- 期刊
治療骨鬆的FRAX®閾值應根據中老年人年齡加以調整
Intervention Threshold of FRAX® Should be Adjusted According to Specific Age in Elder People
摘要
背景：根據世界衛生組織2008年開發評估病患骨折風險的工具（FRAX®），可整合相關臨床危險因子及股骨頸的骨密度，推算病人未來10年主要骨鬆骨折與髖骨骨折之機率，建議40～90歲的人，若主要骨鬆性骨折風險＞20%，及髖部骨折風險＞3%時就應接受骨鬆治療。然而，在一般的臨床經驗裡，我們卻經常發現某些族群，即使骨折風險不高仍有發生骨鬆骨折之現象。因此本篇研究將進一步分析本院50歲以上族群的患者，就骨折史與骨折風險相關之分析，臺灣中老年以上族群的骨折風險閾值是否根據不同年齡層來建立治療指引，以提供臨床人員作為骨鬆治療介入時機之參考。方法：本篇為回顧性研究，收集2014年11月至2021年03月間，曾接受雙能量光吸收測量的門診與住院患者之病歷紀錄。排除條件為骨質密度3個部位中單一部位無法評估之患者（包括腰椎區域鋼釘內固定或椎體成形術、單側或雙側髖部鋼釘內固定或髖關節置換手術）或年齡小於50歲受檢者。最終收集8,049位受檢者資料，男性為1,303名（16.2%），女性為6,746名（83.8%）。將患者的理學檢查、過去病史、骨鬆骨折史、生活型態與10年骨折風險進行分析。結果：經過統計分析發現三個族群之間之理學檢查、過去病史、骨質密度、10年骨折率皆呈顯著差異。其中，10年骨折風險各組間隨年齡增加，且各年齡群組中部分未達建議之治療標準即可能產生一個或一個部位以上之骨折。低骨密度與高FRAX®是骨鬆性骨折獨立且重要之因素。結論：我們發現，曾經骨折之患者骨質密度比未骨折之患者骨質密度低。當利用FRAX®評估受檢者骨折率時，50歲以上受檢者，建議應根據不同年齡層，調整治療的FRAX®閾值，將有利於對中高風險的骨鬆患者及早提出接受治療與追蹤的建議。
並列摘要
Background: In 2008, the World Health Organization developed an assessment tool, which integrates relevant clinical risk factors and the bone mineral density (BMD) of the femoral neck to estimate a patient's next 10-year fracture risk. It is recommended that the patients whose major osteoporotic fractures ＞ 20% and the risk of hip fractures ＞ 3% should be treated. However, we noted that certain groups who had low fracture risk still have osteoporotic fractures. Therefore, the aim of this study was to analyze the relationship between fracture history and fracture risk of patients over 50 years old and to clarify whether the fracture risk threshold of the elder people in Taiwan should be adjusted according to a specific age. Method: It was a retrospective study. The subjects who had undergone dual energy x-ray absorptiometry from November 2014 to March 2021 were enrolled. Patients who cannot be assessed in a single region of the 3 parts, including internal fixation, vertebroplasty surgery in the lumbar spine area, unilateral or bilateral with hip joint internal fixation, or total hip replacement surgery, or patients younger than 50 years were excluded. The basic data of 8,049 subjects were collected, and there were 1,303 (16.2%) males and 6,746 (83.8%) females. Their age, anthropometry, past medical history, history of osteoporosis fractures, life style, and 10-year fracture risk were analyzed. Results : There were significant differences in anthropometry, including body height, body weight, body mass index, as well as past medical history, BMD, and the ten-year probability of fracture among the three ethnic groups. The probability of a ten-year fracture increases with age among each group, and some of the age groups do not meet the recommended treatment standards, which may cause one or more fractures. Low bone density and high FRAX® were independent and significant factors in osteoporosis fracture. Conclusions: This study showed that the BMD was significantly lower in the patients with previous fractures. It is the intervention threshold with FRAX® for osteoporosis treatment whether specific age groups in the elder people over 50 years old that should be modified. It is recommended that the FRAX® threshold for treatment should be adjusted according to different age groups, which will help to make early recommendations for treatment and follow-up for patients with middle-to-high-risk osteoporosis.