Martineau Patrick, Leslie William D, Johansson Helena, Oden Anders, McCloskey Eugene V, Hans Didier, Kanis John A
Department of Radiology, University of Ottawa, Ottawa, Canada.
Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
J Bone Miner Res. 2017 Jul;32(7):1568-1574. doi: 10.1002/jbmr.3124. Epub 2017 Apr 7.
Decreased lumbar spine trabecular bone score (TBS), a dual-energy X-ray absorptiometry (DXA)-derived image texture measurement, is a risk factor for major osteoporotic fracture (MOF) and hip fracture (HF) independent of 10-year fracture probability estimated using FRAX. We determined how often applying the TBS adjustment to fracture probability altered treatment qualification. Using a population-based registry containing all clinical DXA results for Manitoba, Canada, we identified 34,316 women with baseline spine and hip DXA, FRAX-based fracture probability measurements (computed with femoral neck bone mineral density), lumbar spine TBS, and minimum 5 years of observation (mean 8.7 years). Population-based health services data were used to identify incident non-traumatic MOF and HF in 3503 and 945 women, respectively. Baseline MOF and HF probabilities were estimated using FRAX before and after applying the TBS adjustment. Risk recategorization was assessed using net reclassification improvement (NRI) for individual FRAX-based intervention criteria and three national clinical practice guidelines (CPGs) (US National Osteoporosis Foundation, Osteoporosis Canada, and UK National Osteoporosis Guideline Group). Overall, proportions of women reclassified with the TBS adjustment to FRAX were small (less than 5%) with more than 90% of the reclassification occurring close to the intervention threshold. For women close to an intervention cut-off reclassification, rates ranged from 9.0% to 17.9% and were <1% otherwise. There was a small but significant improvement in overall NRI for all individual FRAX-based intervention criteria (range 0.007 to 0.018) and all three national CPGs (range 0.008 to 0.011). NRI was larger in women below age 65 years (up to 0.056 for hip fracture). In summary, a small but significant improvement in MOF and HF risk assessment was found by using lumbar spine TBS to adjust FRAX probability. An improvement in risk reclassification was observed for CPGs from three different countries, with almost all of the benefit found in individuals close to an intervention threshold. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.
腰椎小梁骨评分（TBS）降低是一种通过双能X线吸收法（DXA）得出的图像纹理测量指标，它是主要骨质疏松性骨折（MOF）和髋部骨折（HF）的危险因素，独立于使用FRAX估算的10年骨折概率。我们确定了将TBS调整应用于骨折概率时，改变治疗资格的频率。利用一个包含加拿大曼尼托巴省所有临床DXA结果的基于人群的登记系统，我们识别出34316名女性，她们有基线脊柱和髋部DXA、基于FRAX的骨折概率测量值（根据股骨颈骨密度计算）、腰椎TBS以及至少5年的观察期（平均8.7年）。基于人群的健康服务数据被用于分别识别3503名和945名女性中的非创伤性MOF和HF事件。在应用TBS调整前后，使用FRAX估算基线MOF和HF概率。使用基于个体FRAX的干预标准和三个国家临床实践指南（CPG）（美国国家骨质疏松基金会、加拿大骨质疏松协会和英国国家骨质疏松指南小组）的净重新分类改善（NRI）来评估风险重新分类。总体而言，通过TBS调整FRAX后重新分类的女性比例较小（不到5%），超过90%的重新分类发生在接近干预阈值处。对于接近干预临界值重新分类的女性，比率范围为9.0%至17.9%，否则低于1%。对于所有基于个体FRAX的干预标准（范围为0.007至0.018）和所有三个国家CPG（范围为0.008至0.011），总体NRI有小幅但显著的改善。65岁以下女性的NRI更大（髋部骨折高达0.056）。总之，通过使用腰椎TBS调整FRAX概率，发现MOF和HF风险评估有小幅但显著的改善。观察到来自三个不同国家的CPG在风险重新分类方面有所改善，几乎所有益处都出现在接近干预阈值的个体中。© 2017美国骨与矿物质研究学会。© 2017美国骨与矿物质研究学会。
