Li Guowei, Thabane Lehana, Papaioannou Alexandra, Adachi Jonathan D
Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada; St. Joseph's Hospital, McMaster University, 25 Charlton Avenue East, Hamilton, ON L8N 1Y2, Canada.
Bone. 2015 Aug;77:107-14. doi: 10.1016/j.bone.2015.04.028. Epub 2015 Apr 25.
A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk.
基于老年人虚弱程度的累积缺陷衰弱指数（FI）可以量化并预测骨折风险。我们旨在利用全球女性骨质疏松症纵向研究（GLOW）3年汉密尔顿队列的数据，比较FI与骨折风险评估工具（FRAX）在预测主要骨质疏松性骨折（髋部、上臂或肩部、脊柱或腕部）和髋部骨折风险方面的预测能力。该研究纳入了3985名女性，平均年龄为69.4岁（标准差[SD]=8.89）。在随访期间，报告了149例（3.98%）新发主要骨质疏松性骨折和18例（0.48%）髋部骨折。FRAX和FI彼此显著相关。FRAX和FI均显著预测了主要骨质疏松性骨折的风险，FRAX和FI每增加0.01的风险比（HR）分别为1.03（95%置信区间[CI]：1.02 - 1.05）和1.02（95%CI：1.01 - 1.04）。FRAX和FI每增加0.10（约一个标准差）的HR分别为1.37（95%CI：1.19 - 1.58）和1.26（95%CI：1.12 - 1.42）。发现模型具有相似的判别能力：FRAX的c指数 = 0.62，FI的c指数 = 0.61。当选择切点将参与者分为低风险、中风险和高风险组时，与低风险女性相比，FI的高风险组骨折风险显著增加（HR = 2.04，95%CI：1.36 - 3.07），但中风险组未增加（HR = 1.23，95%CI：0.82 - 1.84）；而对于FRAX，仅当生存时间超过18个月（550天）时，中风险组（HR = 2.00，95%CI：1.09 - 3.68）和高风险组（HR = 2.61，95%CI：1.48 - 4.58）才显著预测主要骨质疏松性骨折的风险。髋部骨折及敏感性分析中观察到类似结果。总之，FI在预测未来骨折风险方面与FRAX相当，这表明虚弱状态的测量可能有助于老年人的骨折风险评估和骨折预防。需要来自骨质疏松症药物干预随机对照试验的进一步证据来支持将FI和FRAX作为骨折风险的有效测量指标。
