Future Osteoporotic Fracture Risk Related to Lumbar Vertebral Trabecular Attenuation Measured at Routine Body CT.
Future Osteoporotic Fracture Risk Related to Lumbar Vertebral Trabecular Attenuation Measured at Routine Body CT.
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DOI：
10.1002/jbmr.3383
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Pickhardt PJ
中科院分区：
文献类型：
--
作者：
Lee SJ;Graffy PM;Zea RD;Ziemlewicz TJ;Pickhardt PJ
我们试图确定在常规身体CT扫描上测量的各种不相关适应症的椎体骨小梁衰减值是否可以预测未来多个骨骼部位的骨质疏松性骨折。对于这项符合HIPAA标准并经IRB批准的回顾性队列研究，测量了1966名连续老年人的第一腰椎骨小梁衰减，这些老年人在一年内在一家机构接受了胸部和/或腹部CT。通过使用ICD-9编码的脊椎、髋部和四肢骨折的电子健康记录数据库查询，确定患者CT研究日期后发生的新发病理性脆性骨折。进行单变量和多变量考克斯比例风险回归，以确定L1小梁衰减对无瘤生存率的影响。CT检查时的年龄、性别和既往脆性骨折作为混杂因素纳入多变量生存分析。通过计算优化校正的一致性指数来评估模型的区分能力。最终分析共纳入507例患者（平均年龄73.4 ± 6.3岁; 277例女性，230例男性）。中位CT后随访间隔为5.8年（四分位距2.1 - 11.0年）。单变量分析显示，L1衰减值≤ 90 HU与无瘤生存率降低显著相关（对数秩检验p <0.001）。在调整了年龄、性别、既往骨折、糖皮质激素使用、双膦酸盐使用、慢性肾脏疾病、烟草使用、酒精滥用、癌症史和类风湿性关节炎史后，多变量分析表明L1衰减对无瘤生存率的持续适度影响（HR：0.63/10单位增加; 95%CI：0.47 - 0.85）。模型一致性指数为0.700。在观察到的L1 HU范围内，大多数子队列的严重骨关节炎相关骨折的10年概率跨越治疗阈值。总之，对于因任何适应症接受全身CT扫描的患者，L1椎体骨小梁衰减是一种简单的测量方法，当≤ 90 HU时，可识别无骨折生存率显著降低的患者。
We sought to determine if vertebral trabecular attenuation values measured on routine body CT scans obtained for a variety of unrelated indications can predict future osteoporotic fractures at multiple skeletal sites. For this HIPAA-compliant and IRB-approved retrospective cohort study, trabecular attenuation of the first lumbar vertebra was measured in 1966 consecutive older adults who underwent chest and/or abdominal CT at a single institution over the course of one year. New pathologic fragility fractures that occurred after a patient’s CT study date were identified through an electronic health record database query using ICD-9 codes for vertebral, hip, and extremity fractures. Univariate and multivariate Cox proportional hazards regression were performed to determine the effect of L1 trabecular attenuation on fracture-free survival. Age at CT, gender, and presence of a prior fragility fracture were included as confounders in multivariate survival analysis. Model discriminative capability was assessed through calculation of an optimism-corrected concordance index. A total of 507 patients (mean age 73.4 ± 6.3 years; 277 women, 230 men) were included in the final analysis. The median post-CT follow-up interval was 5.8 years (interquartile range 2.1 – 11.0 years). Univariate analysis showed that L1 attenuation values ≤90 HU are significantly associated with decreased fracture-free survival (p< 0.001 by log-rank test). After adjusting for age, gender, prior fracture, glucocorticoid use, bisphosphonate use, chronic kidney disease, tobacco use, ethanol abuse, cancer history, and rheumatoid arthritis history, multivariate analysis demonstrated a persistent modest effect of L1 attenuation on fracture-free survival (HR: 0.63 per 10-unit increase; 95% CI: 0.47 – 0.85). The model concordance index was 0.700. Ten-year probabilities for major osteoporosis-related fractures straddled the treatment threshold for most sub-cohorts over the observed L1 HU range. In conclusion, for patients undergoing body CT scanning for any indication, L1 vertebral trabecular attenuation is a simple measure that, when ≤90 HU, identifies patients with a significant decrease in fracture free survival.
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影响因子：
2.8
作者：
Emohare, Osa;Dittmer, Alison;Polly, David W., Jr.
通讯作者：
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影响因子：
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作者：
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