Use of FRAX as a Determinant for Risk-Based Osteoporosis Screening May Decrease Unnecessary Testing While Improving the Odds of Identifying Treatment Candidates
Use of FRAX as a Determinant for Risk-Based Osteoporosis Screening May Decrease Unnecessary Testing While Improving the Odds of Identifying Treatment Candidates
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DOI：
10.1016/j.whi.2014.06.006
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发表时间：
2014-11-01
影响因子：
3.2
通讯作者：
Chang, Yu-Hui H.
中科院分区：
文献类型：
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作者：
Edwards, Frederick D.;Grover, Michael L.;Chang, Yu-Hui H.
目的：我们利用两种不同的指南评估了符合指南的骨质疏松症筛查对基线行为的假设影响，并确定了每种指南识别骨质疏松症治疗候选者的相对能力。方法：我们对骨折风险感知研究进行了二次分析，该研究招募了 50 至 75 岁的患者，完成有关其骨骼健康的调查问卷。我们确定了基线筛查率和治疗候选者的检测，然后评估了遵守美国预防服务工作组 (USPSTF) 和国家骨质疏松症基金会 (NOF) 标准的假设影响，特别是对于 50 至 64 岁的女性。结果：在接受筛查的 144 名 50 至 64 岁女性中，有 14 名 (9.7%) 是治疗候选者。基于识别一种或多种风险 (NOF) 的筛查将导致对 144 名患者中的 102 名患者 (71%) 进行检测，以识别 14 种候选治疗方法中的 12 种 (86%)。应用 USPSTF 标准（9.3% FRAX 阈值）将测试 144 名女性中的 45 名 (31%)，以识别 14 名治疗候选者中的 11 名 (79%)。基于 NOF 风险的标准将导致绝对筛查率适度降低（16%，p = .0011；95% CI，7%-25%），但在识别候选治疗方案方面仅略有改善（比值比，2.67；95% CI，0.57-12.47）。应用更具选择性的 USPSTF 标准大大减少了不必要的检测（绝对筛查率降低 56%；p < .0001；95% CI，47%-64%），同时进一步提高识别候选治疗方案的几率（比值比，10.35；95% CI，2.72-39.35）。结论：在考虑筛查年轻患者时，仅在 9.3% 的情况下系统计算 FRAX 并进行排序达到骨折风险阈值可能会减少许多女性不必要的筛查，同时仍能确定适当的骨质疏松症治疗候选者。版权所有 (C) 2014，雅各布斯妇女健康研究所。由爱思唯尔公司出版
Purpose: We have assessed the hypothetical impact of guideline-concordant osteoporosis screening on baseline behaviors utilizing two different guidelines and determined the relative ability of each to identify osteoporosis treatment candidates.Methods: We conducted secondary analyses from the Fracture Risk Perception Study, which enrolled patients aged 50 to 75 years to complete questionnaires about their bone health. We determined our baseline screening rates and detection of treatment candidates and then assessed the hypothetical impact of adherence to U. S. Preventive Services Task Force (USPSTF) and National Osteoporosis Foundation (NOF) criteria, particularly for women aged 50 to 64.Results: Of 144 women aged 50 to 64 years screened, 14 (9.7%) were treatment candidates. Screening based on identification of one or more risks (NOF) would lead to testing of 102 of the 144 patients (71%) to identify 12 of 14 treatment candidates (86%). Applying USPSTF criteria (9.3% FRAX threshold) would test 45 of the same 144 women (31%) to identify 11 of 14 treatment candidates (79%). NOF risk-based criteria would result in a moderate absolute screening rate reduction (16%, p = .0011; 95% CI, 7%-25%), but only marginal improvement in identifying treatment candidates (odds ratio, 2.67; 95% CI, 0.57-12.47). Applying the more selective USPSTF criteria greatly reduced unnecessary testing (56% absolute screening rate reduction; p < .0001; 95% CI, 47%-64%) while further improving the odds of identifying treatment candidates (odds ratio, 10.35; 95% CI, 2.72-39.35).Conclusions: When contemplating screening younger patients, systematic calculation of FRAX and ordering only when the 9.3% fracture risk threshold is reached may decrease unnecessary screening for many women while still identifying appropriate osteoporosis treatment candidates. Copyright (C) 2014 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.