Contributions of bone density and structure to fracture risk assessment in men and women
Contributions of bone density and structure to fracture risk assessment in men and women
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DOI：
10.1007/s00198-004-1820-1
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发表时间：
2005-05-01
影响因子：
4
通讯作者：
Riggs, BL
中科院分区：
文献类型：
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作者：
Melton, LJ;Beck, TJ;Riggs, BL
虽然骨密度(BMD)是骨折的有力预测指标，但它只是骨强度的替代指标。骨结构参数现在可以通过骨密度扫描进行测量，但尚不清楚它们是否对风险评估更有用。我们使用髋关节结构分析程序测量了结构参数，并与标准的髋部骨密度相比较，评估了它们与骨折风险之间的关系，该样本以人群为基础，包括213名绝经后女性和200名男性，年龄≥为50岁。总体而言，38%的女性和27%的男性因中度创伤(一半涉及髋部、脊柱或前臂远端)而经历过骨折，而分别有23%和36%的人曾因严重创伤而骨折。在调整年龄的Logistic回归分析中，髋部骨密度和结构参数总体上都与中度创伤骨折相关，特别是在女性中，但在多因素模型中，最好的预测因素是股骨颈骨密度(优势比[OR]，2.8；95%可信区间[CI]，1.9-4.0)。然而，骨密度和结构参数有很强的相关性，而且可以互换，预测能力几乎没有降低。这些变量对男性中度创伤骨折的预测性较差。最佳模型包括年龄(OR每10年，1.5；95%CI，1.1~2.1)、股骨颈截面弹性系数(OR，1.6；95%CI，1.1~2.5)和股骨粗隆间屈曲比(OR，1.6；95%CI，1.3~2.0)。对身体大小的修正并没有改变这些关系。结构参数可以很好地预测严重创伤引起的骨折：女性股骨颈屈曲率(OR，1.2；95%CI，1.04-1.5)和男性股骨粗隆间屈曲率(OR，1.4；95%CI，1.2-1.6)。这些数据表明，通过双能X射线骨密度仪评估的选定结构变量在预测骨折风险方面将与标准骨密度测量一样好。然而，由于强相关性，可以使用一些判断来选择最容易测量的变量。
Although bone mineral density (BMD) is a strong predictor of fractures, it is only a surrogate for bone strength. Bone structural parameters can now be measured on BMD scans, but it is unclear whether they would be more useful for risk assessment. We measured structural parameters using the Hip Structural Analysis Program and evaluated their association, compared with standard hip BMD, with fracture risk in a population-based sample of 213 postmenopausal women and 200 men ≥ 50 years of age. Altogether, 38% of the women and 27% of the men had experienced a fracture due to moderate trauma ( half involved hip, spine or distal forearm), while 23% and 36%, respectively, had a previous fracture due to severe trauma. In logistic regression analyses adjusted for age, the hip BMD and structural parameters were all associated with moderate trauma fractures generally, and osteoporotic fractures specifically, in women, but the best predictor in a multivariate model was femoral neck BMD ( odds ratio [ OR], 2.8; 95% confidence interval [CI], 1.9 - 4.0). BMD and the structural parameters were strongly correlated, however, and could be interchanged with little reduction in predictive power. These variables were less predictive of moderate trauma fractures in men. The best model included age ( OR per 10 years, 1.5; 95% CI, 1.1 - 2.1), femoral neck section modulus ( OR, 1.6; 95% CI, 1.1 - 2.5) and intertrochanteric buckling ratio ( OR, 1.6; 95% CI, 1.3 - 2.0). Correction for body size did not alter these relationships. Fractures due to severe trauma were best predicted by structural parameters: in women, femoral neck buckling ratio ( OR, 1.2; 95% CI, 1.04 - 1.5) and, in men, intertrochanteric buckling ratio ( OR, 1.4; 95% CI, 1.2 - 1.6). These data suggest that selected structural variables as assessed by dual-energy X-ray absorptiometry would be as good as standard BMD measurements for predicting fracture risk. Because of the strong correlations, however, some judgment can be used in selecting the variables easiest to measure.