The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women
The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women
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DOI：
10.1007/s00198-007-0343-y
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发表时间：
2007-08-01
影响因子：
4
通讯作者：
Yoshimura, N.
中科院分区：
文献类型：
--
作者：
Kanis, J. A.;Oden, A.;Yoshimura, N.
BMD和临床危险因素可预测髋部和其他腰椎骨折。临床危险因素和BMD的组合提供了更高的特异性和灵敏度比任何一个单独的。介绍和hypotheses为了开发一个风险评估工具的基础上，临床危险因素（CRF）与和不BMD.Methods九个基于人群的研究，其中BMD和CRF记录在基线。泊松回归模型被开发用于髋部骨折和其他骨质疏松性骨折，有和没有髋部BMD。骨折风险用风险梯度（GR，risk ratio/SD change in risk score）表示。结果CRF单独预测髋部骨折，50岁时GR为2.1/SD，随年龄增长而下降。单独使用BMD提供了更高的GR（3.7/SD），并与CRF和BMD（4.2/SD）的联合使用得到进一步改善。对于其他腰椎骨折，GR低于髋部骨折。在50岁时，仅CRF的GR为1.4/SD，与BMD提供的GR（GR=1.4/SD）相似，联合用药未显著增加（GR=1.4/SD）。在11个独立的人群为基础的cohols. Conclusions的临床危险因素与BMD的性能特征进行了验证，开发的模型提供了综合使用的验证的临床危险因素在男性和女性，以帮助骨折风险预测的基础。
BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone.Introduction and hypotheses To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD.Methods Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score).Results CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR=1.4/SD) and was not markedly increased by the combination (GR=1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts.Conclusions The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.