Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Endocr Pract. 2021 May;27(5):408-412. doi: 10.1016/j.eprac.2020.12.010. Epub 2021 Feb 26.
To investigate the added value of 1/3 radius (1/3R) for the diagnosis of osteoporosis by spine and hip sites and its correlation with prevalent fractures and predicted fracture risk.
Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fractures (MOF) with/without trabecular bone score were considered proxy for fracture risk. The contribution of 1/3R to risk prediction was depicted via linear regression models with FRAX score as the dependent variable-first only with central and then with radius T-score as an additional covariate. Significance of change in the explained variance was compared by F-test.
The study included 1453 patients, 86% women, aged 66 ± 10 years. A total of 32% (n = 471) were osteoporotic by spine/hip and 8% (n = 115) by radius only, constituting a 24.4% increase in the number of subjects defined as osteoporotic (n = 586, 40%). Prior fracture prevalence was similar among patients with osteoporosis by spine/hip (17.4%) and radius only (19.1%) (P = .77). FRAX prediction by a regression model using spine/hip T-score yielded explained variance of 51.8% and 49.9% for MOF and 39.8% and 36.4% for hip (with/without trabecular bone score adjustment, respectively). The contribution of 1/3R was statistically significant (P < .001) and slightly increased the explained variance to 52.3% and 50.4% for MOF and 40.9% and 37.4% for hip, respectively.
Reclassification of BMD results according to radius measurements results in higher diagnostic output. Prior fractures were equally prevalent among patients with radius-only and classic-site osteoporosis. FRAX tool performance slightly improved by incorporating radius BMD. Whether this approach may lead to a better fracture prediction warrants further prospective evaluation.
研究脊柱和髋部部位 1/3 半径（1/3R）对骨质疏松症诊断的附加价值及其与现患骨折和预测骨折风险的相关性。
考虑使用髋部和主要骨质疏松性骨折（MOF）骨折风险评估工具（FRAX）评分以及有无小梁骨评分作为骨折风险的替代指标。通过线性回归模型，将 FRAX 评分作为因变量，首先仅使用中心和然后使用半径 T 值作为附加协变量，来描述 1/3R 对风险预测的贡献。通过 F 检验比较解释方差变化的显著性。
该研究纳入了 1453 名患者，86%为女性，年龄 66±10 岁。总共 32%（n=471）的患者脊柱/髋部骨密度结果为骨质疏松症，8%（n=115）的患者仅桡骨骨密度结果为骨质疏松症，这使被定义为骨质疏松症的患者人数增加了 24.4%（n=586，40%）。仅脊柱/髋部骨密度结果为骨质疏松症的患者与仅桡骨骨密度结果为骨质疏松症的患者（分别为 17.4%和 19.1%）的既往骨折发生率相似（P=0.77）。使用脊柱/髋部 T 值的回归模型进行 FRAX 预测，MOF 和髋部（有/无小梁骨评分校正）的解释方差分别为 51.8%和 49.9%以及 39.8%和 36.4%。1/3R 的贡献具有统计学意义（P<0.001），并使 MOF 和髋部的解释方差分别略微增加至 52.3%和 50.4%以及 40.9%和 37.4%。
根据桡骨测量结果重新分类 BMD 结果会产生更高的诊断输出。仅桡骨和经典部位骨质疏松症患者的既往骨折发生率相当。纳入桡骨骨密度可使 FRAX 工具的性能略有改善。这种方法是否能更好地预测骨折还需要进一步的前瞻性评估。
