Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of General Internal Medicine, McGill University, Montreal, Quebec, Canada.
J Bone Miner Res. 2022 Oct;37(10):2018-2024. doi: 10.1002/jbmr.4672. Epub 2022 Sep 7.
The Fracture Risk Assessment Tool (FRAX®) combines clinical risk factors and optionally femoral neck bone density to estimate major osteoporotic fracture (MOF) and hip fracture probability. Hip dual-energy X-ray absorptiometry (DXA) simultaneously measures the trochanter and total hip, but these regions are not considered by FRAX. Our aim was to determine whether discordance in trochanter and total hip bone density (defined as ≥1 T-score difference from the femoral neck) affects fracture risk adjusted for fracture probability. Using the Manitoba bone density registry, we identified 84,773 women and men age 40 years or older undergoing baseline hip DXA. The outcomes were incident MOF and hip fracture. Cox regression hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for baseline fracture probability were used to test the association between hip T-score discordance and incident fractures. Hip T-score discordance affected more than one in five subjects (trochanter lower in 3.9%, higher in 14.2%; total hip lower in 0.3%, higher in 14.9%). After mean 8.8 years there were 8444 incident MOF including 2664 hip fractures. Discordantly lower trochanter and lower total hip T-score (≥1 below femoral neck) was associated with increased risk for MOF (adjusted HRs 1.47 and 1.60) and hip fracture (HRs 1.85 and 2.12), while discordantly higher trochanter and total hip T-score (≥1 above femoral neck) was associated with lower risk for MOF (HRs 0.83 and 0.71) and hip fracture (HRs 0.79 and 0.68). In models that examined the trochanter and total hip simultaneously, discordantly lower trochanter T-score was associated with increased incident MOF and hip fracture risk (HRs 1.43 and 1.79) whereas discordantly higher total hip T-score was associated with lower risk (HRs 0.73 and 0.75). In conclusion, trochanter and total hip regions frequently show T-scores that are discordant with the femoral neck. This information strongly affects incident fracture risk independent of fracture probability scores computed with femoral neck bone density. © 2022 American Society for Bone and Mineral Research (ASBMR).
骨折风险评估工具 (FRAX®) 结合临床风险因素和股骨颈骨密度，估算主要骨质疏松性骨折 (MOF) 和髋部骨折的概率。髋关节双能 X 射线吸收法 (DXA) 同时测量转子和全髋关节，但 FRAX 不考虑这些部位。我们的目的是确定转子和全髋关节骨密度（定义为与股骨颈相差≥1 T 评分）的差异是否会影响骨折风险校正后的骨折概率。我们使用马尼托巴骨密度登记处，确定了 84773 名年龄在 40 岁或以上进行基线髋关节 DXA 的女性和男性。结果是 MOF 和髋部骨折的发生率。使用 Cox 回归风险比 (HR) 和 95%置信区间 (CI) 对基线骨折概率进行调整，以检验髋关节 T 评分差异与骨折发生率之间的关系。髋关节 T 评分差异影响了五分之一以上的患者（转子处骨密度较低的占 3.9%，较高的占 14.2%；全髋关节骨密度较低的占 0.3%，较高的占 14.9%）。在平均 8.8 年后，发生了 8444 例 MOF，其中包括 2664 例髋部骨折。转子和全髋关节 T 评分不一致（低于股骨颈 1 分以上）与 MOF（调整后的 HRs 1.47 和 1.60）和髋部骨折（HRs 1.85 和 2.12）的风险增加相关，而转子和全髋关节 T 评分不一致（高于股骨颈 1 分以上）与 MOF（HRs 0.83 和 0.71）和髋部骨折（HRs 0.79 和 0.68）的风险降低相关。在同时检查转子和全髋关节的模型中，转子 T 评分不一致与 MOF 和髋部骨折的发生率增加相关（HRs 1.43 和 1.79），而全髋关节 T 评分不一致与风险降低相关（HRs 0.73 和 0.75）。总之，转子和全髋关节部位的 T 评分经常与股骨颈不一致。这一信息对骨折发生率有很大影响，独立于基于股骨颈骨密度计算的骨折概率评分。2022 年美国骨矿研究学会（ASBMR）。
