McCloskey Eugene V, Odén Anders, Harvey Nicholas C, Leslie William D, Hans Didier, Johansson Helena, Kanis John A
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
Calcif Tissue Int. 2015 Jun;96(6):500-9. doi: 10.1007/s00223-015-9980-x. Epub 2015 Mar 22.
The aim of the present study was to determine the impact of trabecular bone score on the probability of fracture above that provided by the clinical risk factors utilized in FRAX. We performed a retrospective cohort study of 33,352 women aged 40-99 years from the province of Manitoba, Canada, with baseline measurements of lumbar spine trabecular bone score (TBS) and FRAX risk variables. The analysis was cohort-specific rather than based on the Canadian version of FRAX. The associations between trabecular bone score, the FRAX risk factors and the risk of fracture or death were examined using an extension of the Poisson regression model and used to calculate 10-year probabilities of fracture with and without TBS and to derive an algorithm to adjust fracture probability to take account of the independent contribution of TBS to fracture and mortality risk. During a mean follow-up of 4.7 years, 1754 women died and 1639 sustained one or more major osteoporotic fractures excluding hip fracture and 306 women sustained one or more hip fracture. When fully adjusted for FRAX risk variables, TBS remained a statistically significant predictor of major osteoporotic fractures excluding hip fracture (HR/SD 1.18, 95% CI 1.12-1.24), death (HR/SD 1.20, 95% CI 1.14-1.26) and hip fracture (HR/SD 1.23, 95% CI 1.09-1.38). Models adjusting major osteoporotic fracture and hip fracture probability were derived, accounting for age and trabecular bone score with death considered as a competing event. Lumbar spine texture analysis using TBS is a risk factor for osteoporotic fracture and a risk factor for death. The predictive ability of TBS is independent of FRAX clinical risk factors and femoral neck BMD. Adjustment of fracture probability to take account of the independent contribution of TBS to fracture and mortality risk requires validation in independent cohorts.
本研究的目的是确定小梁骨评分对骨折概率的影响，该影响超出了FRAX中使用的临床风险因素所提供的范围。我们对加拿大曼尼托巴省33352名年龄在40 - 99岁的女性进行了一项回顾性队列研究，这些女性有腰椎小梁骨评分（TBS）和FRAX风险变量的基线测量值。分析是针对特定队列的，而非基于加拿大版的FRAX。使用泊松回归模型的扩展来检验小梁骨评分、FRAX风险因素与骨折或死亡风险之间的关联，并用于计算有和没有TBS时的10年骨折概率，以及推导一种算法来调整骨折概率，以考虑TBS对骨折和死亡风险的独立贡献。在平均4.7年的随访期间，1754名女性死亡，1639名女性发生了一次或多次除髋部骨折外的主要骨质疏松性骨折，306名女性发生了一次或多次髋部骨折。在对FRAX风险变量进行完全调整后，TBS仍然是除髋部骨折外主要骨质疏松性骨折（风险比/标准差1.18，95%置信区间1.12 - 1.24）、死亡（风险比/标准差1.20，95%置信区间1.14 - 1.26）和髋部骨折（风险比/标准差1.23，95%置信区间1.09 - 1.38）的统计学显著预测指标。推导了调整主要骨质疏松性骨折和髋部骨折概率的模型，将年龄和小梁骨评分考虑在内，并将死亡视为竞争事件。使用TBS进行腰椎纹理分析是骨质疏松性骨折的一个风险因素，也是死亡的一个风险因素。TBS的预测能力独立于FRAX临床风险因素和股骨颈骨密度。调整骨折概率以考虑TBS对骨折和死亡风险的独立贡献需要在独立队列中进行验证。
