不同模式骨折风险评估工具在绝经后女性的应用和评估

摘要

目的：评估应用不同模式骨折风险评估工具（ FRAX®）预测不同临床危险因子及股骨颈骨密度（ BMD）的T值情况下的绝经后女性10年骨折概率的差异，探讨各种模式筛选骨质疏松性骨折高危患者的能力。方法收集2011年2-8月在上海交通大学附属第六人民医院骨质疏松与骨病专科门诊就诊、年龄50~90岁、自然绝经且绝经时间＞1年、诊断为低骨量的女性患者769例，应用FRAX®的中国大陆、中国台湾、韩国、中国香港模式，计算骨折概率〔主要骨质疏松性骨折概率（ MOF）和髋部骨折概率（ HF）〕，同时综合年龄、身高和体质量，设定固定人群，计算单一危险因子、不同年龄和不同股骨颈BMD的T值条件下绝经后女性的10年骨折概率，筛选达到骨质疏松性骨折高危患者诊断标准的个体。结果 FRAX®中国大陆模式MOF、HF低于其他3种模式（ P＜0.01）。不同模式FRAX®设定年龄70岁绝经后女性，股骨颈BMD的T值为-2.0 SD，体质量60 kg，身高160 cm的人群，在无骨折危险因子的条件下，中国大陆模式10年MOF为4.6％、HF为1.4％，中国台湾模式分别为10.0％、3.2％，韩国模式分别为7.4％、2.3％，中国香港模式分别为9.0％、2.6％。各种骨折危险因子都增加了绝经后女性10年骨折概率。在55岁时，4种模式10年骨折概率相差不大，但在65、75、85岁时，中国大陆模式明显低于其他3种模式。4种模式的10年骨折概率均随着股骨颈BMD的T值升高而下降。结论 FRAX®中国大陆模式低估了10年骨折概率，不能早期发现骨折高风险人群。%Objective The aim of the present study was to evaluate the probability difference of osteoporotic fracture 10 years after postmenopausal predicted by different national version of the WHO fracture risk assessment tool( FRAX® )in case of different clinical risk and bone mineral density( BMD)T value of the femoral neck,and to explore the screening ability of pa-tients at high risk of osteoporotic fracture. Methods 769 cases visiting the department of osteoporosis and bone diseases in the Sixth Affiliated People's Hospital of Shanghai Jiaotong University from February to August,2011 who were 50-90,natural men-opause and at least one year,diagnosed with low bone mass were collected and calculated the probability of fracture( MOF and HF) during these 10 years by different FRAX® versions from Chinese Mainland,Taiwan,South Korea and Hong Kong,China and the fracture probability under the conditions of single risk factor,different ages and femoral neck BMD T value. The individu-als which achieved the diagnostic criteria of high risk with osteoporotic fractures were screened. Results 10-year fracture proba-bility of MOF and HF which was calculated by FRAX® version of Chinese Mainland version was significantly lower than those of Taiwan,South Korea and Hong Kong,China(P<0. 01). Under the condition that the age was 70,femoral neck BMD T value was-2. 0 SD,body weight was 60 kg and the height was 160 cm set by different FRAX® and in no case of fracture risk factors, MOF of HF of ten years were 4. 6% and 1. 4%( Chinese Mainland Model),10. 0% and 3. 2%( Taiwan Model),7. 4% and 2. 3%(South Korea Model),9. 0% and 2. 6%(Hong Kong,China Model). All kinds of facture risk factors increased the probability. At the age of 55,no obvious difference was found,but at 65,75 and 85 the fracture probability was significantly lower judged by Chinese Mainland Model than the other three. In addition,the probability of 10 years all decreased with the in-crease of femoral neck BMD T value by the four models. Conclusion The FRAX® of Chinese Mainland Model underestimates the 10-year fracture probability. It can not early detect the individuals with highly fracture risk.