Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women
Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women
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DOI：
10.1371/journal.pone.0185363
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发表时间：
2017-09-25
期刊：
影响因子：
3.7
通讯作者：
Bjornerem, Ashild
中科院分区：
文献类型：
--
作者：
Kral, Rita;Osima, Marit;Bjornerem, Ashild
骨折风险评估工具 (FRAX) 和 Garvan 计算器改进了骨折风险的个体预测。然而，可能增强这些工具的预测能力的额外骨骼测量是研究的主题。人们对皮质参数，尤其是皮质孔隙率越来越感兴趣。 FRAX 和 Garvan 都不包含皮质结构的测量，这对骨骼强度很重要，并且提供了超出传统方法的独立信息。我们检验了皮质参数与骨折风险相关的假设，与 FRAX 和 Garvan 估计无关。这项巢式病例对照研究包括 211 名 54-94 岁患有非椎骨骨折的绝经后女性，以及来自挪威特罗姆瑟研究的 232 名对照组。我们评估了 FRAX 和 Garvan 对脆性骨折的 10 年风险评估，并使用 StrAx1.0 软件根据计算机断层扫描图像量化了股骨粗隆下皮质的孔隙度、厚度和面积。根据标准差，皮质孔隙率越高、皮质越薄、皮质面积越小，骨折的优势比（95% 置信区间）分别为 1.71 (1.38-2.11)、1.79 (1.44-2.23) 和 1.52 (1.19-1.95)。根据 FRAX 和 Garvan 估计值进行调整后，皮质孔隙度和厚度（而非面积）仍然与骨折相关。在 FRAX 或 Garvan 中添加皮质孔隙度和厚度会导致接受者操作特征曲线下的面积更大。当使用皮质孔隙度（> 80%）或皮质厚度（20%）时，分别识别出 45.5% 和 42.7% 的骨折病例。使用相同的皮质孔隙率或厚度截止值并结合 Garvan（阈值 >25%），分别确定了 51.2% 和 48.3%。所有组合的特异性范围为 81.0-83.6%。皮质孔隙率或厚度的测量发现单独使用 FRAX 未识别出 20.4% 和 17.5% 的额外骨折病例，单独使用 Garvan 未识别出 16.6% 和 13.7% 的骨折病例。总之，皮质参数可能有助于提高对有骨折风险的女性的识别，分别识别出 48.3% 和 48.3% 的女性。所有组合的特异性范围为 81.0-83.6%。皮质孔隙率或厚度的测量发现单独使用 FRAX 未识别出 20.4% 和 17.5% 的额外骨折病例，单独使用 Garvan 未识别出 16.6% 和 13.7% 的骨折病例。总之，皮质参数可能有助于提高对有骨折风险的女性的识别。
The Fracture Risk Assessment Tool (FRAX) and Garvan Calculator have improved the individual prediction of fracture risk. However, additional bone measurements that might enhance the predictive ability of these tools are the subject of research. There is increasing interest in cortical parameters, especially cortical porosity. Neither FRAX nor Garvan include measurements of cortical architecture, important for bone strength, and providing independent information beyond the conventional approaches. We tested the hypothesis that cortical parameters are associated with fracture risk, independent of FRAX and Garvan estimates. This nested case-control study included 211 postmenopausal women aged 54-94 years with nonvertebral fractures, and 232 controls from the Tromso Study in Norway. We assessed FRAX and Garvan 10-year risk estimates for fragility fracture, and quantified femoral subtrochanteric cortical porosity, thickness, and area from computed tomography images using StrAx1.0 software. Per standard deviation higher cortical porosity, thinner cortices, and smaller cortical area, the odds ratio (95% confidence interval) for fracture was 1.71 (1.38-2.11), 1.79 (1.44-2.23), and 1.52 (1.19-1.95), respectively. Cortical porosity and thickness, but not area, remained associated with fracture when adjusted for FRAX and Garvan estimates. Adding cortical porosity and thickness to FRAX or Garvan resulted in greater area under the receiver operating characteristic curves. When using cortical porosity (>80th percentile) or cortical thickness (20%), 45.5% and 42.7% of fracture cases were identified, respectively. Using the same cutoffs for cortical porosity or thickness combined with Garvan (threshold >25%), 51.2% and 48.3% were identified, respectively. Specificity for all combinations ranged from 81.0-83.6%. Measurement of cortical porosity or thickness identified 20.4% and 17.5% additional fracture cases that, were unidentified using FRAX alone, and 16.6% and 13.7% fracture cases unidentified using Garvan alone. In conclusion, cortical parameters may help to improve identification of women at risk for fracture.and 48.3% were identified, respectively. Specificity for all combinations ranged from 81.0-83.6%. Measurement of cortical porosity or thickness identified 20.4% and 17.5% additional fracture cases that, were unidentified using FRAX alone, and 16.6% and 13.7% fracture cases unidentified using Garvan alone. In conclusion, cortical parameters may help to improve identification of women at risk for fracture.