足跟定量超声对新发骨折的预测能力：个体水平的荟萃分析。
Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis.
作者信息
McCloskey E V, Kanis J A, Odén A, Harvey N C, Bauer D, González-Macias J, Hans D, Kaptoge S, Krieg M A, Kwok T, Marin F, Moayyeri A, Orwoll E, Gluёr C, Johansson H
机构信息
Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK,
出版信息
Osteoporos Int. 2015 Jul;26(7):1979-87. doi: 10.1007/s00198-015-3072-7. Epub 2015 Feb 18.
UNLABELLED
The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time.
INTRODUCTION
The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture.
METHODS
In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored.
RESULTS
Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20-100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40-1.51) and SOS (1.42, 95 % CI 1.36-1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56-1.82) and 1.60 (95 % CI, 1.48-1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p < 0.001). The predictive value of QUS was the same for men and women and for all ages (p > 0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p = 0.018 and p = 0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42-1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27-1.46).
CONCLUSIONS
Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.
未标注
在一项对46124名个体和3018例新发骨折的9项前瞻性研究的个体水平数据荟萃分析中，评估了骨定量超声（QUS）与骨折风险之间的关系。低QUS与骨折风险增加相关，包括髋部骨折。与骨质疏松性骨折的关联随时间降低。
引言
本荟萃分析的目的是研究QUS参数与骨折风险之间的关联。
方法
在个体水平分析中，我们研究了来自亚洲、欧洲和北美的9个前瞻性队列中的参与者。在基线时测量跟骨宽带超声衰减（BUA，dB/MHz）和声速（SOS，m/s）。随访期间的骨折通过自我报告收集，在一些队列中通过X线摄影确认。使用泊松回归扩展来检查每个队列中QUS与经年龄和自基线以来的时间调整后的骨折风险之间的风险梯度（GR，每降低1个标准差的风险比）。探索了QUS与年龄以及自基线以来的时间之间的相互作用。
结果
46124名男性和女性有基线测量数据，平均年龄70岁（范围20 - 100岁）。在214000人年的随访期间发生了3018例骨质疏松性骨折（787例髋部骨折）。骨质疏松性骨折的汇总GR对于BUA（1.45，95%置信区间（CI）1.40 - 1.51）和SOS（1.42，95% CI 1.36 - 1.47）相似。对于髋部骨折，相应的GR分别为1.69（95% CI，1.56 - 1.82）和1.60（95% CI，1.48 - 1.72）。然而，在较低的基线BUA和SOS时，两种骨折结局的GR均显著更高（p < 0.001）。QUS对男性和女性以及所有年龄段的预测价值相同（p > 0.20），但BUA和SOS对骨质疏松性骨折的预测价值随时间降低（分别为p = 0.018和p = 0.010）。例如，经年龄调整后，基线后1年时BUA对骨质疏松性骨折的GR为1.51（95% CI 1.42 - 1.61），但在5年时为1.36（95% CI 1.27 - 1.46）。
结论
我们的结果证实，定量超声是男性和女性骨折的独立预测指标，尤其是在低QUS值时。
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