虚拟切片为即将发生的骨折风险提供处置时机


  【24drs.com】一篇新的前瞻研究指出,藉由高分辨率周边定量计算机断层(HRPQCT, Scanco Medical公司)进行的远端桡骨虚拟切片,可以比股骨颈骨质密度检查(BMD)或使用骨折风险评估工具(FRAX)更能确认妇女即将发生的骨折风险。
  
  法国里昂大学Roland Chapurlat博士表示,大多数研究着眼于骨折的长期风险,当然,这是重要的,不过,最需要治疗的是那些即将有骨折风险者。
  
  我们根据皮质孔隙度和骨小梁密度发展出结构脆弱性评分(SFS),这两者都是结构脆弱性的指标,我们发现,曾发生骨折妇女的SFS分数较高,在9年追踪期间,对于即将发生骨折以及其它所有骨折类型,也是如此。
  
  Chapurlat博士在美国骨骼与矿物质研究协会2016年会中发表此研究。
  
  会议共同主持人、南丹麦大学的Bo Abrahamsen博士受邀对研究发表评论时认为,得以快速评估患者即将发生骨折之风险将是有用的临床工具,至少,我们有快速作用的药物。
  
  不过,Abrahamsen博士提醒,HRPQCT主要还是一项研究工具,且只有一些学术中心有。
  
  所以,这还不是标准设备。为了取得影像,你需要精良的设备、且目前比双能量x光吸收仪[DEXA]贵得多,因此取得本项测试将比普遍的DEXA更受限。
  
  尽管如此,他注意到,有朝一日,如果这设备更广泛地被使用,这些扫描应该会更便宜。
  
  「Os des Femmes de Lyon (OFELY)」研究纳入589名42-90岁的停经后妇女,在9.4年追踪期间,135人发生偶发性骨折。
  
  处理影像遮蔽骨折状态。
  
  股骨颈BMD和FRAX分数—仅依赖临床变项预测患者10年时发生严重骨质疏松性骨折的可能性—在追踪的前两年内,也进行了评估,比较它们对于掌握妇女即将发生骨折之风险的能力。
  
  如同Chapurlat博士之报告,相较于没有骨折的对照组,发生骨折的135名妇女的SFS分数比较高。
  
  但是,股骨颈T-分数比较低,骨折者的平均分数为-1.6分,没有骨折的对照组的平均分数为-1.3分,而FRAX分数不出所料比较高,骨折者的平均分数为13.9分,没有骨折者的平均分数为10分(所有的终点P值皆为 .001)。
  
  比较SFS分数在约9.4年追踪期间预测所有骨折的能力,Chapurlat博士等人发现,相较于股骨颈BMD以及FRAX分数,SFS可多辨识26%以上即将发生的骨折风险。
  
  Chapurlat博士指出,此外,根据BMD和FRAX辨识[有骨折风险]的患者,90%也可由SFS掌握,不过,这与较高的伪阳性比率有关。
  
  对于所有即将发生的骨折,他指出,SFS多发现31%的患者有风险,此时,根据BMD和FRAX辨识的所有患者也可由SFS掌握,尽管伪阳性比率依旧略高于其它两项检测。
  
  如果将范围缩小到所有即将发生的重大骨质疏松性骨折,SFS分数可比BMD和FRAX多辨识45%即将有风险的患者。
  
  Chapurlat博士观察发现,同样的,由BMD和FRAX辨识的所有重大骨质疏松性骨折患者,也可由SFS掌握。
  
  Chapurlat博士结论指出,合并高孔隙率和低骨小梁密度(SFS)评估结构性恶化,可辨识妇女的所有骨折与所有即将发生之骨折的风险,包括9年追踪期间的严重骨质疏松性骨折,且它的表现优于股骨颈BMD或FRAX。他表示,HRPQCT 评估影像所须使用的软件应可在明年内上线。
  
  一旦获取影像,在SFS将只需要几分钟的时间即可达成。
  
  资料来源:http://www.24drs.com/
  
  Native link:Virtual Biopsy Provides Window Into Imminent Fracture Risk

Virtual Biopsy Provides Window Into Imminent Fracture Risk

By Pam Harrison
Medscape Medical News

ATLANTA — A "virtual biopsy" of the distal radius taken with the help of high-resolution peripheral quantitative computed tomography (HRPQCT, Scanco Medical) identifies women at risk for imminent fracture better than bone-mineral density (BMD) at the femoral neck or use of the fracture risk-assessment tool (FRAX), a new prospective study indicates.

