骨质疏松症:依年龄即可预测骨折


  【24drs.com】一篇比较研究发现,单纯依照妇女的年纪即可预测她的骨质疏松骨折风险,和多因素、正式的风险预测模式一样有效。
  
  宾州Reading医院内科与妇产科Xuezhi Jiang医师等人在10月的妇产科(Obstetrics & Gynecology)期刊中写道,但这不意味著目前只需要考虑年纪。
  
  虽然年龄不应该被单独作为骨折的一个独立预测因子,此次研究的资料认为,当评估骨质疏松病患之筛检与治疗时,应谨慎考量年龄因素;不过,并不建议放弃骨质疏松性骨折的预测模型,因为目前还没有更好的替代模式。
  
  他们的研究对象是615名停经年龄的妇女,年龄大于65岁被视为预测骨质疏松性骨折风险的一个显著因素,且与世界卫生组织骨折风险评估工具及北美停经协会2006-2010年骨质疏松治疗指引一样,是可以信赖的预测因子。
  
  这个世代中,共有15名妇女发生骨折,她们的平均年纪是70.7岁,没有发生骨折者为61.2岁,这个差异达统计上的显著意义(P < .001);这15名发生骨折的妇女超过半数(60%)被诊断有骨质疏松,没有骨折的600名妇女则是仅10%有这项诊断(P < .001)。
  
  单看年龄即是骨折的一个显著预测因子(曲线下面积(AUC)为0.79;95%信心区间[CI],0.67 - 0.91;P < .001)。以65岁为最佳的临界点,达80%敏感度以及73%专一性。相较之下,骨折风险评估工具的AUC是0.76 (95% CI,0.64 - 0.89),北美停经协会2010年骨质疏松治疗指引的AUC则是0.77 (95% CI,0.66 - 0.88)。
  
  校正种族、抽菸、使用类固醇、母亲髋骨骨折、类风湿性关节炎之后,相较于65岁以下停经妇女,较年长妇女的骨折校正胜算比为10.2。
  
  研究者发现,这15名妇女中,9人有骨折风险评估工具中需要治疗的明确骨折风险。同样地,根据北美停经协会2006年和2010年骨质疏松治疗指引,分别有其中9和12名妇女需要治疗。
  
  作者们写道,在我们的分析中,这三种预测模式都是预测骨折的有效工具。不过,看来这些模式都没有比单纯依照年龄更佳, 资料认为,年龄至少和北美停经协会2010年骨质疏松治疗指引以及骨折风险评估工具和[骨质密度]是一样好的骨折预测因子。
  
  Jiang医师等人在2007年1月1日至2009年3月1日间招募了49岁以上妇女进行研究,因为这是回溯型研究,所有妇女在参与研究之前就发生了骨折,这是相当大的研究限制,根据作者指出,未来需要进行前瞻型研究,以优化筛选工具,并进一步验证目前的风险预测模型。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7017&x_classno=0&x_chkdelpoint=Y
  

Osteoporosis: Age Alone Good Predictor of Fractures

By Damian McNamara
Medscape Medical News

A woman's age alone might predict her risk for osteoporotic fractures as effectively as more comprehensive, official risk prediction models would, a comparison study reveals.

This does not mean, however, that age alone should be considered at this point, Xuezhi Jiang, MD, from the Department of Obstetrics-Gynecology and the Department of Internal Medicine at the Reading Hospital in Pennsylvania, and colleagues write in the October issue of Obstetrics & Gynecology.

"Although age alone should not be used as an independent predictor of fractures, data from this study suggest that age should be carefully considered when evaluating patients for osteoporosis screening and treatment," they write.

"[I]t is not recommended to abandon the osteoporotic fracture prediction models, because there is no better alternative model available currently," they add.

In their study of 615 menopausal-age women, age greater than 65 years emerged as a significant predictor of osteoporotic fracture risk and was as reliable a predictor as the World Health Organization Fracture Risk Assessment Tool and the North American Menopause Society osteoporosis treatment guidelines from 2006 and 2010.

A total of 15 women in this cohort experienced a fracture. Their mean age was 70.7 years vs 61.2 years among those without a fracture history. The difference was statistically significant (P < .001). More than half of the 15 women who had a fracture (60%) were also diagnosed with osteoporosis compared with 10% of the 600 fracture-free women (P < .001).

Age alone is a significant predicting factor for fracture (area under the curve (AUC), 0.79; 95% confidence interval [CI], 0.67 - 0.91; P < .001). Using an optimal cutoff at age 65 years produced a sensitivity of 80% and a specificity of 73%. In comparison, the AUC for the Fracture Risk Assessment Tool was 0.76 (95% CI, 0.64 - 0.89), and the AUC for the North American Menopause Society Treatment Guideline 2010 was 0.77 (95% CI, 0.66 - 0.88).

Compared with postmenopausal women younger than 65 years, the adjusted odds ratio for fracture in older women was 10.2, after adjusting for race, smoking, steroid use, parent hip fracture, and rheumatoid arthritis.

The researchers determined that 9 of the 15 women carried a sufficient fracture risk to require treatment according to the Fracture Risk Assessment Tool. Similarly, 9 and 12 of the women would require treatment according to the North American Menopause Society position statements from 2006 and 2010, respectively.

"In our analysis, all three prediction models were effective tools for predicting fractures," the authors write. "However, it appears that all of these models are no better predictors of fracture than age alone. The data indicate that age may be at least as good of a fracture predictor as the North American Menopause Society 2010 guidelines and the Fracture Risk Assessment Tool with [bone mineral density]."

Dr. Jiang and colleagues recruited women older than 49 years for the study between January 1, 2007, and March 1, 2009. Because the study was retrospective, all women who had a fracture experienced it before entry into the study, which is a potential limitation. Future, prospective studies are warranted, according to the authors, to optimize a screening instrument and to further validate current risk prediction models.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2013;122:1040-1046.

    
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