骨折风险评估工具(FRAX(R))在评价绝经后女性骨密度的临床意义

摘要

目的 探讨骨折风险评估工具(FRAX(R))在评价绝经后女性骨密度变化中的作用.方法 2014年12月至2015年12月完成双能X线骨密度测定的绝经后女性166例,问卷采集信息,应用FRAX计算代入或不代入股骨颈骨密度时各研究对象10年内骨质疏松性骨折概率,并结合骨密度测定结果、OSTA及IOF 1 min测试题进行统计学分析.结果 ①骨量异常组年龄较高、体重较轻、BMI较低、身高变化较多、绝经年限较长,两组间具有既往骨折史的人数差异有统计学意义.②有或无BMD时,骨量异常组10年内骨质疏松性骨折概率均显著高于骨量正常组.③有或无股骨颈BMD时,FRAX(R)预测值与股骨颈骨密度T值之间均呈显著负相关,而有和无股骨颈BMD的FRAX(R)预测值之间呈显著正相关.④随着年龄或骨质疏松风险的增长,骨量异常发生率逐渐上升,10年内骨质疏松性骨折概率显著升高.⑤不代入BMD时,10年内主要骨质疏松性骨折概率识别骨量异常的ROC曲线的AUC为0.705(P＜0.001),cutoff值为3.75％,准确度为中等;10年内髋骨骨折概率识别骨量异常的ROC曲线的AUC为0.743(P＜0.001),cutoff值为1.75％,准确度中等.结论 FRAX(R)能够反映机体骨密度变化,全面评估骨折风险,并可作为一项基本的筛检工具,应用于识别绝经后女性骨质疏松的高危人群.%Objective To investigate the effect of WHO Fracture Risk Assessment Tool (FRAX?) on the change of bone mineral density (BMD) in postmenopausal women.Methods-BMD of 166 postmenopausal women was measured using dual energy x-ray absorptiometry from December 2014 to December 2015.All risk factors were collected from subjects requested in the FRAX? assessment.The 10-year probability of major fracture and hip fracture of each individual was calculated by the FRAX? algorithms of Chinese model (with and without BMD).The statistical analysis was performed with a SPSS software.Results (1) The patients with abnormal bone mass had elder age,lighter weight,lower BMI,more reduction in height,longer menopause duration than those in the normal group.The number of people with history of fractures was significantly different between the two groups.(2) The 10-year probability of fractures in abnormal bone mass group was higher than that in normal group,with or without BMD.(3) The FRAX? prediction of fracture (with or without BMD) was negatively correlated with T values of the femoral neck (P ＜ 0.01),and there was a positive correlation between BMD and the FRAX? prediction of fracture with or without BMD (P ＜ 0.01).(4) Along with the increase of age or osteoporosis-risk,the incidence of osteopenia and osteoporosis increased,and higher 10-year probability of osteoporotic fracture was observed (P ＜ 0.01).(5) Receiver operating characteristic curve analysis showed that PMOF without BMD (AUC:0.705,cutoff 3.5％,P＜0.001) andPHF without BMD (AUC:0.743,cutoff 1.5％,P＜0.001) could identifyabnormal BMD in postmenopausal women.Conclusion The application of the FRAX~ tool can reflect the change of BMD andevaluate the risk of osteoporosis.It can also be a primary screen tool for recognizing high risk population in postmenopausal women.