骨質疏鬆症:依年齡即可預測骨折


  【24drs.com】一篇比較研究發現,單純依照婦女的年紀即可預測她的骨質疏鬆骨折風險,和多因素、正式的風險預測模式一樣有效。
  
  賓州Reading醫院內科與婦產科Xuezhi Jiang醫師等人在10月的婦產科(Obstetrics & Gynecology)期刊中寫道,但這不意味著目前只需要考慮年紀。
  
  雖然年齡不應該被單獨作為骨折的一個獨立預測因子,此次研究的資料認為,當評估骨質疏鬆病患之篩檢與治療時,應謹慎考量年齡因素;不過,並不建議放棄骨質疏鬆性骨折的預測模型,因為目前還沒有更好的替代模式。
  
  他們的研究對象是615名停經年齡的婦女,年齡大於65歲被視為預測骨質疏鬆性骨折風險的一個顯著因素,且與世界衛生組織骨折風險評估工具及北美停經協會2006-2010年骨質疏鬆治療指引一樣,是可以信賴的預測因子。
  
  這個世代中,共有15名婦女發生骨折,她們的平均年紀是70.7歲,沒有發生骨折者為61.2歲,這個差異達統計上的顯著意義(P < .001);這15名發生骨折的婦女超過半數(60%)被診斷有骨質疏鬆,沒有骨折的600名婦女則是僅10%有這項診斷(P < .001)。
  
  單看年齡即是骨折的一個顯著預測因子(曲線下面積(AUC)為0.79;95%信心區間[CI],0.67 - 0.91;P < .001)。以65歲為最佳的臨界點,達80%敏感度以及73%專一性。相較之下,骨折風險評估工具的AUC是0.76 (95% CI,0.64 - 0.89),北美停經協會2010年骨質疏鬆治療指引的AUC則是0.77 (95% CI,0.66 - 0.88)。
  
  校正種族、抽菸、使用類固醇、母親髖骨骨折、類風濕性關節炎之後,相較於65歲以下停經婦女,較年長婦女的骨折校正勝算比為10.2。
  
  研究者發現,這15名婦女中,9人有骨折風險評估工具中需要治療的明確骨折風險。同樣地,根據北美停經協會2006年和2010年骨質疏鬆治療指引,分別有其中9和12名婦女需要治療。
  
  作者們寫道,在我們的分析中,這三種預測模式都是預測骨折的有效工具。不過,看來這些模式都沒有比單純依照年齡更佳, 資料認為,年齡至少和北美停經協會2010年骨質疏鬆治療指引以及骨折風險評估工具和[骨質密度]是一樣好的骨折預測因子。
  
  Jiang醫師等人在2007年1月1日至2009年3月1日間招募了49歲以上婦女進行研究,因為這是回溯型研究,所有婦女在參與研究之前就發生了骨折,這是相當大的研究限制,根據作者指出,未來需要進行前瞻型研究,以優化篩選工具,並進一步驗證目前的風險預測模型。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7017&x_classno=0&x_chkdelpoint=Y
  

Osteoporosis: Age Alone Good Predictor of Fractures

By Damian McNamara
Medscape Medical News

A woman's age alone might predict her risk for osteoporotic fractures as effectively as more comprehensive, official risk prediction models would, a comparison study reveals.

This does not mean, however, that age alone should be considered at this point, Xuezhi Jiang, MD, from the Department of Obstetrics-Gynecology and the Department of Internal Medicine at the Reading Hospital in Pennsylvania, and colleagues write in the October issue of Obstetrics & Gynecology.

"Although age alone should not be used as an independent predictor of fractures, data from this study suggest that age should be carefully considered when evaluating patients for osteoporosis screening and treatment," they write.

"[I]t is not recommended to abandon the osteoporotic fracture prediction models, because there is no better alternative model available currently," they add.

In their study of 615 menopausal-age women, age greater than 65 years emerged as a significant predictor of osteoporotic fracture risk and was as reliable a predictor as the World Health Organization Fracture Risk Assessment Tool and the North American Menopause Society osteoporosis treatment guidelines from 2006 and 2010.

A total of 15 women in this cohort experienced a fracture. Their mean age was 70.7 years vs 61.2 years among those without a fracture history. The difference was statistically significant (P < .001). More than half of the 15 women who had a fracture (60%) were also diagnosed with osteoporosis compared with 10% of the 600 fracture-free women (P < .001).

Age alone is a significant predicting factor for fracture (area under the curve (AUC), 0.79; 95% confidence interval [CI], 0.67 - 0.91; P < .001). Using an optimal cutoff at age 65 years produced a sensitivity of 80% and a specificity of 73%. In comparison, the AUC for the Fracture Risk Assessment Tool was 0.76 (95% CI, 0.64 - 0.89), and the AUC for the North American Menopause Society Treatment Guideline 2010 was 0.77 (95% CI, 0.66 - 0.88).

Compared with postmenopausal women younger than 65 years, the adjusted odds ratio for fracture in older women was 10.2, after adjusting for race, smoking, steroid use, parent hip fracture, and rheumatoid arthritis.

The researchers determined that 9 of the 15 women carried a sufficient fracture risk to require treatment according to the Fracture Risk Assessment Tool. Similarly, 9 and 12 of the women would require treatment according to the North American Menopause Society position statements from 2006 and 2010, respectively.

"In our analysis, all three prediction models were effective tools for predicting fractures," the authors write. "However, it appears that all of these models are no better predictors of fracture than age alone. The data indicate that age may be at least as good of a fracture predictor as the North American Menopause Society 2010 guidelines and the Fracture Risk Assessment Tool with [bone mineral density]."

Dr. Jiang and colleagues recruited women older than 49 years for the study between January 1, 2007, and March 1, 2009. Because the study was retrospective, all women who had a fracture experienced it before entry into the study, which is a potential limitation. Future, prospective studies are warranted, according to the authors, to optimize a screening instrument and to further validate current risk prediction models.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2013;122:1040-1046.

    
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