Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
University of Wisconsin, Madison, WI, USA.
Arch Osteoporos. 2020 Jun 23;15(1):93. doi: 10.1007/s11657-020-00775-8.
Among 39,475 women, age 65 years and older, use of fracture history, major osteoporotic fracture (MOF) probability from FRAX®, vertebral fracture assessment (VFA), and bone mineral density (BMD) T-score stratified women into different levels of risk. The majority of women identified as being at high risk from fracture history, FRAX MOF-BMD > 20%, or vertebral fracture on VFA had a BMD T-score in the osteoporotic range.
To inform criteria for pharmacologic treatment in women age 65 years and older, we examined subgroups defined from fracture history, MOF calculated with BMD (MOF-BMD), VFA, and BMD T-score using the population-based Manitoba BMD Program registry.
The study population consisted of women age > 65 years was divided into mutually exclusive subgroups based upon fracture history, MOF-BMD ≥ 20%, vertebral fracture on VFA, and osteoporotic BMD T-score. Healthcare records were assessed for the presence of fracture diagnosis codes occurring after DXA assessment. For each subgroup, we estimated the proportion of individuals with BMD T-score in the osteoporotic range, predicted versus observed 10-year MOF probability, hazard ratio (HR) for MOF, and number needed to treat (NNT) for 3 years to prevent a fracture event.
The study population consisted of 39,475 women (median age 72 years). The majority of women (76.8%) selected as being at high risk based on fracture history, MOF-BMD > 20%, or vertebral fracture on VFA had a BMD T-score in the osteoporotic range. During a median follow-up of 8 years, 5169 (13.1%) sustained one or more incident MOF. Fracture rates and HRs generally paralleled the FRAX prediction, except in women with a positive VFA where predicted risk based upon clinical risk factors prior to VFA underestimated the observed risk. NNT differed by the risk subgroup, and showed a gradient of decreasing NNT (consistent with greater benefit) in individuals with the highest fracture risk.
Fracture history, fracture probability from FRAX, targeted vertebral fracture assessment (VFA), and BMD T-score can stratify older women into different levels of risk and treatment benefit. These results are expected to inform clinical practice guidelines in Canada.
目的：为了明确 65 岁及以上女性患者药物治疗的标准，我们基于人群为基础的曼尼托巴骨密度计划登记处，利用骨折史、基于骨密度的骨折风险评估（FRAX）计算的主要骨质疏松性骨折（MOF）、椎体骨折评估（VFA）和骨密度 T 评分，对来自骨折史、MOF-BMD≥20%、VFA 椎体骨折和骨质疏松性 BMD T 评分的亚组进行定义，然后检查这些定义的亚组。
方法：研究人群为年龄>65 岁的女性，将其根据骨折史、MOF-BMD≥20%、VFA 椎体骨折和骨质疏松性 BMD T 评分，分为互斥的亚组。评估医疗记录中是否存在 DXA 评估后发生的骨折诊断代码。对于每个亚组，我们估计了骨密度 T 评分处于骨质疏松范围的个体比例、预测与观察到的 10 年 MOF 概率、MOF 的风险比（HR）以及预防 3 年内骨折事件的治疗需要数（NNT）。
结果：研究人群包括 39475 名女性（中位年龄 72 岁）。大多数女性（76.8%）因骨折史、MOF-BMD>20%或 VFA 椎体骨折被选为高风险人群，这些女性的骨密度 T 评分处于骨质疏松范围。在中位随访 8 年期间，5169 名（13.1%）女性发生了 1 次或多次 MOF。骨折率和 HR 通常与 FRAX 预测一致，但在 VFA 阳性的女性中，在 VFA 之前基于临床危险因素预测的风险低估了观察到的风险。NNT 因风险亚组而异，在骨折风险最高的个体中，NNT 呈下降趋势（与更大的益处一致）。
结论：骨折史、FRAX 骨折概率、有针对性的 VFA 和 BMD T 评分可将老年女性分为不同的风险和治疗效果水平。这些结果有望为加拿大的临床实践指南提供信息。
