Aspray Terry J
Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK and Newcastle University Framlington Place Newcastle upon Tyne NE2 4AB, UK.
Ther Adv Musculoskelet Dis. 2015 Feb;7(1):17-25. doi: 10.1177/1759720X14564562.
More than half of older women who sustain a fragility fracture do not have osteoporosis by World Health Organization (WHO) bone mineral density (BMD) criteria; and, while BMD has been used to assess fracture risk for over 30 years, a range of other skeletal and nonskeletal clinical risk factors (CRFs) for fracture have been recognized. More than 30 assessment tools using CRFs have been developed, some predicting fracture risk and others low BMD alone. Recent systematic reviews have reported that many tools have not been validated against fracture incidence, and that the complexity of tools and the number of CRFs included do not ensure best performance with poor assessment of (internal or comparative) validity. Internationally, FRAX® is the most commonly recommended tool, in addition to QFracture in the UK, The Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool in Canada and Garvan in Australia. All tools estimate standard 10-year risk of major osteoporotic and 10-year risk of hip fracture: FRAX® is able to estimate fracture risk either with or without BMD, but CAROC and Garvan both require BMD and QFracture does not. The best evidence for the utility of these tools is in case finding but there may be future prospects for the use of 10-year fracture risk as a common currency with reference to the benefits of treatment, whether pharmacological or lifestyle. The use of this metric is important in supporting health economic analyses. However, further calibration studies will be needed to prove that the tools are robust and that their estimates can be used in supporting treatment decisions, independent of BMD.
超过半数发生脆性骨折的老年女性未达到世界卫生组织（WHO）的骨密度（BMD）标准；并且，虽然骨密度已被用于评估骨折风险30多年，但一系列其他骨骼和非骨骼临床风险因素（CRF）也已被确认。已经开发了30多种使用临床风险因素的评估工具，一些用于预测骨折风险，另一些仅用于预测低骨密度。最近的系统评价报告称，许多工具尚未根据骨折发生率进行验证，而且工具的复杂性和所包含的临床风险因素数量并不能确保最佳性能，对（内部或比较）有效性的评估较差。在国际上，FRAX®是最常被推荐的工具，此外还有英国 的QFracture、加拿大的加拿大放射学家协会和加拿大骨质疏松症协会（CAROC）工具以及澳大利亚的Garvan工具。所有工具都估计主要骨质疏松性骨折的标准10年风险和髋部骨折的10年风险：FRAX®能够在有或没有骨密度的情况下估计骨折风险，但CAROC和Garvan都需要骨密度，而QFracture则不需要。这些工具实用性的最佳证据在于病例发现，但将10年骨折风险作为衡量治疗益处（无论是药物治疗还是生活方式治疗）的通用货币可能有未来前景。使用这一指标对于支持健康经济分析很重要。然而，需要进一步的校准研究来证明这些工具是可靠的，并且它们的估计值可用于支持独立于骨密度的治疗决策。
