Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.
Department of Neurosciences and Rehabilitation, "Carlo Poma" Hospital, ASST-Mantova, Mantova, Italy.
Bone. 2020 May;134:115297. doi: 10.1016/j.bone.2020.115297. Epub 2020 Feb 21.
To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures.
A population of Caucasian women (30-90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA.
1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9-5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77-3.76, p < 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20-2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p < 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p < 0.001).
REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.
研究无线电射频超声多谱仪（REMS）的 T 评分值在识别骨质疏松性骨折高危患者中的有效性。
本研究纳入了 2013 年至 2016 年间的高加索女性人群（30-90 岁），在轴向部位进行双能 X 线吸收法（DXA）和 REMS 扫描。在长达 5 年的随访期间评估脆性骨折的发生率。随后，将有和无脆性骨折的患者分为两组，年龄匹配，比例为 1:2（分别为 F'组和 NF'组）。定量评估 REMS T 评分在两组之间的区分性能，并与 DXA 进行比较。
共纳入 1516 名患者，1370 名患者完成了随访（平均年龄±标准差：3.7±0.8 岁；范围：1.9-5.0 年）。骨折发生率为 14.0%。年龄匹配的两组分别包括 175 名骨折患者和 350 名非骨折患者（中位年龄 70.2[四分位间距：61.0-73.3]和 67.3[65.4-69.8]岁，p 值无统计学意义）。两组的身高、体重和 BMI 也平衡（p 值无统计学意义）。正如预期的那样，REMS T 评分（椎体部位，F'组为-2.9[-3.6 至-1.9]，NF'组为-2.2[-2.9 至-1.2]）和 DXA T 评分（F'组为-2.8[-3.3 至-1.9]，NF'组为-2.2[-2.9 至-1.4]）的差异均具有统计学意义（p 值均<0.001）。股骨颈也得到了类似的结果。考虑到 T 评分的截断值为-2.5，REMS 能够以 65.1%的灵敏度和 57.7%的特异性识别 F'组患者（比值比（OR）=2.6，95%可信区间（CI）：1.77-3.76，p<0.001），而 DXA 的灵敏度和特异性分别为 57.1%和 56.3%（OR=1.7，95%CI：1.20-2.51，p 值=0.0032）。对于股骨颈，REMS 的灵敏度和特异性分别为 40.2%和 79.9%，OR 为 2.81（95%CI：1.80-4.39，p<0.001）。而 DXA 的灵敏度和特异性分别为 42.3%和 79.3%，OR 为 2.68（95%CI：1.71-4.21，p<0.001）。
REMS T 评分是一种有效的预测女性人群脆性骨折风险的指标，是在临床常规中增强骨质疏松症诊断的有前途的参数。
