Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies
Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies
复制标题
DOI：
10.1016/s8756-3282(01)00653-6
复制
发表时间：
2002-01-01
期刊：
影响因子：
4.1
通讯作者：
Dawson, A
中科院分区：
文献类型：
--
作者：
Kanis, JA;Johnell, O;Dawson, A
骨矿物质密度（BMD）测量广泛用于估计骨质疏松性骨折的风险。此外，还确定了许多其他风险因素，其中已知的一些因素会独立于 BMD 测量而增加风险。与单独使用 BMD 相比，BMD 与此类风险因素的结合增加了风险/标准差 (SD) 的梯度。在本文中，我们根据年龄、性别和相对风险报告了骨折概率，并以瑞典人口为模型，研究了骨质疏松性骨折风险梯度的变化对评估敏感性和特异性的影响。髋部、临床椎骨、前臂或肱骨近端骨折的十年风险是通过风险梯度的增量来计算的，骨骼风险每变化一个 SD，风险梯度从 1.5 到 6.0 不等。高风险群体的识别对评估的特异性影响不大，但增加了各种假设的敏感性。纳入所有四种骨折类型对敏感性影响不大，但增加了测试的阳性预测值。阳性预测值也随着年龄的增长而增加，因此，当针对一小部分人群 (0.5-5%) 时，测试 65 岁女性的阳性预测值大于 50%，风险梯度为 2.0-2.5/SD。在 65 岁时对女性进行筛查并以 25% 的人口为目标进行直接干预，通过使用中等风险梯度 (RR = 2.0/SD) 的多项测试，可以在未来 10 年内挽救高达 23% 的女性骨折。这种梯度可以通过使用多种危险因素来识别处于危险中的患者来实现。 (C) 2002 by Elsevier Science Inc. All rights reserved.
Bone mineral density (BMD) measurements are widely used to estimate the risk of osteoporotic fractures. In addition, many other risk factors have been identified, sonic of which are known to add to the risk independently of BMD measurements. The combination of BMD with such risk factors increases the gradient of risk/standard deviation (SD) than that achieved by BMD alone. In this paper, we report the fracture probabilities according to age, gender, and relative risk, and have investigated the effects of changes in the gradient of risk for osteoporotic fractures on the sensitivity and specificity of assessments, modeled on the population of Sweden. Ten-year risks of hip, clinical vertebral, forearm, or proximal humeral fracture were computed with increments in gradient of risk that varied from 1.5 to 6.0 per SD change in skeletal risk. The identification of high-risk groups had little effect on the specificity of assessments, but increased the sensitivity over a wide range of assumptions. The inclusion of all four fracture types had little effect on sensitivity, but increased the positive predictive value of the test. Positive predictive value also increased with age, so that values greater than 50% were obtained testing women at the age of 65 years with modest gradient of risk of 2.0-2.5/SD when small segments of the population were targeted (0.5-5%). Screening of women to direct intervention at the age of 65 years and targeting 25% of the population could save up to 23% of all fractures in women over the next 10 years by the use of multiple tests with a moderate gradient of risk (RR = 2.0/SD). Such gradients might be achieved with the use of multiple risk factors to identify patients at risk. (C) 2002 by Elsevier Science Inc. All rights reserved.