The Prevalence of Osteoporosis in Patients With Low FRAX Risk

骨折風險評估工具中低風險患者的骨質疏鬆症患病率

陳保良(Pao-Liang Chen) ； 王昱豐(Yuh-Feng Wang) ； 莊紫翎(Tzyy-Ling Chuang) ； 周詩瑾(Shih-Chin Chou) ； 廖建國(Jian-Guo Liao) ； 林俊宏(Chun-Hung Lin)

《核子醫學暨分子影像雜誌》 33卷2期 (2020/06) Pp. 88-98

https://doi.org/10.6332/ANMMI.202006_33(2).0003

摘要

Background: In clinical practice for the bone mineral density (BMD) evaluation, lumbar spine and bilateral hip areas, were included. However, the fracture risk assessment tool (FRAX) only adapts the hip areas as calculation factor. That is, for cases with osteoporosis in lumbar spine but normal in hip areas, FRAX might underestimate the risk of spinal fracture. The aim of this study analyzes the difference between low fracture risk (major osteoporotic fracture risk ＜ 20%, and hip fracture risk ＜ 3%) and high-risk group according to FRAX in osteoporotic patients. Methods: This retrospective research study, outpatient records and dual-energy X-ray absorptiometry (DXA) with variable for FRAX (age, gender, height, weight, previous fracture, smoking, glucocorticoids, rheumatoid arthritis, alcohol and high fracture probabilities) from November 2014 to December 2019 were collected. Past history of spinal surgery and total hip replacement or incomplete medical records were excluded. Seven thousand one hundred forty-eight cases, 1,183 (17%) males and 5,965 (83%) females, were included for analysis. Results: There showed older, higher, heavier, higher cigarette and alcohol taking rate, lower rheumatoid arthritis rate and lower fracture probabilities in men than in women with significant difference (p ＜ 0.05). Significant difference in the BMD and FRAX fracture probabilities between normal, low bone density, and osteoporosis groups were also noted. In osteoporotic cases, older, shorter, thinner, less BMD/T-score of bilateral femoral neck and bilateral total femurs in high fracture risk group than low fracture risk group with significant difference (p ＜ 0.05). Four point four percent patients with low FRAX risk were diagnosed to be osteoporosis solely because of the lumbar BMD measurement was no more than -2.5. In addition, the demographic variables in the osteoporotic patients showed significant difference between high FRAX risk group and low FRAX risk group. Conclusions: In this study, the osteoporotic cases defined by lumbar vertebrae DXA results with fair bilateral hip DXA results are classified into low fracture risk group. Therefore, three areas (lumbar vertebrae and bilateral hips) DXA scan and 10-years fracture risk calculation for bilateral hips should be performed together to provide clinicians with accurate reference for patient treatment and medication.

關鍵字

bone mineral density ； fracture risk assessment tool ； osteoporosis

並列摘要

背景：一般在骨質密度的檢查部位包括腰椎以及兩側的髖關節，而骨折風險度評估工具是以髖關節的骨質密度做為評估依據。然而，若單純以骨折風險度做為患者的追蹤或評估依據，可能會有所失漏。因此，本篇研究分析在骨質疏鬆組當中，骨折低風險的患者（主要骨鬆性骨折率＜20%、髖部骨折率＜ 3%）與骨折高風險組別中，是否有差異性。方法：本篇為回顧性研究，收集2014年11月至2019年12月接受雙能量光吸收測量的門診患者之病歷紀錄。排除過去因脊柱手術和人工髖關節置換手術或病歷紀錄不完整之病人。最終收集7,148位受檢者資料，男性為1,183名（17%），女性為5,965名（83%）。將患者的理學檢查、過去病史、生活型態和10年骨折率相進行分析。結果：經過統計分析發現男女之間之年齡、身高、體重、過去病史與包括（先前骨折、吸煙、服用類固醇、類風濕性關節炎、喝酒及高骨折風險）之危險因子達統計差異。正常組、低骨密度組和骨質疏鬆組三組間之骨礦物質密度量測和骨折風險評估工具的骨折率有顯著差異。高、低骨折風險族群之骨礦物質密度量測和骨折風險評估工具有顯著差異。有4.4%患者僅因腰椎骨質密度區域為骨質疏鬆症，但骨折風險評估工具判斷為低骨折風險，且大多因腰椎T值≤ -2.5而被判斷為骨質疏鬆症，除此之外在骨質疏鬆症組別中高骨折風險與低骨折風險族群，各項目均達顯著差異。結論：本篇研究發現，在骨質疏鬆組當中，仍存在著骨折低風險的患者；此類患者為腰椎區域有骨質疏鬆發生，但雙側髖關節處的骨質密度仍未明顯流失，因此其骨折風險度評估之結果呈現低風險度。我們強烈建議執行骨質密度檢查時需要掃描三個部位（腰椎與雙側髖部），並進行雙側髖部10年骨折率計算，如此可以提供臨床醫師針對患者治療與用藥準確之參考。

並列關鍵字

骨質密度 ； 骨折風險評估工具 ； 骨質疏鬆症