Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: The EPISEM prospective cohort of 12,958 elderly women
Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: The EPISEM prospective cohort of 12,958 elderly women
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DOI：
10.1359/jbmr.080229
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发表时间：
2008-07-01
影响因子：
6.2
通讯作者：
Krieg, Marc-Antoine
中科院分区：
文献类型：
--
作者：
Hans, Didier;Durosier, Claire;Krieg, Marc-Antoine
这项研究旨在开发一种髋关节筛查工具，结合相关的临床危险因素(CRF)和脚后跟的定量超声(QUS)来确定老年女性髋部骨折的10年概率。EPISEM数据库由大约13,000名70岁的女性组成，来自法国和瑞士的两个以人口为基础的欧洲白人队列。所有女性都有CRF的基线数据，以及根据脚后跟QUS得出的僵硬指数(SI)的基线测量。对女性进行前瞻性跟踪，以确定意外骨折。多变量分析被用来确定对髋部骨折风险有显著贡献的CRF，这些CRF被用来产生CRF评分。计算CRF评分、SI和结合两者的风险梯度(GR；RR/SD变化)和受试者操作特征曲线下面积(AUC)。对于组合模型，计算了髋部骨折的10年概率。在平均3.2年的随访期内，共观察到三百零七个髋部骨折。除SI外，髋部骨折的重要CRF还有体重指数(BMI)、骨折史、座椅受损测试、最近跌倒史、当前吸烟和糖尿病。综合SI+CRF评分，髋部骨折平均GR为2.10分/SD，而单纯SI组GR为1.77分，CRF评分为1.52分。因此，CRF的使用单独提高了SI的预测价值。例如，在一名80岁的女性中，两到四个CRF的存在分别将SI Z评分为+2和-3的髋部骨折的概率从16.9%增加到26.6%，从52.6%增加到70.5%。CRFS和QUSSI的联合使用是评估老年女性髋部骨折概率的一种有前景的工具，特别是在DXA有限的情况下。
This study aimed to develop a hip screening tool that combines relevant clinical risk factors (CRFs) and quantitative ultrasound (QUS) at the heel to determine the 10-yr probability of hip fractures in elderly women. The EPISEM database, comprised of similar to 13,000 women >= 70 yr of age, was derived from two population-based white European cohorts in France and Switzerland. All women had baseline data on CRFs and a baseline measurement of the stiffness index (SI) derived from QUS at the heel. Women were followed prospectively to identify incident fractures. Multivariate analysis was performed to determine the CRFs that contributed significantly to hip fracture risk, and these were used to generate a CRF score. Gradients of risk (GR; RR/SD change) and areas under receiver operating characteristic curves (AUC) were calculated for the CRF score, SI, and a score combining both. The 10-yr probability of hip fracture was computed for the combined model. Three hundred seven hip fractures were observed over a mean follow-up of 3.2 yr. In addition to SI, significant CRFs for hip fracture were body mass index (BMI), history of fracture, an impaired chair test, history of a recent fall, current cigarette smoking, and diabetes mellitus. The average GR for hip fracture was 2.10 per SD with the combined SI + CRF score compared with a GR of 1.77 with SI alone and of 1.52 with the CRF score alone. Thus, the use of CRFs enhanced the predictive value of SI alone. For example, in a woman 80 yr of age, the presence of two to four CRFs increased the probability of hip fracture from 16.9% to 26.6% and from 52.6% to 70.5% for SI Z-scores of +2 and -3, respectively. The combined use of CRFs and QUS SI is a promising tool to assess hip fracture probability in elderly women, especially when access to DXA is limited.