比较改善糖尿病骨折风险评估方法：曼尼托巴 BMD 登记处。
Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry.
机构信息
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia.
出版信息
J Bone Miner Res. 2018 Nov;33(11):1923-1930. doi: 10.1002/jbmr.3538. Epub 2018 Jul 16.
Type 2 diabetes is a risk factor for fracture independent of FRAX (fracture risk assessment) probability. We directly compared four proposed methods to improve the performance of FRAX for type 2 diabetes by: (1) including the rheumatoid arthritis (RA) input to FRAX; (2) making a trabecular bone score (TBS) adjustment to FRAX; (3) reducing the femoral neck T-score input to FRAX by 0.5 SD; and (4) increasing the age input to FRAX by 10 years. We examined major osteoporotic fractures (MOFs) and hip fractures (HFs) over a mean of 8.3 years observation among 44,543 women and men 40 years of age or older (4136 with diabetes) with baseline lumbar spine and hip DXA from 1999 through 2016. Controlled for unadjusted FRAX probability, diabetes was associated with an increased risk for MOFs and HFs. All four FRAX adjustments attenuated the effect of diabetes, but a residual effect of diabetes was seen on MOF risk after TBS adjustment, and on HF risk after the RA and TBS adjustments. Among those with diabetes, unadjusted FRAX risk underestimated MOF (observed/predicted ratio 1.15; 95% CI, 1.03 to 1.28), but this was no longer significant after applying the diabetes adjustments. HF risk was more severely underestimated (observed/predicted ratio 1.85; 95% CI, 1.51 to 2.20) and was only partially corrected with the diabetes adjustments (still significant for the RA and TBS adjustments). Among those with diabetes, there was moderate reclassification based upon a fixed MOF cut-off of 20% (4.1% to 7.1%) or fixed HF cut-off of 3% (5.7% to 16.5%). Net reclassification improvement increased for MOF with each of the diabetes adjustments (range 3.9% to 5.6% in the diabetes subgroup). In conclusion, each of the proposed methods for addressing limitations in the ability of FRAX to assess fracture risk in individuals with diabetes was found to improve performance, though no single method was optimal in all settings. © 2018 American Society for Bone and Mineral Research.
2 型糖尿病是骨折的风险因素，与 FRAX（骨折风险评估）概率无关。我们直接比较了四种改进 FRAX 对 2 型糖尿病患者的性能的建议方法：（1）将类风湿关节炎（RA）输入 FRAX；（2）对 FRAX 进行小梁骨评分（TBS）调整；（3）将 FRAX 的股骨颈 T 评分输入降低 0.5 SD；（4）将 FRAX 的年龄输入增加 10 年。我们在 1999 年至 2016 年间对 44543 名年龄在 40 岁或以上（4136 名患有糖尿病）的男性和女性进行了平均 8.3 年的腰椎和髋关节 DXA 随访，观察到主要骨质疏松性骨折（MOF）和髋部骨折（HF）。在未调整的 FRAX 概率校正后，糖尿病与 MOF 和 HF 风险增加相关。四种 FRAX 调整均减弱了糖尿病的作用，但 TBS 调整后仍可见糖尿病对 MOF 风险的残余影响，RA 和 TBS 调整后仍可见 HF 风险的残余影响。在患有糖尿病的患者中，未经调整的 FRAX 风险低估了 MOF（观察到的/预测的比值为 1.15；95%CI，1.03 至 1.28），但在应用糖尿病调整后，这不再具有统计学意义。HF 风险的低估更为严重（观察到的/预测的比值为 1.85；95%CI，1.51 至 2.20），并且仅部分纠正了糖尿病调整（RA 和 TBS 调整仍然具有统计学意义）。在患有糖尿病的患者中，基于 MOF 固定截止值 20%（4.1%至 7.1%）或 HF 固定截止值 3%（5.7%至 16.5%），存在中度重新分类。每个糖尿病调整的 MOF 都增加了重新分类的改善（糖尿病亚组的范围为 3.9%至 5.6%）。总之，每种用于解决 FRAX 评估糖尿病患者骨折风险能力的局限性的建议方法都被发现可改善性能，但在所有情况下都没有单一方法是最佳的。© 2018 美国骨骼和矿物质研究协会。
Zotero 插件