Horta-Baas Gabriel, Pérez Bolde-Hernández Arturo, Pérez-Pérez Argelia, Vergara-Sánchez Imelda, Romero-Figueroa María Del Socorro
Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México.
Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México.
Med Clin (Barc). 2017 May 10;148(9):387-393. doi: 10.1016/j.medcli.2016.11.025. Epub 2017 Jan 22.
The use of FRAX without the inclusion of bone mineral density (FRAX-BMI) may be useful in clinical practice to identify patients at high risk of fracture and inform treatment decisions, but its usefulness is debated. The aim of the study is to evaluate the agreement between the risk of fracture calculated by FRAX with or without bone mineral density (BMD).
A cross-sectional study was conducted with 431 women (40-90 years) without treatment. The concordance of the probability of fracture was assessed by the concordance correlation coefficient (CCC), and by Bland-Altman method. The kappa index was used to evaluate the agreement between treatment indications.
The difference between the risks of a major osteoporosis fracture (MOFR) was 1.02±1.40% (95% CI -2 to 1.90) and -0.03±0.51% (95% CI -1.18 to 1.32) for the hip fracture risk (HFR). Agreement between MOFR and HFR FRAX scores was good (CCC 0.879, 95% CI 0.85-0.90 and CCC 0.821, 95% CI 0.79-0.85, respectively). The correlation between BMD of the femoral neck and fracture risk calculated by FRAX-BMI was a moderate, MOFR (r=-0.55, P<.001) and HFR (r=-0.54, P<.001). The agreement between the recommendations of treatment was 87% (kappa 0.61).
The good agreement between the risk of fracture obtained suggests that FRAX-BMI allows us to provide an estimate of risk in most cases.
在临床实践中，使用不包含骨密度的FRAX（FRAX-BMI）可能有助于识别骨折高危患者并指导治疗决策，但其有效性存在争议。本研究的目的是评估使用或不使用骨密度（BMD）的FRAX计算的骨折风险之间的一致性。
对431名未接受治疗的40至90岁女性进行了横断面研究。通过一致性相关系数（CCC）和Bland-Altman方法评估骨折概率的一致性。kappa指数用于评估治疗指征之间的一致性。
主要骨质疏松性骨折（MOFR）风险之间的差异为1.02±1.40%（95%CI -2至1.90），髋部骨折风险（HFR）为-0.03±0.51%（95%CI -1.18至1.32）。MOFR和HFR的FRAX评分之间的一致性良好（CCC分别为0.879，95%CI 0.85 - 0.90和CCC 0.821，95%CI 0.79 - 0.85）。股骨颈骨密度与FRAX-BMI计算的骨折风险之间的相关性为中等，MOFR（r = -0.55，P <.001）和HFR（r = -0.54，P <.001）。治疗建议之间的一致性为87%（kappa 0.61）。
所获得的骨折风险之间的良好一致性表明，FRAX-BMI在大多数情况下能够让我们对风险进行估计。
