Leslie William D, Lix Lisa M, Morin Suzanne N, Johansson Helena, Odén Anders, McCloskey Eugene V, Kanis John A
Department of Medicine (W.D.L., S.N.M.), and Department of Community Health Sciences (L.M.L.), University of Manitoba, Winnipeg, Canada R2H 2A6; and Centre for Metabolic Bone Diseases (H.J., A.O., E.V.M., J.A.K.), Sheffield S5 7AU, United Kingdom.
J Clin Endocrinol Metab. 2015 May;100(5):2063-70. doi: 10.1210/jc.2014-4390. Epub 2015 Mar 9.
Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape.
The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm.
This was a retrospective registry study using BMD results for Manitoba, Canada.
Women aged 40 years and older with baseline hip DXA, derived hip geometry measures, and FRAX scores (n = 50 420) participated in the study.
Hospitalized hip fracture (n = 1020) diagnosed during 319 137 person-years of follow-up (median 6.4 y) was measured.
Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age [hazard ratio (HR) 1.30 per SD increase, 95% confidence interval (CI) 1.22-1.38], and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P < .001); relative to quintile 1 (referent), the HR increased from 1.43 (95% CI 1.12-1.82) for quintile 2, 1.61 (95% CI 1.27-2.04) for quintile 3, 1.85 (95% CI 1.47-2.32) for quintile 4, and 2.45 (95% CI 1.96-3.05) for quintile 5. There was a modest but significant improvement in net reclassification improvement (1.5%) and integrated discrimination improvement (0.7%) indices. The effect of HAL was particularly strong among younger, nonosteoporotic women (FRAX adjusted HR 1.70 per SD increase, 95% CI 1.48-1.94).
DXA-derived hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score and may be of clinical value in refining hip fracture risk.
在临床实践中，双能X线吸收法（DXA）测量的骨密度（BMD）被广泛用于评估骨骼强度，但DXA仪器也能测量与骨骼形状相关的生物力学参数。
本研究的目的是确定DXA得出的髋部几何测量值是否能提供独立于骨折风险评估工具（FRAX）算法所确定的髋部骨折概率的骨折预测信息。
这是一项利用加拿大曼尼托巴省BMD结果的回顾性登记研究。
年龄在40岁及以上、有基线髋部DXA、得出的髋部几何测量值和FRAX评分（n = 50420）的女性参与了本研究。
测量了在319137人年的随访（中位时间6.4年）期间诊断出的住院髋部骨折（n = 1020）。
在髋部几何测量值中，髋轴长度（HAL）在调整年龄后与髋部骨折风险呈现出一致的关联[每标准差增加的风险比（HR）为1.30，95%置信区间（CI）为1.22 - 1.38]，并且在进一步调整BMD或FRAX评分后不受影响。在调整了BMD的FRAX评分后，HAL五分位数增加对髋部骨折风险有显著影响（线性趋势P <.001）；相对于第1五分位数（参照），第2五分位数的HR从1.43（95%CI 1.12 - 1.82）增加到第3五分位数的1.61（95%CI 1.27 - 2.04）、第4五分位数的1.85（95%CI 1.47 - 2.32）和第5五分位数 的2.45（95%CI 1.96 - 3.05）。净重新分类改善指数（1.5%）和综合判别改善指数（0.7%）有适度但显著的改善。HAL的影响在年轻的非骨质疏松女性中尤为强烈（调整FRAX后的HR为每标准差增加1.70，95%CI为1.48 - 1.94）。
DXA得出的髋部几何测量值与髋部骨折风险相关，但许多测量值并未提供显著的独立预测信息。发现HAL在调整BMD或FRAX评分后可预测髋部骨折，并且在细化髋部骨折风险方面可能具有临床价值。
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