虛擬切片為即將發生的骨折風險提供處置時機


  【24drs.com】一篇新的前瞻研究指出,藉由高解析度周邊定量電腦斷層(HRPQCT, Scanco Medical公司)進行的遠端橈骨虛擬切片,可以比股骨頸骨質密度檢查(BMD)或使用骨折風險評估工具(FRAX)更能確認婦女即將發生的骨折風險。
  
  法國里昂大學Roland Chapurlat博士表示,大多數研究著眼於骨折的長期風險,當然,這是重要的,不過,最需要治療的是那些即將有骨折風險者。
  
  我們根據皮質孔隙度和骨小梁密度發展出結構脆弱性評分(SFS),這兩者都是結構脆弱性的指標,我們發現,曾發生骨折婦女的SFS分數較高,在9年追蹤期間,對於即將發生骨折以及其他所有骨折類型,也是如此。
  
  Chapurlat博士在美國骨骼與礦物質研究協會2016年會中發表此研究。
  
  會議共同主持人、南丹麥大學的Bo Abrahamsen博士受邀對研究發表評論時認為,得以快速評估患者即將發生骨折之風險將是有用的臨床工具,至少,我們有快速作用的藥物。
  
  不過,Abrahamsen博士提醒,HRPQCT主要還是一項研究工具,且只有一些學術中心有。
  
  所以,這還不是標準設備。為了取得影像,你需要精良的設備、且目前比雙能量x光吸收儀[DEXA]貴得多,因此取得本項測試將比普遍的DEXA更受限。
  
  儘管如此,他注意到,有朝一日,如果這設備更廣泛地被使用,這些掃描應該會更便宜。
  
  「Os des Femmes de Lyon (OFELY)」研究納入589名42-90歲的停經後婦女,在9.4年追蹤期間,135人發生偶發性骨折。
  
  處理影像遮蔽骨折狀態。
  
  股骨頸BMD和FRAX分數—僅依賴臨床變項預測患者10年時發生嚴重骨質疏鬆性骨折的可能性—在追蹤的前兩年內,也進行了評估,比較它們對於掌握婦女即將發生骨折之風險的能力。
  
  如同Chapurlat博士之報告,相較於沒有骨折的對照組,發生骨折的135名婦女的SFS分數比較高。
  
  但是,股骨頸T-分數比較低,骨折者的平均分數為-1.6分,沒有骨折的對照組的平均分數為-1.3分,而FRAX分數不出所料比較高,骨折者的平均分數為13.9分,沒有骨折者的平均分數為10分(所有的終點P值皆為 .001)。
  
  比較SFS分數在約9.4年追蹤期間預測所有骨折的能力,Chapurlat博士等人發現,相較於股骨頸BMD以及FRAX分數,SFS可多辨識26%以上即將發生的骨折風險。
  
  Chapurlat博士指出,此外,根據BMD和FRAX辨識[有骨折風險]的患者,90%也可由SFS掌握,不過,這與較高的偽陽性比率有關。
  
  對於所有即將發生的骨折,他指出,SFS多發現31%的患者有風險,此時,根據BMD和FRAX辨識的所有患者也可由SFS掌握,儘管偽陽性比率依舊略高於其他兩項檢測。
  
  如果將範圍縮小到所有即將發生的重大骨質疏鬆性骨折,SFS分數可比BMD和FRAX多辨識45%即將有風險的患者。
  
  Chapurlat博士觀察發現,同樣的,由BMD和FRAX辨識的所有重大骨質疏鬆性骨折患者,也可由SFS掌握。
  
  Chapurlat博士結論指出,合併高孔隙率和低骨小梁密度(SFS)評估結構性惡化,可辨識婦女的所有骨折與所有即將發生之骨折的風險,包括9年追蹤期間的嚴重骨質疏鬆性骨折,且它的表現優於股骨頸BMD或FRAX。他表示,HRPQCT 評估影像所須使用的軟體應可在明年內上線。
  
  一旦獲取影像,在SFS將只需要幾分鐘的時間即可達成。
  
  資料來源:http://www.24drs.com/
  
  Native link:Virtual Biopsy Provides Window Into Imminent Fracture Risk

Virtual Biopsy Provides Window Into Imminent Fracture Risk

By Pam Harrison
Medscape Medical News

ATLANTA — A "virtual biopsy" of the distal radius taken with the help of high-resolution peripheral quantitative computed tomography (HRPQCT, Scanco Medical) identifies women at risk for imminent fracture better than bone-mineral density (BMD) at the femoral neck or use of the fracture risk-assessment tool (FRAX), a new prospective study indicates.

