临床实践中通过重复骨密度测量进行骨折预测。

Fracture prediction from repeat BMD measurements in clinical practice.

作者信息

Leslie W D, Brennan-Olsen S L, Morin S N, Lix L M

机构信息

University of Manitoba, Winnipeg, Manitoba, Canada.

Department of Medicine (C5121), 409 Tache Avenue, R2H 2A6, Winnipeg, MB, Canada.

出版信息

Osteoporos Int. 2016 Jan;27(1):203-10. doi: 10.1007/s00198-015-3259-y. Epub 2015 Aug 5.

DOI:10.1007/s00198-015-3259-y

PMID:26243362

Abstract

UNLABELLED

We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment. We report that repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.

INTRODUCTION

In clinical practice, many patients selectively undergo repeat bone mineral density (BMD) measurements. We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment and whether this is affected by preceding change in BMD or recent osteoporosis therapy.

METHODS

We identified women and men aged ≥ 50 years who had a BMD measurement during 1990-2009 from a large clinical BMD database for Manitoba, Canada (n = 50,215). Patient subgroups aged ≥ 50 years at baseline with repeat BMD measures were identified. Data were linked to an administrative data repository, from which osteoporosis therapy, fracture outcomes, and covariates were extracted. Using Cox proportional hazards models, we assessed covariate-adjusted risk for major osteoporotic fracture (MOF) and hip fracture according to BMD (total hip, lumbar spine, femoral neck) at different time points.

RESULTS

Prevalence of osteoporosis therapy increased from 18 % at baseline to 55 % by the fourth measurement. Total hip BMD was predictive of MOF at each time point. In the patient subgroup with two repeat BMD measurements (n = 13,481), MOF prediction with the first and second measurements was similar: adjusted-hazard ratio (HR) per SD 1.45 (95 % CI 1.34-1.56) vs. 1.64 (95 % CI 1.48-1.81), respectively. No differences were seen when the second measurement results were stratified by preceding change in BMD or osteoporosis therapy (both p-interactions >0.2). Similar results were seen for hip fracture prediction and when spine and femoral neck BMD were analyzed.

CONCLUSION

Repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.

摘要

未标注

我们研究了临床人群中重复进行骨密度（BMD）测量对于骨折风险评估是否有用。我们报告称，重复进行BMD测量是临床人群骨折的有力预测指标；这不受先前BMD变化或近期骨质疏松治疗的影响。

引言

在临床实践中，许多患者选择性地接受重复骨密度（BMD）测量。我们研究了临床人群中重复进行BMD测量对于骨折风险评估是否有用，以及这是否受先前BMD变化或近期骨质疏松治疗的影响。

方法

我们从加拿大曼尼托巴省一个大型临床BMD数据库中识别出1990年至2009年期间进行过BMD测量的年龄≥50岁的女性和男性（n = 50,215）。确定了基线年龄≥50岁且有重复BMD测量的患者亚组。数据与一个行政数据存储库相关联，从中提取骨质疏松治疗、骨折结局和协变量。使用Cox比例风险模型，我们根据不同时间点的BMD（全髋、腰椎、股骨颈）评估了协变量调整后的主要骨质疏松性骨折（MOF）和髋部骨折风险。

结果

骨质疏松治疗的患病率从基线时的18%增加到第四次测量时的55%。全髋BMD在每个时间点都是MOF的预测指标。在有两次重复BMD测量的患者亚组（n = 13,481）中，第一次和第二次测量对MOF的预测相似：每标准差的调整风险比（HR）分别为1.45（95%CI 1.34 - 1.56）和1.64（95%CI 1.48 - 1.81）。当根据先前的BMD变化或骨质疏松治疗对第二次测量结果进行分层时，未发现差异（两者p交互作用>0.2）。对于髋部骨折预测以及分析脊柱和股骨颈BMD时也得到了类似结果。