Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.
Bone. 2019 May;122:14-21. doi: 10.1016/j.bone.2019.02.008. Epub 2019 Feb 8.
Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures.
This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire.
Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ -2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%.
More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.
挪威的骨折发病率居世界之首。椎体骨折评估（VFA）和小梁骨评分（TBS）可提供骨折风险信息，但尚未在挪威脆性骨折患者中研究其重要性。本研究的目的是检查一组女性和男性脆性骨折患者的临床特征，使用 VFA 评估其椎体骨折的发生率和 TBS 低值的发生率，并探讨性别之间以及有和无椎体骨折患者之间的差异。
本研究是挪威捕获骨折倡议（NoFRACT）的横断面亚研究，共纳入 839 例脆性骨折患者。其中，804 例患者使用双能 X 线吸收法评估了全髋、股骨颈和/或脊柱的骨密度（BMD），679 例行 VFA 检查，771 例计算了 TBS 值，696 例患者回答了调查问卷。
患者平均年龄为 65.8（8.8）岁，80.5%为女性。VFA 显示 34.8%的患者存在椎体骨折，34.0%的患者 TBS 值较低（≤1.23），性别之间无差异。在所有有 VFA 和 TBS 有效测量值的患者中，53.8%的患者有椎体骨折、TBS 值较低或两者兼有。在股骨颈骨密度 T 评分≤-2.5 的患者中，53.6%的患者有椎体骨折、TBS 值较低或两者兼有。所有患者中，13.8%的患者股骨颈最低 T 评分骨骼部位存在 T 评分≤-2.5，而 T 评分最低骨骼部位的相应比例为 27.4%。女性在所有部位的 BMD 均低于男性，TBS 值也低于男性（1.27 比 1.29）（均 P<0.05）。有椎体骨折的患者年龄更大（69.4 岁比 64.0 岁），所有部位的 BMD 均较低，TBS 值也较低（1.25 比 1.29）（均 P<0.05）。评估前，8.2%的患者正在服用抗骨质疏松药物（AOD），评估后，处方率增加到 56.2%。
超过一半的脆性骨折患者有椎体骨折、TBS 值较低或两者兼有。从评估前的 8.2%到评估后的 56.2%，AOD 的处方率增加了七倍，这强调了在脆性骨折后进行风险评估的重要性。
