Chao An-Shine, Chen Fang-Ping, Lin Yu-Ching, Huang Ting-Shuo, Fan Chih-Ming, Yu Yu-Wei
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan.
Taiwan J Obstet Gynecol. 2015 Dec;54(6):722-5. doi: 10.1016/j.tjog.2015.10.005.
To evaluate the efficacy of the World Health Organization Fracture Risk Assessment Tool, excluding bone mineral density (pre-BMD FRAX), in identifying Taiwanese postmenopausal women needing dual-energy X-ray absorptiometry (DXA) examination for further treatment.
The pre-BMD FRAX score was calculated for 231 postmenopausal women who participated in public health education workshops in the local Keelung community, Taiwan. DXA scanning and vertebral fracture assessment (VFA) were arranged for women classified as intermediate or high risk for fracture using the pre-BMD FRAX fracture probability.
Pre-BMD FRAX classified 26 women as intermediate risk and 37 as having high risk for fracture. Subsequent DXA scans for these 63 women showed that 36 were osteoporotic, 19 were osteopenic, and eight had normal bone density. Concurrent VFA revealed 25 spine factures in which 14 were osteoporotic, seven were osteopenic, and four had normal bone density. The efficacy of the pre-BMD FRAX score to identify those patients with low bone mass by DXA was 87.3% (55/63). When VFA was combined with BMD to identify those patients with high risk (osteopenia, osteoporosis, or spinal fracture), the efficacy of the pre-BMD score increased to 93.7% (59/63). According to the National Osteoporosis Foundation, the overall concordance between pre-BMD FRAX and BMD, expressed through the kappa index, was 0.967. Compared with the evaluation when BMD was used alone, there was a significant increase in efficacy in identifying women who need treatment using BMD plus VFA or FRAX plus BMD. Furthermore, the highest efficacy was achieved when FRAX with BMD and VFA was used.
The pre-BMD FRAX score not only efficiently predicts postmenopausal patients who are potentially at risk and might require treatment but also reduces unnecessary DXA use. Concurrent VFA during DXA use increases spine fracture detection. This improvement in diagnostic efficacy allows clinicians to provide the most appropriate therapeutic recommendation.
评估世界卫生组织骨折风险评估工具（不包括骨密度，即预骨密度FRAX）在识别台湾绝经后妇女是否需要进行双能X线吸收测定（DXA）检查以进行进一步治疗方面的有效性。
为231名参加台湾基隆当地社区公共健康教育讲习班的绝经后妇女计算预骨密度FRAX评分。对于使用预骨密度FRAX骨折概率分类为骨折中度或高度风险的妇女，安排进行DXA扫描和椎体骨折评估（VFA）。
预骨密度FRAX将26名妇女分类为中度风险，37名妇女分类为骨折高风险。对这63名妇女随后进行的DXA扫描显示，36名患有骨质疏松症，19名患有骨质减少症，8名骨密度正常。同时进行的VFA显示有25例脊柱骨折，其中14例为骨质疏松性骨折，7例为骨质减少性骨折，4例骨密度正常。预骨密度FRAX评分通过DXA识别骨量低患者的有效性为87.3%（55/63）。当VFA与骨密度相结合以识别高风险（骨质减少、骨质疏松或脊柱骨折）患者时，预骨密度评分的有效性提高到93.7%（59/63）。根据美国国家骨质疏松基金会，通过kappa指数表示的预骨密度FRAX与骨密度之间的总体一致性为0.967。与单独使用骨密度进行评估相比，使用骨密度加VFA或FRAX加骨密度识别需要治疗的妇女时，有效性有显著提高。此外，使用FRAX结合骨密度和VFA时有效性最高。
预骨密度FRAX评分不仅能有效预测可能有风险且可能需要治疗的绝经后患者，还能减少不必要的DXA使用。在使用DXA期间同时进行VFA可增加脊柱骨折的检测。这种诊断有效性的提高使临床医生能够提供最合适的治疗建议。
