95%CI；0.695 - 0.777），无BMD和有BMD时FRAX对髋部骨折的AUC ROC分别为0.756（95%CI；0.716 - 0.796）和0.747（95%CI；0.709 - 0.785）。腰椎T值和股骨颈T值的AUC ROC分别为0.660（95%CI；0.611 - 0.708）和0.707（95%CI；0.664 - 0.751）。
在无症状绝经后女性中，无BMD时FRAX对主要骨折的风险在识别患有VF的女性方面比腰椎和股骨颈T值具有更好的鉴别能力，表明其在识别可能需要进行VFA检查的女性方面有用。
