Can hip fracture prediction in women be estimated beyond bone mineral density measurement alone?
Can hip fracture prediction in women be estimated beyond bone mineral density measurement alone?
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DOI：
10.1177/1759720x09359541
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发表时间：
2010-04
影响因子：
4.2
通讯作者：
P. Geusens;T. van Geel;J. V. D. van den Bergh
中科院分区：
文献类型：
--
作者：
P. Geusens;T. van Geel;J. V. D. van den Bergh
髋部骨折的病因是多因素的，包括骨骼和跌倒相关因素。通过髋关节强度分析（HSA）和双能X线吸收测量（DXA）图像的有限元分析评估的骨密度（BMD）低、BMD相关和BMD无关的骨强度几何成分以及超声参数与髋部骨折的存在和发生率相关。此外，临床危险因素与髋部骨折的风险有关，与BMD无关。它们被纳入骨折风险评估工具（FRAX）病例发现算法，以估计个体患者10年髋部骨折的风险，有和没有BMD。跌倒风险不包括在FRAX中，但包括在其他病例发现工具中，如Garvan算法，以预测5年和10年髋部骨折风险。激素、细胞因子、生长因子、骨吸收标志物和遗传背景与髋部骨折风险相关。维生素D缺乏症是世界范围内的地方病，血清中25-羟基维生素D [25（OH）D]水平低可预测髋部骨折风险。在髋部骨折预防的背景下，使用临床风险、BMD、骨几何结构和跌倒相关风险计算绝对骨折风险是可行的，但需要通过将骨和跌倒相关风险因素整合到临床使用的单个病例发现算法中来进一步细化。
The etiology of hip fractures is multifactorial and includes bone and fall-related factors. Low bone mineral density (BMD) and BMD-related and BMD-independent geometric components of bone strength, evaluated by hip strength analysis (HSA) and finite element analysis analyses on dual-energy X-ray absorptiometry (DXA) images, and ultrasound parameters are related to the presence and incidence of hip fracture. In addition, clinical risk factors contribute to the risk of hip fractures, independent of BMD. They are included in the fracture risk assessment tool (FRAX) case finding algorithm to estimate in the individual patient the 10-year risk of hip fracture, with and without BMD. Fall risks are not included in FRAX, but are included in other case finding tools, such as the Garvan algorithm, to predict the 5- and 10-year hip fracture risk. Hormones, cytokines, growth factors, markers of bone resorption and genetic background have been related to hip fracture risk. Vitamin D deficiency is endemic worldwide and low serum levels of 25-hydroxyvitamin D [25(OH)D] predict hip fracture risk. In the context of hip fracture prevention calculation of absolute fracture risk using clinical risks, BMD, bone geometry and fall-related risks is feasible, but needs further refinement by integrating bone and fall-related risk factors into a single case finding algorithm for clinical use.