骨应变指数可预测脆性骨折。OFELY研究。

The bone strain index predicts fragility fractures. The OFELY study.

作者信息

Sornay-Rendu Elisabeth, Duboeuf François, Ulivieri Fabio Massimo, Rinaudo Luca, Chapurlat Roland

机构信息

INSERM UMR 1033 and Université Claude Bernard-Lyon 1, Hôpital E Herriot, Lyon, France.

Casa di Cura la Madonnina, Via Quadronno 29, 20122 Milano, Italy.

出版信息

Bone. 2022 Apr;157:116348. doi: 10.1016/j.bone.2022.116348. Epub 2022 Feb 1.

DOI:10.1016/j.bone.2022.116348

PMID:35121211

Abstract

Recently, the bone strain index (BSI), a new index of bone strength based on a finite element model (FEA) from dual X-ray absorptiometry (DXA), has been developed. BSI represents the average equivalent strain inside the bone, assuming that a higher strain level (high BSI) indicates a condition of higher risk. Our study aimed to analyze the relationship between BSI and age, BMI and areal BMD in pre- and postmenopausal women and to prospectively investigate fracture prediction (Fx) by BSI in postmenopausal women. Methods. At the 14th annual follow-up of the OFELY study, BSI was measured at spine (Spine BSI) and femoral scans (Neck and Total Hip BSI), in addition to areal BMD with DXA (Hologic QDR 4500) in 846 women, mean (SD) age 60 yr (15). The FRAX® (fracture risk assessment tool) for major osteoporotic fractures (MOF) was calculated with FN areal BMD (aBMD) at baseline; incident fragility fractures were annually registered until January 2016. Results. In premenopausal women (n = 261), Neck and Total Hip BSI were slightly negatively correlated with age (Spearman r = -0.13 and -0.15 respectively, p = 0.03), whereas all BSIs were positively correlated with BMI (r = +0.20 to 0.37, p < 0.01) and negatively with BMD (r = -0.69 to -0.37, p < 0.0001). In postmenopausal women (n = 585), Neck and Total Hip BSI were positively correlated with age (Spearman r = +0.26 and +0.31 respectively, p < 0.0001), whereas Spine BSI was positively correlated with BMI (r = +0.22, p < 0.0001) and all BSIs were negatively correlated with BMD (r = -0.81 to -0.60, p < 0.0001). During a median [IQ] 9.3 [1.0] years of follow-up, 133 postmenopausal women reported an incident fragility Fx, including 80 women with a major osteoporotic Fx (MOF) and 26 women with clinical vertebral Fx (VFx). Each SD increase of BSI value was associated with a significant increase of the risk of all fragility Fx with an age-adjusted HR of 1.23 for Neck BSI (p = 0.02); 1.27 for Total Hip BSI (p = 0.004) and 1.35 for Spine BSI (p < 0.0001). After adjustment for FRAX®, the association remained statistically significant for Total Hip BSI (HR 1.24, p = 0.02 for all fragility Fx; 1.31, p = 0.01 for MOF) and Spine BSI (HR 1.33, p < 0.0001 for all fragility Fx; 1.33, p = 0.005 for MOF; 1.67, p = 0.002 for clinical VFx). In conclusion, spine and femur BSI, an FEA DXA derived index, predict incident fragility fracture in postmenopausal women, regardless of FRAX®.

摘要

最近，基于双能X线吸收法（DXA）有限元模型（FEA）的骨强度新指标——骨应变指数（BSI）已被开发出来。BSI代表骨内平均等效应变，假设较高的应变水平（高BSI）表明风险较高。我们的研究旨在分析绝经前和绝经后女性中BSI与年龄、体重指数（BMI）和骨面积密度（aBMD）之间的关系，并前瞻性地研究绝经后女性中BSI对骨折预测（Fx）的作用。方法：在OFELY研究的第14次年度随访中，除了用DXA（Hologic QDR 4500）测量846名女性的骨面积密度外，还测量了她们脊柱（脊柱BSI）和股骨扫描部位（颈部和全髋部BSI）的BSI，这些女性的平均（标准差）年龄为60岁（15岁）。用基线时股骨颈骨面积密度（aBMD）计算主要骨质疏松性骨折（MOF）的FRAX®（骨折风险评估工具）；直至2016年1月，每年记录新发脆性骨折情况。结果：在绝经前女性（n = 261）中，颈部和全髋部BSI与年龄呈轻度负相关（Spearman相关系数r分别为-0.13和-0.15，p = 0.03），而所有BSI与BMI呈正相关（r = +0.20至0.37，p < 0.01），与骨密度呈负相关（r = -0.69至-0.37，p < 0.0001）。在绝经后女性（n = 585）中，颈部和全髋部BSI与年龄呈正相关（Spearman相关系数r分别为+0.26和+0.31，p < 0.0001），而脊柱BSI与BMI呈正相关（r = +0.22，p < 0.0001），所有BSI与骨密度呈负相关（r = -0.81至-0.60，p < 0.0001）。在中位[四分位间距]9.3[1.0]年的随访期间，133名绝经后女性报告了新发脆性骨折，其中包括80名患有主要骨质疏松性骨折（MOF）的女性和26名患有临床椎体骨折（VFx）的女性。BSI值每增加1个标准差，所有脆性骨折风险均显著增加，年龄调整后的风险比（HR）：颈部BSI为1.23（p = 0.02）；全髋部BSI为1.27（p = 0.004）；脊柱BSI为1.35（p < 0.0001）。在对FRAX®进行校正后，全髋部BSI（所有脆性骨折的HR为1.24，p = 0.02；MOF的HR为1.31，p = 0.01）和脊柱BSI（所有脆性骨折的HR为1.33，p < 0.0001；MOF的HR为1.33，p = 0.005；临床VFx的HR为1.67，p = 0.002）的相关性仍具有统计学意义。总之，基于DXA有限元分析得出的脊柱和股骨BSI可预测绝经后女性的新发脆性骨折，且不受FRAX®影响。