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Developing Model-based Bone Density Reference Values for African-American Women

为非裔美国女性制定基于模型的骨密度参考值

基本信息

批准号：
9305795
负责人：
Qing Wu
金额：
$ 44.83万
依托单位：
UNIVERSITY OF NEVADA LAS VEGAS
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9305795
关键词：
African American Age Assessment tool Big Data Blood Pressure Bone Density Caucasians Cessation of life Characteristics Cholesterol Clinical Computerized Medical Record Custom Data Databases Development Diagnosis Disease Environment Ethnic Origin Female Fracture Goals Individual Life Expectancy Measurement Medical Medical Research Methodology Methods Minority Minority Groups Modeling National Health and Nutrition Examination Survey Normal Range Osteoporosis Outcome Patients Performance Physiological Pilot Projects Plant Roots Population Research Postmenopause Prevention Procedures Public Health Publications Publishing Race Reference Values Research Research Design Sample Size Sampling Scoring Method Specificity Statistical Models Students Supervision Testing Validation Variant Woman Work World Health Organization base bone clinical practice cohort design ethnic minority population experience fracture risk fragility fracture hands on research health care disparity health disparity improved innovation interest novel novel strategies osteoporosis with pathological fracture precision medicine racial and ethnic racial disparity standard care statistics study population

项目摘要

Project Summary / Abstract Clinical reference values are typically derived from Caucasians, with limited sample sizes and simplistic statistics. As a result, applying these reference values to racial/ethnic minorities often causes misdiagnosis. Our long-term goal is to develop innovative methodologies to produce and validate precision reference values. The reference values of bone mineral density (BMD) are proving increasingly inaccurate since a substantial number of patients who sustain fragility fractures have what the standard T-score method defines as a normal BMD value. The T-score method was originally proposed only for postmenopausal Caucasian women, and as a result there is no empirical method designed specifically to define BMD reference values for racial/ethnic minorities. Therefore, with life expectancy increasing, osteoporotic fractures in minorities including African- American women are becoming a major public health issue. The objective of this application is to develop a novel method to determine precision BMD reference values for African-American women, a group whose osteoporotic fractures have previously been under-recognized and undertreated. On the basis of preliminary data produced by the applicant, the central hypothesis is that for African-American women a new method based on “the best statistical model” of normal BMD will be a significantly better predictor of osteoporotic fracture than the T-Score method. This hypothesis will be tested by pursuing three specific aims: 1) identifying the best statistical model of normal BMD; 2) determining the model-based precision threshold of BMD; and 3) validating the precision reference values for African-American women. For Aim 1, this project will leverage multiple existing NHANES databases to develop a highly accurate statistical model of normal BMD for African- American women. For Aim 2, a precision threshold that matches an individual's characteristics will be determined by utilizing the best BMD model and cohort data containing fracture outcome. Under Aim 3, Study of Osteoporosis Fracture data will be utilized to validate the model-based method by comparing its predictive accuracy for osteoporotic fracture with traditional methods. This innovative approach will replace the traditional “one-size-fits-all” clinical reference value, fundamentally shifting current research and clinical practice paradigms from one static cutoff point for everyone to precision thresholds fitting individual characteristics. The new approach will overcome the limitations of the T-score method, thus increasing the prediction accuracy of the WHO's Fracture Risk Assessment Tool, and the accuracy of osteoporosis diagnoses in general. The approach developed herein can be extended to the development of many other types of precision reference values. In addition, this project will engage students in the research of precision medicine through the use of “big data,” thus providing them with hands-on research experience and stimulating their research interest in health disparities.

项目摘要/摘要