Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men
Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men
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DOI：
10.1002/jbmr.2713
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发表时间：
2016-03-01
影响因子：
6.2
通讯作者：
Ensrud, Kristine E.
中科院分区：
文献类型：
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作者：
Schousboe, John T.;Vo, Tien;Ensrud, Kristine E.
小梁骨评分 (TBS) 已被证明可以预测绝经后女性和老年男性的主要骨质疏松症（临床椎骨、髋部、肱骨和腕部）和髋部骨折，但 TBS 与男性中这些骨折事件的关联（独立于普遍的放射照相椎骨骨折）尚不清楚。 TBS 是通过对参加男性骨质疏松性骨折 (MrOS) 研究的 5979 名 65 岁男性进行基线访视时获得的前后位 (AP) 脊柱双能 X 射线吸收测量 (DXA) 扫描进行估计，并通过比例风险模型估计其与重大骨质疏松和髋部骨折事件的关联。使用 Harrell 的 C 统计量和分类净重分类改善指数对模型辨别力进行了测试，其中重大骨质疏松症的 10 年风险切点为 20%，髋部骨折的 10 年风险切点为 3%。 TBS 标准差每降低一次，重大骨质疏松性骨折的风险比为 1.27（95% 置信区间 [CI] 1.17 至 1.39），髋部骨折的风险比为 1.20（95% CI 1.05 至 1.39），根据 FRAX 与骨密度 (BMD) 10 年骨折风险和普遍的放射学椎体骨折进行调整。在同一模型中，与没有普遍放射学椎体骨折的患者相比，患有普遍放射学椎体骨折的患者发生严重骨质疏松性骨折的风险比为 1.92（95% CI 1.49 至 2.48），髋部骨折的风险比为 1.86（95% CI 1.26 至 2.74）。当 TBS、普遍的放射学椎体骨折状态或两者与 BMD 和年龄一起添加到 FRAX 中时，主要骨质疏松性骨折病例的分类分别提高了 3.3%、5.2% 和 6.2%，并且非病例正确分类的损失最小。 TBS 和普遍的影像学椎体骨折都没有改善对髋部骨折病例或非病例的区分。总之，TBS 和普遍的影像学椎体骨折与老年男性发生的重大骨质疏松性骨折和 FRAX 10 年骨折风险相互独立相关，这些数据支持将它们与 FRAX 结合使用来评估老年男性的骨折风险。 (c) 2015 年美国骨与矿物质研究学会。
Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged 65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other and FRAX 10-year fracture risks, and these data support their use in conjunction with FRAX for fracture risk assessment in older men. (c) 2015 American Society for Bone and Mineral Research.