"Most studies have looked at long-term risk of fracture, which is important, of course, but women who are most in need of treatment are those who are at imminent fracture risk," Roland Chapurlat, MD, PhD, from the University of Lyon, France, told Medscape Medical News.

"We developed the Structural Fragility Score (SFS) based on cortical porosity and trabecular density, both of which are markers of structural fragility, and we found that the SFS was greater in women who had sustained a previous fracture, and this was also the case for both imminent fracture and all other types of fracture that occurred during the 9-year follow-up."

The research was presented here by Dr Chapurlat during the annual meeting of the American Society of Bone and Mineral Research 2016 Annual Meeting.

Asked by Medscape Medical News to comment on the study, session cochair Bo Abrahamsen, MD, PhD, from the University of Southern Denmark, Odense, suggested that being able to quickly assess a patient's risk of imminent fracture would be a "useful clinical tool, at least insofar as we have medications that work quickly."

Dr Abrahamsen cautioned, however, that the HRPQCT is still largely a research tool and available only in limited numbers of academic centers.

"So this is not a standard piece of equipment. To acquire the image, you need sophisticated equipment that is currently much more expensive than [dual-energy X-ray absorptiometry] DEXA, so access to this test will likely be more limited than it is for plain DEXA," he noted.

Nevertheless, in time "these scans should become cheaper if the equipment is more widely used," he observed.

SFS Identifies More Imminent Fractures in OFELY Study

The Os des Femmes de Lyon (OFELY) study involved 589 postmenopausal women between 42 and 90 years of age. During 9.4 years of follow-up, 135 sustained an incident fracture.

Images were processed blind to fracture status.

Both the femoral neck BMD and FRAX scores — which rely on clinical variables alone to predict a patient's 10-year probability of having a major osteoporotic fracture — were also assessed to compare their ability to capture women at risk for imminent fracture within the first 2 years of follow-up.

As Dr Chapurlat reported, SFS scores were higher among the women who had sustained the 135 documented fractures, compared with nonfracture controls.

But the femoral neck T-score was lower, at a mean of -1.6 among fracture cases compared with a mean of -1.3 for nonfracture controls, while FRAX scores were predictably higher, at a mean of 13.9 for women who had a fracture compared with a mean of 10 for women who did not sustain a fracture (all end points P = .001).

Comparing the ability of the SFS to predict all fractures over the 9.4-year follow-up, Dr Chapurlat and colleagues found that the SFS identified 26% more patients at risk for imminent fracture than either BMD at the femoral neck and the FRAX score.

Further, "90% of patients identified on BMD and FRAX [at risk for any fracture] were also captured by the SFS, although this was associated with a slightly higher false-positive rate," Dr Chapurlat added.

For all imminent fractures, "the SFS identified 31% more patients at risk," and this time, "all patients identified by BMD and FRAX were also captured by the SFS, even though the false-positive rate was again a bit higher than it was for the other two tests," he noted.

Narrowed down to all impending major osteoporotic fractures, the SFS score identified 45% more patients who were at imminent risk of having a major osteoporotic fracture than BMD and FRAX did.

Again, all patients identified at risk for a major osteoporotic fracture by BMD and FRAX were also captured by SFS, as Dr Chapurlat observed.

"Assessment of structural deterioration by combining high porosity and low trabecular density (SFS) identifies women at risk for all fractures and all imminent fractures, including major osteoporotic fractures over 9 years of follow-up, and it performed better than either femoral neck BMD or FRAX," Dr Chapurlat concluded, adding that the software used to assess the images acquired by HRPQCT should be available online sometime next year.

Once images are acquired, "it will only take a few minutes to arrive at the SFS," he added.

Neither Dr Chapurlat nor Dr Abrahamsen had any relevant financial relationships.

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American Society of Bone and Mineral Research 2016 Annual Meeting. September 17, 2016; Atlanta, Georgia. Abstract 1076.

    
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