Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, University of Gothenburg, Gothenburg, Sweden.
Department of Orthopaedics, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden.
Osteoporos Int. 2022 Aug;33(8):1725-1738. doi: 10.1007/s00198-022-06387-x. Epub 2022 Apr 22.
Vertebral fracture (VF) is a strong predictor of subsequent fracture. In this study of older women, VF, identified by dual-energy X-ray absorptiometry (DXA) vertebral fracture assessment (VFA), were associated with an increased risk of incident fractures and had a substantial impact on fracture probability, supporting the utility of VFA in clinical practice.
Clinical and occult VF can be identified using VFA with dual-energy X-ray absorptiometry (DXA). The aim of this study was to investigate to what extent VFA-identified VF improve fracture risk prediction, independently of bone mineral density (BMD) and clinical risk factors used in FRAX.
A total of 2852 women, 75-80 years old, from the prospective population-based study SUPERB cohort, were included in this study. At baseline, BMD was measured by DXA, VF diagnosed by VFA, and questionnaires used to collect data on risk factors for fractures. Incident fractures were captured by X-ray records or by diagnosis codes. An extension of Poisson regression was used to estimate the association between VFA-identified VF and the risk of fracture and the 5- and 10-year probability of major osteoporotic fracture (MOF) was calculated from the hazard functions for fracture and death.
During a median follow-up of 5.15 years (IQR 4.3-5.9 years), the number of women who died or suffered a MOF, clinical VF, or hip fracture was 229, 422, 160, and 124, respectively. A VFA-identified VF was associated with an increased risk of incident MOF (hazard ratio [HR] = 1.78; 95% confidence interval [CI] 1.46-2.18), clinical VF (HR = 2.88; 95% [CI] 2.11-3.93), and hip fracture (HR = 1.67; 95% [CI] 1.15-2.42), adjusted for age, height, and weight. For women at age 75 years, a VFA-identified VF was associated with 1.2-1.4-fold greater 10-year MOF probability compared with not taking VFA into account, depending on BMD.
Identifying an occult VF using VFA has a substantial impact on fracture probability, indicating that VFA is an efficient method to improve fracture prediction in older women.
临床和隐匿性椎体骨折可以通过双能 X 射线吸收法（DXA）进行椎体骨折评估（VFA）来识别。本研究的目的是探讨 VFA 识别的 VF 在多大程度上可以提高骨折风险预测的准确性，而不考虑 FRAX 中使用的骨密度（BMD）和临床危险因素。
本研究共纳入了 2852 名年龄在 75-80 岁的前瞻性人群队列研究 SUPERB 队列的女性。基线时，使用 DXA 测量 BMD，通过 VFA 诊断 VF，并使用问卷调查收集骨折危险因素的数据。通过 X 射线记录或诊断代码捕获新发骨折。使用泊松回归扩展来估计 VFA 识别的 VF 与骨折风险之间的关联，并根据骨折和死亡的危险函数计算 5 年和 10 年主要骨质疏松性骨折（MOF）的概率。
在中位随访 5.15 年（IQR 4.3-5.9 年）期间，发生 MOF、临床 VF、髋部骨折或死亡的女性人数分别为 229、422、160 和 124。VFA 识别的 VF 与 MOF（危险比 [HR] = 1.78；95%置信区间 [CI] 1.46-2.18）、临床 VF（HR = 2.88；95% [CI] 2.11-3.93）和髋部骨折（HR = 1.67；95% [CI] 1.15-2.42）的发生风险增加相关，校正年龄、身高和体重后。对于 75 岁的女性，与不考虑 VFA 相比，VFA 识别的 VF 与 10 年 MOF 概率增加 1.2-1.4 倍，具体取决于 BMD。
使用 VFA 识别隐匿性 VF 对骨折概率有重大影响，这表明 VFA 是一种提高老年女性骨折预测准确性的有效方法。
