Naylor Kyla L, Garg Amit X, Zou Guangyong, Langsetmo Lisa, Leslie William D, Fraser Lisa-Ann, Adachi Jonathan D, Morin Suzanne, Goltzman David, Lentle Brian, Jackson Stuart A, Josse Robert G, Jamal Sophie A
Division of Nephrology, Departments of Epidemiology and Biostatistics and
Division of Nephrology, Departments of Epidemiology and Biostatistics and Institute for Clinical Evaluative Sciences, Ontario, Canada;
Clin J Am Soc Nephrol. 2015 Apr 7;10(4):646-53. doi: 10.2215/CJN.06040614. Epub 2015 Feb 5.
The Fracture Risk Assessment Tool (FRAX) is widely used to predict the 10-year probability of fracture; however, the clinical utility of FRAX in CKD is unknown. This study assessed the predictive ability of FRAX in individuals with reduced kidney function compared with individuals with normal kidney function.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The discrimination and calibration (defined as the agreement between observed and predicted values) of FRAX were examined using data from the Canadian Multicentre Osteoporosis Study (CaMos). This study included individuals aged ≥40 years with an eGFR value at year 10 of CaMos (defined as baseline). The cohort was stratified by kidney function at baseline (eGFR<60 ml/min per 1.73 m(2) [72.2% stage 3a, 23.8% stage 3b, and 4.0% stage 4/5] versus ≥60 ml/min per 1.73 m(2)) and followed individuals for a mean of 4.8 years for an incident major osteoporotic fracture (clinical spine, hip, forearm/wrist, or humerus).
There were 320 individuals with an eGFR<60 ml/min per 1.73 m(2) and 1787 with an eGFR≥60 ml/min per 1.73 m(2). The mean age was 67±10 years and 71% were women. The 5-year observed major osteoporotic fracture risk was 5.3% (95% confidence interval [95% CI], 3.3% to 8.6%) in individuals with an eGFR<60 ml/min per 1.73 m(2), which was comparable to the FRAX-predicted fracture risk (6.4% with bone mineral density; 8.2% without bone mineral density). A statistically significant difference was not observed in the area under the curve values for FRAX in individuals with an eGFR<60 ml/min per 1.73 m(2) versus ≥60 ml/min per 1.73 m(2) (0.69 [95% CI, 0.54 to 0.83] versus 0.76 [95% CI, 0.70 to 0.82]; P=0.38).
This study showed that FRAX was able to predict major osteoporotic fractures in individuals with reduced kidney function; further study is needed before FRAX should be routinely used in individuals with reduced kidney function.
骨折风险评估工具（FRAX）被广泛用于预测10年骨折概率；然而，FRAX在慢性肾脏病（CKD）中的临床实用性尚不清楚。本研究评估了FRAX在肾功能减退个体与肾功能正常个体中的预测能力。
设计、地点、参与者及测量方法：使用来自加拿大多中心骨质疏松研究（CaMos）的数据，对FRAX的区分度和校准度（定义为观察值与预测值之间的一致性）进行检验。本研究纳入了CaMos研究第10年时年龄≥40岁且有估算肾小球滤过率（eGFR）值的个体（定义为基线）。该队列根据基线时的肾功能进行分层（eGFR<60 ml/min/1.73 m²[72.2%为3a期，23.8%为3b期，4.0%为4/5期]与≥60 ml/min/1.73 m²），并对个体进行平均4.8年的随访，以观察首次发生的严重骨质疏松性骨折（临床椎体、髋部、前臂/腕部或肱骨骨折）情况。
有320例个体的eGFR<60 ml/min/1.73 m²，1787例个体的eGFR≥60 ml/min/1.73 m²。平均年龄为67±10岁，71%为女性。eGFR<60 ml/min/1.73 m²的个体5年观察到的严重骨质疏松性骨折风险为5.3%（95%置信区间[95%CI]，3.3%至8.6%），这与FRAX预测的骨折风险相当（有骨密度时为6.4%；无骨密度时为8.2%）。eGFR<60 ml/min/1.73 m²的个体与eGFR≥60 ml/min/1.73 m²的个体相比，FRAX曲线下面积值未观察到统计学显著差异（分别为0.69[95%CI，0.54至0.83]与0.76[95%CI，0.70至0.82]；P = 0.38）。
本研究表明，FRAX能够预测肾功能减退个体的严重骨质疏松性骨折；在将FRAX常规用于肾功能减退个体之前，还需要进一步研究。
