Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women - The study of osteoporotic fractures
Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women - The study of osteoporotic fractures
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DOI：
10.1001/archinte.167.2.155
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发表时间：
2007-01-22
影响因子：
--
通讯作者：
Cummings, Steve R.
中科院分区：
文献类型：
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作者：
Hillier, Teresa A.;Stone, Katie L.;Cummings, Steve R.
背景资料：是否重复骨矿物质密度（BMD）的测量增加的好处超出了最初的BMD测量预测骨折在老年women.Methods：我们前瞻性地测量了4124老年妇女（平均值+/- SD年龄，72 +/- 4岁）从1989年至1990年和8年后再次髋关节BMD。非创伤性髋关节和非脊柱骨折事件通过放射学报告进行验证（> 95%随访）。此外，1991年至1992年以及11.4年后再次通过脊柱侧位X线片对其中2129名妇女进行了形态测量学定义。骨折风险的预测进行了评估与比例风险模型和接收器操作特征曲线BMD measurements.Results：平均超过5年后，重复BMD测量，877名妇女经历了一个意外的非创伤性非脊柱骨折（275髋骨折）。此外，340名妇女发生脊柱骨折。校正年龄和体重变化后，初始和重复BMD测量与非脊柱骨折（风险比，1.6）、脊柱骨折（比值比，1.8-1.9）和髋部骨折（风险比，2.0-2.2）的骨折风险（BMD每单位标准差降低）相似（所有模型P <0.001）。受试者工作特征曲线（AUC）下的面积显示，在初始BMD、重复BMD或初始BMD加上BMD变化的模型之间，区分非脊柱（AUC，0.65）、脊柱（AUC，0.67-0.68）或髋部（AUC，0.73-0.74）骨折没有显著差异。分层的初始BMD的t评分（正常，骨质减少，或骨质疏松），高骨丢失，或激素治疗并没有改变results.Conclusion：在健康，老年，绝经后妇女，重复测量的BMD长达8年后提供了一点额外的价值，除了最初的BMD测量预测事件骨折。
Background: Whether repeat bone mineral density (BMD) measurement adds benefit beyond the initial BMD measurement in predicting fractures in older women is unknown.Methods: We prospectively measured total hip BMD in 4124 older women (mean +/- SD age, 72 +/- 4 years) from 1989 to 1990 and again 8 years later. Incident nontraumatic hip and nonspine fractures were validated by radiology reports (> 95% follow-up). In addition, spine fractures were defined morphometrically in 2129 of these women by lateral spine x-ray films from 1991 to 1992 and then again 11.4 years later. Prediction of fracture risk was assessed with proportional hazards models and receiver operating characteristic curves for BMD measures.Results: Over a mean of 5 years after the repeat BMD measure, 877 women experienced an incident nontraumatic nonspine fracture (275 hip fractures). In addition, 340 women developed a spine fracture. After adjustment for age and weight change, initial and repeat BMD measurements were similarly associated with fracture risk (per unit standard deviation lower in BMD) for nonspine (hazard ratio, 1.6), spine (odds ratio, 1.8-1.9), and hip (hazard ratio, 2.0-2.2) fractures (P < .001 for all models). Areas under the receiver operating characteristic curves (AUC) revealed no significant differences to discriminate nonspine (AUC, 0.65), spine (AUC, 0.67-0.68), or hip (AUC, 0.73-0.74) fractures between models with initial BMD, repeat BMD, or initial BMD plus change in BMD. Stratification by initial BMD t scores (normal, osteopenic, or osteoporotic), high bone loss, or hormone therapy did not alter results.Conclusion: In healthy, older, postmenopausal women, repeating a measurement of BMD up to 8 years later provides little additional value besides the initial BMD measurement for predicting incident fractures.