"Most studies have looked at long-term risk of fracture, which is important, of course, but women who are most in need of treatment are those who are at imminent fracture risk," Roland Chapurlat, MD, PhD, from the University of Lyon, France, told Medscape Medical News.

"We developed the Structural Fragility Score (SFS) based on cortical porosity and trabecular density, both of which are markers of structural fragility, and we found that the SFS was greater in women who had sustained a previous fracture, and this was also the case for both imminent fracture and all other types of fracture that occurred during the 9-year follow-up."

The research was presented here by Dr Chapurlat during the annual meeting of the American Society of Bone and Mineral Research 2016 Annual Meeting.

Asked by Medscape Medical News to comment on the study, session cochair Bo Abrahamsen, MD, PhD, from the University of Southern Denmark, Odense, suggested that being able to quickly assess a patient's risk of imminent fracture would be a "useful clinical tool, at least insofar as we have medications that work quickly."

Dr Abrahamsen cautioned, however, that the HRPQCT is still largely a research tool and available only in limited numbers of academic centers.

"So this is not a standard piece of equipment. To acquire the image, you need sophisticated equipment that is currently much more expensive than [dual-energy X-ray absorptiometry] DEXA, so access to this test will likely be more limited than it is for plain DEXA," he noted.

Nevertheless, in time "these scans should become cheaper if the equipment is more widely used," he observed.

SFS Identifies More Imminent Fractures in OFELY Study

The Os des Femmes de Lyon (OFELY) study involved 589 postmenopausal women between 42 and 90 years of age. During 9.4 years of follow-up, 135 sustained an incident fracture.

Images were processed blind to fracture status.

Both the femoral neck BMD and FRAX scores — which rely on clinical variables alone to predict a patient's 10-year probability of having a major osteoporotic fracture — were also assessed to compare their ability to capture women at risk for imminent fracture within the first 2 years of follow-up.

As Dr Chapurlat reported, SFS scores were higher among the women who had sustained the 135 documented fractures, compared with nonfracture controls.

But the femoral neck T-score was lower, at a mean of -1.6 among fracture cases compared with a mean of -1.3 for nonfracture controls, while FRAX scores were predictably higher, at a mean of 13.9 for women who had a fracture compared with a mean of 10 for women who did not sustain a fracture (all end points P = .001).

Comparing the ability of the SFS to predict all fractures over the 9.4-year follow-up, Dr Chapurlat and colleagues found that the SFS identified 26% more patients at risk for imminent fracture than either BMD at the femoral neck and the FRAX score.

Further, "90% of patients identified on BMD and FRAX [at risk for any fracture] were also captured by the SFS, although this was associated with a slightly higher false-positive rate," Dr Chapurlat added.

For all imminent fractures, "the SFS identified 31% more patients at risk," and this time, "all patients identified by BMD and FRAX were also captured by the SFS, even though the false-positive rate was again a bit higher than it was for the other two tests," he noted.

Narrowed down to all impending major osteoporotic fractures, the SFS score identified 45% more patients who were at imminent risk of having a major osteoporotic fracture than BMD and FRAX did.

Again, all patients identified at risk for a major osteoporotic fracture by BMD and FRAX were also captured by SFS, as Dr Chapurlat observed.

"Assessment of structural deterioration by combining high porosity and low trabecular density (SFS) identifies women at risk for all fractures and all imminent fractures, including major osteoporotic fractures over 9 years of follow-up, and it performed better than either femoral neck BMD or FRAX," Dr Chapurlat concluded, adding that the software used to assess the images acquired by HRPQCT should be available online sometime next year.

Once images are acquired, "it will only take a few minutes to arrive at the SFS," he added.

Neither Dr Chapurlat nor Dr Abrahamsen had any relevant financial relationships.

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American Society of Bone and Mineral Research 2016 Annual Meeting. September 17, 2016; Atlanta, Georgia. Abstract 1076.

    
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