小梁骨评分可能会提高FRAX®对老年日本男性主要骨质疏松性骨折的预测准确性：藤原京男性骨质疏松风险（FORMEN）队列研究。
Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study.
作者信息
Iki M, Fujita Y, Tamaki J, Kouda K, Yura A, Sato Y, Moon J-S, Winzenrieth R, Okamoto N, Kurumatani N
机构信息
Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
出版信息
Osteoporos Int. 2015 Jun;26(6):1841-8. doi: 10.1007/s00198-015-3092-3. Epub 2015 Mar 10.
UNLABELLED
FRAX® is widely used to evaluate fracture risk of individuals in clinical settings. However, FRAX® prediction accuracy is not sufficient, and improvement is desired. Trabecular bone score, a bone microarchitecture index, may improve FRAX® prediction accuracy for major osteoporotic fractures in community-dwelling elderly Japanese men.
INTRODUCTION
To improve fracture risk assessment in clinical settings, we evaluated whether the combination of FRAX® and Trabecular Bone Score (TBS) improves the prediction accuracy of major osteoporotic fractures (MOFs) in elderly Japanese men compared to FRAX® alone.
METHODS
Two thousand and twelve community-dwelling men aged ≥65 years completed the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Baseline Study comprising lumbar spine (LS) and femoral neck areal bone mineral density (aBMD) measurements, and interviews regarding clinical risk factors required to estimate 10-year risk of MOF (hip, spine, distal forearm, and proximal humerus) using the Japanese version of FRAX® (v.3.8). TBS was calculated for the same vertebrae used for LS-aBMD with TBS iNsight software (v.2.1). MOFs that occurred during the follow-up period were identified by interviews or mail and telephone surveys. Prediction accuracy of a logistic model combining FRAX® score and TBS compared to FRAX® alone was evaluated by area under receiver-operating characteristic curves (AUCs), as well as category-free integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
RESULTS
We identified 22 men with MOFs during 8140 person-years (PY) of follow-up among 1872 men; 67 men who suffered from fractures other than MOFs were excluded. Participants with MOFs had significantly lower TBS (p = 0.0015) and higher FRAX® scores (p = 0.0089) than those without. IDI and NRI showed significant improvements in reclassification accuracy using FRAX® plus TBS compared to FRAX® alone (IDI 0.006 (p = 0.0362), NRI 0.452 (p = 0.0351)), although no difference was observed in AUCs between the two.
CONCLUSIONS
TBS may improve MOF prediction accuracy of FRAX® for community-dwelling elderly Japanese men.
未标注
FRAX®在临床环境中被广泛用于评估个体的骨折风险。然而，FRAX®的预测准确性并不足够，仍需要改进。小梁骨评分作为一种骨微结构指标，可能会提高FRAX®对日本社区居住老年男性主要骨质疏松性骨折的预测准确性。
引言
为了改进临床环境中的骨折风险评估，我们评估了与单独使用FRAX®相比，FRAX®与小梁骨评分（TBS）的组合是否能提高日本老年男性主要骨质疏松性骨折（MOF）的预测准确性。
方法
2012名年龄≥65岁的社区居住男性完成了藤原京男性骨质疏松风险（FORMEN）基线研究，该研究包括腰椎（LS）和股骨颈的面积骨密度（aBMD）测量，以及关于使用日本版FRAX®（v.3.8）估计MOF（髋部、脊柱、远端前臂和近端肱骨）10年风险所需临床风险因素的访谈。使用TBS iNsight软件（v.2.1）计算与LS-aBMD相同椎体的TBS。通过访谈或邮件及电话调查确定随访期间发生的MOF。通过受试者操作特征曲线下面积（AUC）、无类别综合鉴别改善（IDI）和净重新分类改善（NRI）评估与单独使用FRAX®相比，结合FRAX®评分和TBS的逻辑模型的预测准确性。
结果
在1872名男性的8140人年（PY）随访期间，我们确定了22名患有MOF的男性；67名发生MOF以外骨折的男性被排除。与未患MOF的男性相比，患有MOF的参与者的TBS显著更低（p = 0.0015），FRAX®评分更高（p = 0.0089）。与单独使用FRAX®相比，使用FRAX®加TBS在重新分类准确性方面的IDI和NRI显示出显著改善（IDI 0.006（p = 0.0362），NRI 0.452（p = 0.0351）），尽管两者之间的AUC没有差异。
结论
TBS可能会提高FRAX®对日本社区居住老年男性MOF的预测准确性。
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