- 期刊
The Difference Between FRAX and TBS Adjusted FRAX in the Evaluation of 10-Year Risk of Fracture in Healthy Adults
FRAX和TBS FRAX在健康成年人十年骨折風險評估之差異
摘要
Background: Traditional assessment of fracture risk of osteoporosis was considered by the World Health Organization (WHO) a fracture risk assessment tool (FRAX). Newly developed lumbar trabecular bone score (TBS) software has been used as a potential indicator of bone microstructure changes. We compare the FRAX to the TBS adjusted FRAX (T-FRAX) in evaluating fracture risk among normal, osteopenia, and osteoporosis patients. Methods: Subjects were enrolled from May 2014 to November 2015. Bone mineral density, renal function, laboratory data, and fracture risk assessment by FRAX and T-FRAX were investigated. The difference among the groups of normal, osteopenia, and osteoporosis were analyzed via one-way analysis of variance (one-way ANOVA). The difference between FRAX and T-FRAX was further analyzed by paired t-test. Results: Three hundred and ninety-nine subjects were retrospectively evaluated; 184 (46%) are male and 215 (54%) are female. The average height was 162.7 ± 8.2 cm, the average body weight was 63.9 ± 12.3 kg, and the average body mass index (BMI) was 23.85 ± 3.6 kg/m^2. Smoking history, alcohol use, and prevalence of fracture were differed among groups (p ≤ 0.038). Serum creatinine and dual energy X-ray absorptiometry also significantly differed across the three groups (p ＜ 0.001). The risk of fracture was significantly less with T-FRAX compared with FRAX in patients with osteopenia for both right and left major osteoporotic and hip fracture (p ＜ 0.001). The risk of fracture was relatively smaller with T-FRAX than FRAX for right and left hip fracture in patients with osteoporosis (p ＜ 0.001). Conclusions: The study found that, except for major osteoporotic fracture in patients with osteoporosis, T-FRAX resulted in a lower risk of fracture as compared with FRAX. The findings indicate that T-FRAX can be used to assess the future fracture risk and changes in microstructure changes and may provide clinicians as a method of evaluating the effectiveness of a treatment.
並列摘要
目的：骨質疏鬆症是一種以骨骼微結構退化為特徵的骨疾病，由於骨骼結構脆弱，從而增加骨折風險。一般臨床上以世界衛生組織(World Health Organization, WHO)的骨折風險評估工具(fracture risk assessment tool, FRAX)對骨折風險進行評估。最近則有新開發的腰椎骨小梁骨評分軟體(trabecular bone score, TBS)被用作骨微結構變化的潛在指標。本研究的目的是比較FRAX和TBS調整後之FRAX(TBS adjusted FRAX, T-FRAX)評估正常骨質密度者和骨質疏鬆症患者的骨折風險評估之差異。方法：從2014年5月至2015年11月健檢受檢者個案中回溯性評估。分析其骨密度、腎功能、其他抽血數據，以及FRAX和T-FRAX之骨折風險評估對於骨折率之差異，並依其骨密度分作正常、骨質減少和骨質疏鬆症患者等3組加以做分析。我們利用one-way analysis of variance (one-way ANOVA)分析骨質密度3組的差異，也利用成對樣本t檢定分析FRAX與T-FRAX兩種骨折率計算結果之差異。結果：研究族群(n = 399)包括184位男性(46%)和215位女性(54%)。平均身高為162.7 ± 8.2公分，平均體重63.9 ± 12.3公斤，平均體重指數為23.85 ± 3.6 kg/m^2。在此3組中，吸煙史、酒精使用和骨折患病率呈現有意義的差異(p ≤ 0.038)；3組患者的血清肌酐和雙能X光吸收測定法也有差異(p ＜ 0.001)。與右側和左側主要骨質疏鬆和髖部骨折骨質減退患者相比，T-FRAX的骨折風險顯著降低(p ＜ 0.001)。骨質疏鬆症患者右側和左側髖部骨折患者骨折風險相對較小(p ＜ 0.001)。結論：利用T-FRAX可用於評估未來骨折風險，並指出微觀結構變化。我們的研究發現，除了骨質疏鬆症患者的主要骨質疏鬆性骨折外，與FRAX相比，T-FRAX所計算之骨折風險較低，而其所能提供對臨床治療評估的幫助，我們仍在後續繼續的研究中。