Factors associated with 5-year risk of hip fracture in postmenopausal women
Factors associated with 5-year risk of hip fracture in postmenopausal women
复制标题
DOI：
10.1001/jama.298.20.2389
复制
发表时间：
2007-11-28
影响因子：
120.7
通讯作者：
Cauley, Jane
中科院分区：
文献类型：
--
作者：
Robbins, John;Aragaki, Aaron K.;Cauley, Jane
在美国，每年发生的329,000例髋部骨折与高发病率、高死亡率和高成本相关。识别高危人群是迈向预防的一步。目的建立一种预测绝经后妇女髋部骨折5年风险的算法。设计、环境和参与者共93676名妇女参加了妇女健康倡议（WHI）的观察部分，这是一项多民族纵向研究，用于开发基于常见临床特征的预测算法。68132名参与临床试验的女性对预测髋部骨折的选定因素进行了验证。该模型在10750名接受双能x线骨密度扫描（DXA）评估的女性中进行了测试。主要结局测量通过受试者操作特征（ROC）曲线下的面积来预测中央判定髋部骨折。结果在7.6（1.7）年的平均随访期间，观察性研究中的女性共发生1132例髋部骨折（年化率0.16%），而在8.0（1.7）年的平均随访期间，临床试验中的女性共发生791例髋部骨折（年化率0.14%）。11个因素预测5年内髋部骨折：年龄、自我报告的健康状况、体重、身高、种族/民族、自我报告的身体活动、54岁以后的骨折史、父母髋部骨折、目前吸烟、目前使用皮质类固醇和治疗过的糖尿病。受试者工作特征曲线显示，在临床试验的不同女性队列中，该算法曲线下面积为80%（95%置信区间[Cl]， 0.77%-0.82%）。制定了髋部骨折概率的简化积分评分。在参加临床试验的患者中，比较基于10%队列子集的dxa扫描预测和算法的受试者工作特征曲线相似，曲线下面积为79% （95% Cl, 73%-85%）和71% （95% Cl, 66%-76%）。结论该算法基于11个临床因素，可用于预测不同种族绝经后妇女髋部骨折的5年风险。需要进一步的研究来评估该算法的临床意义，特别是确定治疗益处。
Context The 329 000 hip fractures that annually occur in the United States are associated with high morbidity, mortality, and cost. Identification of those at high risk is a step toward prevention.Objective To develop an algorithm to predict the 5-year risk of hip fracture in postmenopausal women.Design, Setting, and Participants A total of 93 676 women who participated in the observational component of the Women's Health Initiative (WHI), a multiethnic longitudinal study, were used to develop a predictive algorithm based on commonly available clinical features. Selected factors that predicted hip fracture were then validated by 68 132 women who participated in the clinical trial. The model was tested in a subset of 10 750 women who had undergone dual-energy x-ray absorptiometry (DXA) scans for bone mass density assessment.Main Outcome Measure The prediction of centrally adjudicated hip fracture, measured by the area under the receiver operator characteristic (ROC) curves.Results During a mean (SD) follow-up of 7.6 ( 1.7) years, 1132 hip fractures were identified among women participating in the observational study (annualized rate, 0.16%), whereas during a mean follow-up of 8.0 ( 1.7) years, 791 hip fractures occurred among women participating in the clinical trial ( annualized rate, 0.14%). Eleven factors predicted hip fracture within 5 years: age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes. Receiver operating characteristic curves showed that the algorithm had an area under the curve of 80% (95% confidence interval [Cl], 0.77%-0.82%) when tested in the cohort of different women who were in the clinical trial. A simplified point score was developed for the probability of hip fracture. Receiver operating characteristic curves comparing DXA-scan prediction based on a 10% subset of the cohort and the algorithm among those who participated the clinical trial were similar, with an area under the curve of 79% ( 95% Cl, 73%-85%) vs 71% ( 95% Cl, 66%-76%).Conclusion This algorithm, based on 11 clinical factors, may be useful to predict the 5-year risk of hip fracture among postmenopausal women of various ethnic backgrounds. Further studies are needed to assess the clinical implication of the algorithm in general and specifically to identify treatment benefits.