Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, USA; Patient Health and Impact, Pfizer Inc., New York, NY, USA.
Department of Endocrinology, The Affiliated Hospital of Medical School, Ningbo University, Zhejiang, China.
Bone. 2020 Jul;136:115358. doi: 10.1016/j.bone.2020.115358. Epub 2020 Apr 5.
Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry.
Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept.
A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%).
VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.
椎体骨折（VF）是绝经后妇女中最常见的骨质疏松性骨折，尽管大多数 VF 是亚临床的。现患 VF 是后续骨折的重要预测指标，因此，VF 的识别可提高对高骨折风险人群的识别。本研究旨在通过双能 X 射线吸收法（VFA）系统地综述评估无症状绝经后妇女 VF 患病率的文献。
2000 年 1 月 1 日至 2018 年 1 月 31 日，检索 Medline、Web of Science 和 Cochrane 数据库，以查找报告使用 VFA 检测无症状绝经后妇女 VFA 检测到的 VF 患病率的英文出版物。我们还检索了报告、会议论文和灰色文献。审查员筛选了研究的合格性，并提取了纳入研究的数据。采用随机效应荟萃分析计算 VF 的患病率。通过精度和 Egger 检验的截距评估发表偏倚的存在。
共确定了 1777 篇文章，对 94 项研究进行了全面审查，对 28 项研究（n=25418）进行了分析。超过三分之二的研究是横断面研究，研究样本量在研究之间差异很大（从 63 到 5156）。平均年龄范围为 59.5 至 86.2 岁。骨质疏松症和骨量减少的患病率分别为 6-57.0%和 25.1-58.9%。然而，在有现患 VF 的女性中，多达 43%的女性患有骨量减少，多达 32%的女性骨密度正常。无症状女性 VFA 检测到的 VF 的加权汇总患病率为 28%（95%CI：23%-32%）。
VFA 能够识别无症状绝经后妇女的现患 VF。使用 VFA 识别出平均 28%的无症状妇女存在 VF，其中许多妇女没有骨质疏松症的诊断。将 VFA 作为常规筛查工具的实施可能会发现高风险女性。VF 的检测可能导致那些原本可能不接受治疗的个体进行药物治疗。
