FRAX及OSTA指数在绝经后骨质疏松风险评估中的作用

摘要

目的 分析骨折风险因子评估工具(FRAX)及亚洲人骨质疏松自我筛查工具(OSTA)指数在绝经后骨质疏松风险中的评估作用,为提高绝经后骨质疏松症早期诊断准确性提供帮助,指导治疗.方法 2015年2月至2016年2月选取绝经后女性120例,采集患者一般资料、病史资料、腰椎L2-4以及大转子骨等骨密度,计算OSTA指数及FRAX(不合骨密度模型)指数的10年髋部骨折风险(HF)及主要骨质疏松骨折风险(M0).对比不同体重指数患者FRAX及OSTA;对比骨质疏松和非骨质疏松患者FRAX及OSTA;分析FRAX及OSTA与腰椎L2-4以及大转子骨等骨密度的关系;绘制ROC曲线评估两个指数预测绝经后骨质疏松的价值.结果 超重及肥胖组OSTA指数较体重正常组高;骨质疏松组与非骨质疏松组OSTA及FRAX指数(HF、MO)差异显著;OSTA评分与腰椎L2-4、Wards三角、股骨颈骨密度、大转子骨密度呈正相关,分别为r=0.435、r=0.411、r=0.499、r=0.500.MO、HF与腰椎L2-4、Wards三角、股骨颈骨密度、大转子骨密度相关呈负相关,MO:分别为r=-0.535、r=-0.702、r=-0.812、r=-0.733,HF为r=-0.463、r=-0.657、r=-0.721、r=-0.345;OSTA指数、HF、MO预测绝经后骨质疏松的特异度和灵敏度分别为56.50％和85.62％、87.44％和82.30％、87.50％和80.25％.P均＜0.05.结论 OSTA及FRAX均可协助绝经后女性骨质疏松识别,指导预防和治疗,应用前景广阔.%Objective To analyze and assess the role of FRAX and OSTA indexes in assessment of risk of postmenopausal osteoporosis in order to raise the accuracy of early diagnosis of osteoporosis in postmenopausal women and to provide the assistance in guidence of treatment.Methods The general information,history of the disease,bone mineral density of L2-4 and greater trocchanter,OSTA index and FRAX index,10 year risk of hip fracture (HF) and major risk of osteoporotic fracture in 120 postmenopausal women during February 2015 to February 2016 were collected,after selecting 120 patients with general information gathering,medical history,bone mineral density of lumbar L2-4 and greater trochanter,combined with its Asian osteoporosis related calculation of self-screening (OSTA) index and fracture risk factor assessment tool (FRAX,excluding mineral density model),10-year risk of hip fracture (HF) and major osteoporotic fracture (MO).Contrast index in patients with different weight indices FRAX and OSTA;and non-contrast osteoporosis and FRAX osteoporotic patients OSTA;and analysis of the relationship between FRAX and OSTA and bone mineral density of lumbar L2-4 and greater trochanter;drawing ROC curve to assess the forecast value of two indices for postmenopausal osteoporosis.Results OSTA index in patients of overweight and obese group compared with that of normal weight group,OSTA index was high;and the difference in OSTA and FRAX indices (HF ＜ MO) in osteoporosis group and non-osteoporosis group was significant;OSTA scores and lumbar L2-4,Wards triangle,femoral neck bone mineral density and trochanter BMD were positively correlated,r =0.435,r =0.411,r =0.499 and r =0.500 respectively.MO,HF and lumbar L2-4,Wards triangle,femoral neck and trochanter BMD were negatively correlated,and major osteoporotic fracture risks (MO) were r =-0.535,r =-0.702,r =-0.812 and r =-0.733 respectively,risks of hip fracture (HF) were r =-0.463,r =-0.657,r =-0.721 and r =-0.345 respectively;the predictive sensitivity and specificity of OSTA index,HF,post-menopausal osteoporosis (MO) were 56.50％ and 85.62％,87.44％ and 82.30％,87.50％ and 80.25％ respectively (P ＜ 0.05).Conclusion OSTA and FRAX can assist the identification of osteoporosis in postmenopausal women,they are helpful in guidence of prevention and treatment of the disease,hence they have wide application for guidance.