Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2022 Dec;45(6):931-939. doi: 10.1016/j.bj.2021.11.008. Epub 2021 Nov 19.
To determine a reliable method to predict prevalent vertebral fractures (VF) by assessing the association between dysmobility syndrome (DS) and VF in a community-dwelling population.
This cross-sectional study enrolled 518 participants from fracture-prevention educational activities held in multiple communities in Taiwan. Assessments included questionnaires, fracture risk assessment tool (FRAX), bone mineral density (BMD) and body composition using dual-energy x-ray absorptiometry (DXA), lateral thoracolumbar spine x-rays (specifically T8-S1), grip strength (GS), walking speed, and fall history.
DS was noted in 257 participants (49.6%) and VF was identified in 196 participants (37.8%). A higher prevalence of VF was noted in those with DS. The prevalence of VF was significantly associated with age, gender, FRAX both with and without BMD, osteoporosis, low GS, and DS. In multivariate models accounting for age and sex, the c-index was greater in those with low GS plus osteoporosis as compared to DS alone. Low GS, osteoporosis, and pre-BMD FRAX all had similar c-indexes. Pre-BMD FRAX plus low GS and osteoporosis was superior in predicting VF compared to pre-BMD FRAX plus low GS or osteoporosis alone. Besides the inclusion of age and gender, the nomogram with pre-BMD FRAX major osteoporosis fracture probability (MOF) plus low GS had improved correlation between the estimated and actual VF probability than those with pre-BMD FRAX MOF plus osteoporosis.
The constructed nomogram containing pre-BMD FRAX MOF plus low GS may be considered as a first-line prevalent VF screening method. Those with high-risk scores should subsequently undergo vertebral radiography and/or BMD.
通过评估失能综合征（DS）与社区居住人群中椎体骨折（VF）之间的关联，确定一种预测普遍发生的 VF 的可靠方法。
本横断面研究纳入了来自台湾多个社区防骨折教育活动的 518 名参与者。评估内容包括问卷调查、骨折风险评估工具（FRAX）、双能 X 射线吸收法（DXA）进行的骨矿物质密度（BMD）和身体成分、侧位胸腰椎 X 射线（T8-S1 具体部位）、握力（GS）、行走速度和跌倒史。
257 名参与者（49.6%）存在 DS，196 名参与者（37.8%）存在 VF。DS 患者的 VF 发生率更高。VF 的发生率与年龄、性别、有无 BMD 的 FRAX、骨质疏松症、低 GS 和 DS 显著相关。在同时考虑年龄和性别的多变量模型中，低 GS 加骨质疏松症的受试者比单纯 DS 的受试者的 c 指数更高。低 GS、骨质疏松症和预 BMD FRAX 的 c 指数相似。预 BMD FRAX 加低 GS 和骨质疏松症在预测 VF 方面优于预 BMD FRAX 加低 GS 或骨质疏松症。除了包含年龄和性别外，预 BMD FRAX 加主要骨质疏松性骨折概率（MOF）和低 GS 的列线图在估计和实际 VF 概率之间的相关性优于预 BMD FRAX MOF 加骨质疏松症。
包含预 BMD FRAX MOF 加低 GS 的列线图可作为预测普遍发生的 VF 的一线筛查方法。高危评分者应随后进行椎体放射成像和/或 BMD。
