- 期刊
運用骨折風險評估工具FRAX®與TBS FRAX®評估良性前列腺肥大對腰椎骨質密度與骨折率增加之影響
Using the Fracture Risk Assessment Tool FRAX® and TBS FRAX® to Evaluate the Impact of Benign Prostatic Hyperplasia on the Increased Lumbar Spine Bone Mineral Density and Fracture Rate
摘要
背景：本篇研究評估了良性前列腺肥大（benign prostatic hyperplasia, BPH）與腰椎骨質密度（bone mineral density, BMD）增加之間的關聯。同時我們運用了十年骨折風險評估工具（fracture risk assessment tool, FRAX®）和骨小樑指數調整後骨折風險評估工具（TBS-adjusted FRAX®, TBS FRAX®），來評估患者的十年骨折風險。透過這些評估工具，我們能夠更準確地預測在患有BPH的患者中，骨折風險的增加情況。研究結果不僅有助於瞭解BPH與BMD、TBS之間的關係，及是否會造成骨折率增加，還能夠為臨床醫生提供更有效的骨折預防策略，從而改善患者骨頭的健康狀況。方法：共有4,927名接受健康檢查的50-90歲中年男性納入了本研究。所有參與者的數據均採回溯性收集。分成正常前列腺與BPH兩組，BPH診斷採用超音波掃描確認，由醫師判定受檢者是否有BPH，也利用雙能量X光吸收儀（dual X-ray absorptiometry）儀器，掃描BMD結果搭配TBS軟體判斷骨小樑骨骼品質。最後使用FRAX®與TBS FRAX®比較確認是否會因腰椎BMD增加，而降低骨折風險。結果：本篇研究結果發現，不論BMD正常、低骨密度或骨質疏鬆，在不同TBS狀態下，BPH與正常前列腺組相比兩組間之TBS均未達統計差異。腰椎BMD對於BPH與正常前列腺組相比，BPH者有較高的BMD，獨獨是在腰椎區域有顯著增加。而TBS FRAX®與FRAX®十年骨折率相比，FRAX®均高於TBS FRAX®且達顯著差異。結論：在臨床上，男性骨質疏鬆症容易被忽略，BPH也隨著年紀增加而增加，部分患者可能因BMD檢查結果正常，而被忽略導致骨折率增加，進而導致高骨折的風險，因此本篇研究建議當患者被診斷出BPH時，建議除了定期追蹤BMD之外，還須搭配計算FRAX®與TBS FRAX®來評估骨折風險，降低男性骨折風險。另外本篇研究也提供臨床醫師在診斷腰椎BMD增加同時患有BPH時，能注意患者的骨折率是否也增加。本篇研究建議以FRAX®來評估骨折風險，可以讓臨床醫師更小心處理BPH者的脆性骨骼問題。
並列摘要
Background: This study explores the relationship between benign prostatic hyperplasia (BPH) and increased lumbar spine bone mineral density (BMD), utilizing the Fracture Risk Assessment Tool (FRAX®) and the Trabecular Bone Score-adjusted FRAX® (TBS FRAX®) to evaluate the 10-year fracture risk in affected patients. By employing these tools, we aim to predict fracture risks in men with BPH more precisely. The findings not only shed light on whether BPH-associated BMD changes contribute to a higher fracture rate but also provide clinicians with more effective strategies for fracture prevention, thereby enhancing patient bone health. Methods: A retrospective analysis was conducted on 4,927 middle-aged men aged 50-90 and above who underwent routine health checkups. Participants were classified into two groups: those with a normal prostate and those diagnosed with BPH via ultrasound, confirmed by physicians. BMD was assessed using dual-energy X-ray absorptiometry, and trabecular bone quality was evaluated with TBS software. Subsequently, FRAX® and TBS FRAX® were applied to ascertain whether increased lumbar spine BMD correlates with a reduced fracture risk. Results: The study revealed that across various TBS states, whether BMD is normal, low, or indicative of osteoporosis, the TBS values between the BPH group and the normal prostate group did not demonstrate any statistically significant differences. Lumbar spine BMD was notably higher in the BPH group than in the normal prostate group, with significant increases observed specifically in the lumbar spine region. Furthermore, FRAX® indicated significantly higher 10-year fracture risks than TBS FRAX®, highlighting meaningful distinctions between the two assessment tools. Conclusion: Osteoporosis in men is frequently underrecognized in clinical practice, while the prevalence of BPH increases with age. Some patients may face an elevated fracture risk with normal BMD results that could potentially be overlooked. Therefore, this study recommends that in addition to regular BMD monitoring, FRAX® and TBS FRAX® should be employed in BPH patients to accurately assess fracture risk and mitigate osteoporosis-related fractures. Clinicians should be particularly vigilant of the heightened fracture risk in patients diagnosed with both increased lumbar spine BMD and BPH, and FRAX® should be regarded as an essential tool in assessing fracture risk, allowing clinicians to more cautiously address the issue of fragile bones in patients with BPH.