Which fractures are most attributable to osteoporosis?
Which fractures are most attributable to osteoporosis?
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DOI：
10.1016/j.jclinepi.2010.07.007
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发表时间：
2011-01
影响因子：
7.2
通讯作者：
Saag, Ken
中科院分区：
文献类型：
--
作者：
Warriner, Amy H.;Patkar, Nivedita M.;Curtis, Jeffrey R.;Delzell, Elizabeth;Gary, Lisa;Kilgore, Meredith;Saag, Ken
确定骨质疏松症可能导致骨折的解剖部位和情况是一个持续争论和争议的话题，对临床医生和研究人员来说都很重要。我们进行了系统的文献综述，并根据特定的骨解剖部位和骨折诊断代码生成了有关骨折风险的证据报告。利用兰德/加州大学洛杉矶分校的适当性流程，我们召集了一个由 11 名专家组成的多学科小组，他们根据证据报告，根据骨折由骨质疏松症引起的可能性对骨折进行了评级。骨折部位（由 ICD-CM 代码确定）根据年龄、性别、种族/民族（非裔美国人和白种人）以及是否存在创伤，按四个临床危险因素类别进行分层。与目前的临床经验一致，最有可能由骨质疏松引起的骨折是股骨颈、椎骨病理性骨折以及腰椎和胸椎骨折。最不可能由骨质疏松引起的骨折是开放性肱骨近端骨折、颅骨和面骨骨折。专家小组认为，老年白人女性的手臂开放性骨折（肱骨近端除外）以及胫骨/腓骨、髌骨、肋骨和骶骨骨折极有可能是由于骨质疏松症所致，但年轻的非洲裔美国男性的可能性较低。所有骨折部位的骨质疏松症归因评分均由多学科专家小组确定，以提供骨折与骨质疏松症相关可能性的循证连续体。
Determining anatomic sites and circumstances under which a fracture may be a consequence of osteoporosis is a topic of ongoing debate and controversy that is important to both clinicians and researchers. We conducted a systematic literature review and generated an evidence report on fracture risk based on specific anatomic bone sites as well as fracture diagnosis codes. Using the RAND/UCLA appropriateness process, we convened a multi-disciplinary panel of 11 experts who rated fractures according to their likelihood of being due to osteoporosis based on the evidence report. Fracture sites (as determined by ICD-CM codes) were stratified by four clinical risk factor categories based on age, sex, race/ethnicity (African- American and Caucasian) and presence or absence of trauma. Consistent with current clinical experience, the fractures rated most likely due to osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral fractures. The fractures rated least likely due to osteoporosis were open proximal humerus fractures, skull, and facial bones. The expert panel rated open fractures of the arm (except proximal humerus) and fractures of the tibia/fibula, patella, ribs, and sacrum as being highly likely due to osteoporosis in older Caucasian women but a lower likelihood in younger African American men. Osteoporosis attribution scores for all fracture sites were determined by a multidisciplinary expert panel to provide an evidence-based continuum of the likelihood of a fracture being associated with osteoporosis.
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DOI：
10.1136/bmj.b4229
发表时间：
2009-11-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Hippisley-Cox J;Coupland C
通讯作者：
Coupland C
DOI：
10.1177/0272989x08315251
发表时间：
2008-09
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
--
作者：
Edelen MO;Burnam MA;Watkins KE;Escarce JJ;Huskamp H;Goldman HH;Rachelefsky G
通讯作者：
Rachelefsky G
影响因子：
39.2
作者：
SEELEY, DG;BROWNER, WS;CUMMINGS, SR
通讯作者：
CUMMINGS, SR
影响因子：
7.2
作者：
RAY, WA;GRIFFIN, MR;ADAMS, ML
通讯作者：
ADAMS, ML
影响因子：
120.7
作者：
Center, Jacqueline R.;Bliue, Dana;Eisman, John A.
通讯作者：
Eisman, John A.