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

• 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
• 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

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 临床参考值通常来自高加索人，样本量有限，并且很简单 统计数据。结果，将这些参考价值应用于种族/族裔少数民族通常会引起误诊。 我们的长期目标是开发创新方法来生成和验证精确参考值。 骨矿物质密度（BMD）的参考值证明越来越不准确，因为 维持脆性骨折的患者数量具有标准T评分方法的定义为正常 BMD值。最初仅针对绝经后高加索妇女提出了T分数法，AS 结果没有专门设计用于定义种族/种族的BMD参考值的经验方法 少数民族。因此，随着预期寿命的增加，包括非洲在内的少数民族的骨质疏松骨折 美国妇女正在成为一个主要的公共卫生问题。该应用的目的是开发 确定非洲裔美国妇女精确BMD参考值的新方法 骨质疏松性裂缝以前已经被低估了，并且没有治疗。基于初步 申请人生产的数据，中央假设是对于非裔美国妇女，一种新方法 基于正常BMD的“最佳统计模型”，将是骨质疏松的更好的预测指标 断裂比T得分法。该假设将通过追求三个具体目标来检验：1）确定 正常BMD的最佳统计模型； 2）确定基于模型的BMD的精确阈值； 3） 验证非裔美国妇女的精确参考值。对于AIM 1，该项目将利用 多个现有的NHANES数据库，以开发非洲正常BMD的高度准确的统计模型 美国妇女。对于AIM 2，与个人特征相匹配的精确阈值将是 使用最佳的BMD模型和含有断裂结果的队列数据确定。在AIM 3下，研究 通过比较其预测性，将利用骨质疏松性骨折数据来验证基于模型的方法 传统方法的骨质疏松骨折的精度。这种创新的方法将取代传统的 “一定大小的所有”临床参考价值，从根本上改变了当前的研究和临床实践 每个人都可以从一个静态截止点的范例来精确阈值适合个体特征。这 新方法将克服T得分方法的局限性，从而提高了预测准确性 WHO的断裂风险评估工具以及骨质疏松症诊断的准确性一般。这 此处开发的方法可以扩展到许多其他类型的精确参考的开发 值。此外，该项目将通过使用 “大数据”，从而为他们提供了动手研究经验，并激发了他们对研究的兴趣 健康分布。