Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Laboratoire de Recherche Translationnelle, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
J Bone Miner Res. 2022 Jan;37(1):59-67. doi: 10.1002/jbmr.4432. Epub 2021 Sep 16.
Patients who sustain a fracture are at greatest risk of recurrent fracture during the next 2 years. We propose three models to identify subjects most at risk of an imminent fracture, according to fracture site (any fracture, major osteoporotic fracture [MOF] or central). They were constructed using data of the prospective Frisbee cohort, which includes 3560 postmenopausal women aged 60 to 85 years who were followed for at least 5 years. A total of 881 subjects had a first incident validated fragility fracture before December 2018. Among these, we validated 130 imminent fractures occurring within the next 2 years; 79 were MOFs, and 88 were central fractures. Clinical risk factors were re-evaluated at the time of the index fracture. Fine and Gray proportional hazard models were derived separately for each group of fractures. The following risk factors were significantly associated with the risk of any imminent fracture: total hip bone mineral density (BMD) (p < 0.001), a fall history (p < 0.001), and comorbidities (p = 0.03). Age (p = 0.05 and p = 0.03, respectively) and a central fracture as the index fracture (p = 0.04 and p = 0.005, respectively) were additional predictors of MOFs and central fractures. The three prediction models are presented as nomograms. The calibration curves and the Brier scores based on bootstrap resampling showed calibration scores of 0.089 for MOF, 0.094 for central fractures, and 0.132 for any fractures. The predictive accuracy of the models expressed as area under the receiver operating characteristic (AUROC) curve (AUC) were 0.74 for central fractures, 0.72 for MOFs, and 0.66 for all fractures, respectively. These AUCs compare well with those of FRAX and Garvan to predict the 5- or 10-year fracture probability. In summary, five predictors (BMD, age, comorbidities, falls, and central fracture as the incident fracture) allow the calculation with a reasonable accuracy of the imminent risk of fracture at different sites (MOF, central fracture, and any fracture) after a recent sentinel fracture. © 2021 American Society for Bone and Mineral Research (ASBMR).
骨折患者在接下来的 2 年内再次骨折的风险最高。我们根据骨折部位（任何部位骨折、主要骨质疏松性骨折[MOF]或中央部位骨折）提出了三种模型来识别即将发生骨折的高风险人群。这些模型是使用前瞻性 Frisbee 队列的数据构建的，该队列包括 3560 名年龄在 60 至 85 岁之间的绝经后女性，随访时间至少为 5 年。共有 881 名患者在 2018 年 12 月前发生了首次经证实的脆性骨折。其中，我们验证了 130 例在接下来的 2 年内即将发生的骨折；79 例为 MOF，88 例为中央部位骨折。在发生索引性骨折时，重新评估了临床危险因素。分别为每组骨折推导 Fine 和 Gray 比例风险模型。以下危险因素与任何即将发生的骨折风险显著相关：全髋关节骨密度（BMD）（p<0.001）、既往跌倒史（p<0.001）和合并症（p=0.03）。年龄（p=0.05 和 p=0.03）和中央部位骨折作为索引性骨折（p=0.04 和 p=0.005）分别是 MOF 和中央部位骨折的其他预测因子。三种预测模型以列线图的形式呈现。基于 bootstrap 重采样的校准曲线和 Brier 评分显示，MOF 的校准评分分别为 0.089、中央部位骨折为 0.094、任何部位骨折为 0.132。模型的预测准确性表示为接受者操作特征（ROC）曲线下面积（AUC），中央部位骨折为 0.74、MOF 为 0.72、所有骨折为 0.66。这些 AUC 与 FRAX 和 Garvan 预测 5 年或 10 年骨折概率的 AUC 相当。总之，五个预测因子（BMD、年龄、合并症、跌倒和中央部位骨折作为首发骨折）可以合理准确地计算近期哨兵骨折后不同部位（MOF、中央部位骨折和任何部位骨折）的骨折即将发生风险。©2021 美国骨骼与矿物质研究学会（ASBMR）。
