斯里兰卡绝经后妇女骨质疏松症管理的基于修订 FRAX®的干预阈值。

Revised FRAX®-based intervention thresholds for the management of osteoporosis among postmenopausal women in Sri Lanka.

机构信息

Department of Medicine, Faculty of Medicine, Population Health Research Center, Galle, Sri Lanka.

Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.

出版信息

Arch Osteoporos. 2019 Mar 9;14(1):33. doi: 10.1007/s11657-019-0585-2.

DOI:10.1007/s11657-019-0585-2

PMID:30850909

Abstract

UNLABELLED

This paper revised the fixed intervention thresholds (ITs) based on the Sri Lankan fracture risk assessment tool (FRAX) published in 2013 and introduced new ITs, hybrid and two-tier, aiming to help clinicians in the management of postmenopausal osteoporosis. The hybrid and two-tier ITs have a better discriminatory power than age-dependent and revised fixed ITs.

INTRODUCTION

This study revised the Sri Lankan FRAX®-based intervention thresholds (ITs) previously published in 2013.

METHOD

Age-dependent ITs were estimated, from 50-80 years with 5-year intervals, using a Sri Lankan FRAX® algorithm for a woman with a BMI of 24.8 kg/m and history of prior fragility fracture without other clinical risk factors. Data of 653 postmenopausal women were used in estimating fixed, hybrid, and two-tier ITs. ITs were determined using the ROC curve and partial Youden index. New ITs were validated using data of 356 postmenopausal women who underwent DXA and 62 women who had a recent fragility fracture. Women in the two groups (n = 653 and n = 356) came from the Southern Province and had undergone DXA in our state-owned tertiary care hospital as a part of their routine clinical assessment.

RESULTS

The mean (SD) age and BMI of the subjects (n = 653) were 62 (8) years and 24.8 (1.2) kg/m, respectively. Age-dependent ITs of major osteoporotic fracture risk (MOFR) and hip fracture risk (HFR) ranged from 2.7 to 18% and from 0.4 to 7.1%. The best fixed ITs for women aged 50-80 years were 9% for MOFR and 3% for HFR. In the hybrid method, MOFR of 6% and HFR of 2% were found appropriate for women aged < 70 years. These were combined with age-dependent ITs for women aged 70 years and above. In the two-tier system, two sets of ITs were calculated (ITs of MOFR/HFR for women aged < 70 years and ≥ 70 years were 6%/2% and 12%/5%, respectively). When age-dependent ITs were considered the reference standard, sensitivities of the fixed, hybrid, and two-tier ITs were 0.63, 0.73, and 0.74, respectively. The specificities were 0.76, 0.86, and 0.80 in the same order. Sensitivities of the age-dependent, fixed, hybrid, and two-tier ITs in identifying a woman with an incident fracture were 26%, 48%, 61%, and 61%, respectively.

CONCLUSIONS

The new fixed MOFR is slightly lower than the previous value and hybrid and two-tier ITs perform better than age-dependent and fixed ITs.

摘要

目的

本研究旨在修订 2013 年发表的斯里兰卡基于骨折风险评估工具（FRAX）的干预阈值（ITs）。

方法

采用斯里兰卡 FRAX®算法，对 BMI 为 24.8kg/m2且无其他临床危险因素的 50-80 岁女性，每 5 年间隔估算年龄依赖性 ITs。利用 653 例绝经后女性的数据估算固定、混合和双层 ITs。使用 ROC 曲线和部分尤登指数确定 ITs。利用在我院接受 DXA 检查的 356 例绝经后女性和 62 例近期脆性骨折女性的数据验证新 ITs。这两组女性（n=653 和 n=356）均来自南方省，且在我院进行 DXA 检查是其常规临床评估的一部分。

结果

653 例受试者的平均（SD）年龄和 BMI 分别为 62（8）岁和 24.8（1.2）kg/m2。主要骨质疏松性骨折风险（MOFR）和髋部骨折风险（HFR）的年龄依赖性 ITs 范围分别为 2.7%至 18%和 0.4%至 7.1%。50-80 岁女性最佳固定 MOFR 为 9%，最佳 HFR 为 3%。在混合方法中，发现年龄<70 岁的女性 MOFR 为 6%，HFR 为 2%较为合适。对于 70 岁及以上的女性，这些将与年龄依赖性 ITs 结合使用。在双层系统中，为年龄<70 岁和≥70 岁的女性分别计算了两套 ITs（女性的 MOFR/HFR 的 ITs 为 6%/2%和 12%/5%）。当年龄依赖性 ITs 作为参考标准时，固定、混合和双层 ITs 的敏感性分别为 0.63、0.73 和 0.74，特异性分别为 0.76、0.86 和 0.80。年龄依赖性、固定、混合和双层 ITs 识别出发生骨折的女性的敏感性分别为 26%、48%、61%和 61%。