- 期刊
評估腎功能下降的成人十年骨折風險：FRAX®與TBS調整後FRAX®之間的比較
Evaluating the 10-Year Fracture Risk in Adults With Decreased Renal Function: A Comparison Between FRAX® and TBS-Adjusted FRAX®
摘要
背景：本研究的目標是探討腎功能降低對骨折率的影響，運用骨折風險評估工具（fracture risk assessment tool, FRAX®）和經過骨小樑指數（trabecular bone score, TBS）調整後的TBS adjusted FRAX®（簡稱TBS FRAX®）在成年人腎功能方面的相關性分析。方法：臺灣南部一家地區醫院接受全面健康評估的個人健康檢查之回溯性研究。將估計腎絲球過濾率（estimated glomerular filtration rate, eGFR）分成四個等級，Group A: eGFR > 90 mL/min/1.73 m^2、Group B: eGFR 60-89 mL/min/1.73 m^2、Group C: eGFR 30-59 mL/min/1.73 m^2、Group D: eGFR 15-29 mL/min/1.73 m^2，用來評估不同腎功能間評估骨折率之差異進行了統計分析，包括單因子變異數分析one-way analysis of variance（one-way ANOVA）和成對t檢驗，以評估FRAX®和TBS FRAX®在成年人受試者中與腎功能觀察相關性的關聯。結果：eGFR各組間，對FRAX®與TBS FRAX®的差異，在FRAX®所估計出來的骨折率皆高於TBS FRAX®，全部p < 0.001，但Group D（eGFR 15-29 mL/min/1.73 m^2）這一組，FRAX®與TBS FRAX®的差異，右側主要骨質疏鬆性骨折率（major）差-0.2 ± 2.6，p = 0.640，髖部骨折率（hip）差0.1 ± 1.2，p = 0.483。左側主要骨質疏鬆性骨折率差-0.3 ± 2.6，p = 0.417，髖部骨折率差0.0 ± 1.2，p = 0.885。在BMD、T值、TBS、TBS FRAX® major在eGFR 60-89 mL/min/1.73 m^2組達最好後開始變糟，FRAX®和TBS FRAX® hip從eGFR > 90 mL/min/1.73 m^2乃最佳點後，腎功能愈差數值愈糟。結論：年人中的eGFR降低與骨質疏鬆風險增加相關。醫療專業人員應對擁有關注較低eGFR的患者潛在骨折風險或骨折率評估，著重於腎功能監測，以減少骨折的可能性。
並列摘要
Background: The objective of this study was to explore the correlation between the impact of reduced renal function on fracture rates by using fracture risk assessment tool (FRAX®) and by trabecular bone score TBS adjusted FRAX® (abbreviated TBS FRAX®) in adults with different renal function. Methods: Individuals who underwent a comprehensive health assessment at a local medical center in southern Taiwan were included in this retrospective evaluation. The estimated glomerular filtration rate (eGFR) was categorized into four groups for statistical analysis: Group A: eGFR > 90 mL/min/1.73 m^2, Group B: eGFR 60-89 mL/min/1.73 m^2, Group C: eGFR 30-59 mL/min/1.73 m^2, and Group D: eGFR 15-29 mL/min/1.73 m^2. This categorization was utilized to assess the differences in fracture rates among different renal function levels. Statistical analyses, including one-way analysis of variance (one-way ANOVA) and paired t-test, were conducted to examine the correlation between FRAX® and TBS FRAX® concerning the renal function observations in the adult population. Results: The differences between FRAX® and TBS FRAX® were assessed among different eGFR groups. In all groups, the fracture rates estimated by FRAX® were significantly higher than those by TBS FRAX® (all p < 0.001). However, in Group D (eGFR 15-29 mL/min/1.73 m^2), the difference between FRAX® and TBS FRAX® of the right major osteoporotic fracture was -0.2 ± 2.6, p = 0.640, right hip fracture was 0.1 ± 1.2, p = 0.483, left major osteoporotic fracture was -0.3 ± 2.6, p = 0.417, and left hip fracture was 0.0 ± 1.2, p = 0.885. Hips BMD, T-score, TBS, TBS FRAX® major showed the best result in the group of eGFR 60-89 mL/ min/1.73 m^2, then they became worse. FRAX® and TBS FRAX® hip showed the best result at group eGFR > 90 mL/min/1.73 m^2, and then they became worse. Conclusion: Reduced eGFR levels in adults are linked to an elevated susceptibility to osteoporosis. Healthcare professionals should remain attentive to the potential fracture risk or fracture rate management in individuals with low eGFR, focusing on renal function to mitigate the likelihood of fractures.