对老年男性进行重复骨密度筛查测量和骨折预测：一项前瞻性队列研究。
Repeat Bone Mineral Density Screening Measurement and Fracture Prediction in Older Men: A Prospective Cohort Study.
机构信息
Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
出版信息
J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3877-e3886. doi: 10.1210/clinem/dgac324.
CONTEXT
Whether repeated bone mineral density (BMD) screening improves fracture prediction in men is uncertain.
OBJECTIVE
We evaluated whether a second BMD 7 years after the initial BMD improves fracture prediction in older men.
METHODS
Among 3651 community-dwelling men (mean age 79.1 years) with total hip BMD at baseline and Year 7 (Y7), self-reported fractures after Y7 were confirmed by radiographic reports. Fracture prediction assessed using Cox proportional hazards regression and logistic regression with receiver operating characteristic curves for models based on initial BMD, BMD change, and the combination of initial BMD and BMD change (combination model).
RESULTS
During an average follow-up of 8.2 years after Y7, 793 men experienced ≥ 1 clinical fractures, including 426 men with major osteoporotic fractures (MOF) and 193 men with hip fractures. Both initial BMD and BMD change were associated with risk of fracture outcomes independent of each other, but the association was stronger for initial BMD. For example, the multivariable hazard ratio of MOF in the combination model per 1 SD decrement in BMD was 1.76 (95% CI 1.57-1.98) for initial BMD and 1.19 (95% CI 1.08-1.32) for BMD change. Discrimination of fracture outcomes with initial BMD models was somewhat better than with BMD change models and similar to combination models (AUC value for MOF 0.68 [95% CI 0.66-0.71] for initial BMD model, 0.63 [95% CI 0.61-0.66] for BMD change model, and 0.69 [95% CI 0.66-0.71] for combination model).
CONCLUSION
Repeating BMD after 7 years did not meaningfully improve fracture prediction at the population level in community-dwelling older men.
背景
重复骨密度（BMD）筛查是否能改善男性骨折预测尚不确定。
目的
我们评估了在老年男性中，初始 BMD 后 7 年再次进行 BMD 检查是否能改善骨折预测。
方法
在 3651 名基线和第 7 年（Y7）时均有全髋 BMD 的社区居住男性中，通过放射报告确认 Y7 后发生的自我报告骨折。使用 Cox 比例风险回归和逻辑回归评估骨折预测，采用受试者工作特征曲线评估基于初始 BMD、BMD 变化和初始 BMD 和 BMD 变化联合（联合模型）的模型。
结果
在 Y7 后平均 8.2 年的随访期间，793 名男性发生≥1 次临床骨折，包括 426 名男性有主要骨质疏松性骨折（MOF）和 193 名男性有髋部骨折。初始 BMD 和 BMD 变化均与骨折结局风险独立相关，但初始 BMD 的相关性更强。例如，联合模型中 BMD 每降低 1 SD，MOF 的多变量危险比为 1.76（95%CI 1.57-1.98），而 BMD 变化的危险比为 1.19（95%CI 1.08-1.32）。初始 BMD 模型对骨折结局的区分度略优于 BMD 变化模型，与联合模型相似（MOF 的 AUC 值为初始 BMD 模型 0.68（95%CI 0.66-0.71），BMD 变化模型 0.63（95%CI 0.61-0.66），联合模型 0.69（95%CI 0.66-0.71））。
结论
在社区居住的老年男性中，7 年后重复 BMD 检查在人群水平上并未显著改善骨折预测。
Zotero 插件