Combined Use of BMD and FRAX for the Prediction of Fracture Risk in Patients With Low Bone Density

結合BMD和FRAX的使用可預測低骨密度患者的骨折風險

10.6332/ANMMI.201909_32(3).0001

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

bone mineral density ； fracture risk assessment tool ； ten-year probability of fracture ； 骨質密度 ； 骨折風險評估工具 ； 十年骨折率

核子醫學暨分子影像雜誌

32卷3期（2019 / 09 / 01）

113 - 122

英文

Background: The fracture risk assessment tool (FRAX) screening tool is used to estimate the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (spine, forearm, hip, or shoulder) in patients with osteoporosis. This study aims to determine whether patients with low bone density without osteoporosis are at greater risk of fracture that could be identified using FRAX. Methods: This retrospective study used a cross-sectional design. Patients who underwent outpatient examination including dual-energy X-ray absorptiometry (DXA) from September 2017 to May 2019 were further screened; those with the history of spinal surgery, total hip replacement, or incomplete medical records were excluded. A total of 2,613 patients were included in the final cohort, 430 males (16%) and 2,183 females (84%). Demographic information and clinical histories, including age, height, weight, and body mass index were collected. Factors associated with a 10-year probability of fracture (previous fracture, parental hip fracture, current smoking, glucocorticoids use, rheumatoid arthritis, secondary osteoporosis and alcohol intake of 3 or more units daily) were also recorded. Results: DXA and FRAX results differed significantly between patients with normal bone density, low bone density, and osteoporosis. DXA and FRAX results of bilateral hips differed significantly between patients with high risk (major osteoporotic fracture, ＞ 20%; hip fracture, ＞ 3%) and low risk (major osteoporotic fracture, ＜ 20%; hip fracture, ＜ 3%) of fracture. High fracture risk was identified by FRAX results as hip fracture ＞ 3% in patients with bone loss not yet progressed to osteoporosis. But our study showed low bone density group was at high risk for major osteoporotic fracture (＞ 20%) and hip fracture (＞ 3%) in a total of 562 patients (22%). Conclusions: Patients with bone loss not yet progressed to osteoporosis would benefit from FRAX determination of 10-year risk of fracture. While both DXA and FRAX can be used to determine the 10-year probability of fracture in patients with bone loss, we recommend the use of FRAX in the clinical setting.

背景：骨折風險評估工具（fracture risk assessment tool, FRAX）用於評估髖部及主要骨質疏鬆性骨折（脊柱、前臂、髖部或肩部）的10年骨折率，本研究旨在證明骨密度低的患者，是否可以透過FRAX進行鑑別評估是否存在更大的骨折風險。方法：本研究是利用回顧橫斷面設計。自2017年9月至2019年5月接受門診雙能量X射線吸收測定法（dual-energy X-ray absorptiometry, DXA）檢查的患者；排除有脊柱手術史，全髖關節置換術或病歷的不完整都將不納入本研究。最終總共收集2,613名患者，430名男性（16%）和2,183名女性（84%）。收集資料包含臨床病史，包括年齡，身高，體重，身體質量指數。還記錄了與10年骨折率相關的因素（包含患者本身有無骨折、父母髖骨骨折、目前吸煙、使用糖皮質激素、類風濕性關節炎、繼發性骨質疏鬆症和每日3次或以上的酒精攝入量）。結果：骨密度正常，骨密度低和骨質疏鬆的患者DXA和FRAX結果差異顯著。雙側髖關節的DXA和FRAX結果在高風險（主要骨質疏鬆性骨折＞20；髖部骨折＞3%）和低風險（主要骨質疏鬆性骨折＜20%；髖部骨折＜3%）的患者中差異顯著差異。骨密度低的患者的FRAX結果其髖部骨折＞3，為骨折高風險之族群。但是低骨質密度中高風險主要骨鬆性骨折率＞20%與髖骨骨折率＞3%總計562位（占22%）。結論：骨質流失尚未發展為骨質疏鬆症的患者可將受益於FRAX測定10年骨折風險。雖然DXA和FRAX都可用於確定骨質流失患者的10年骨折概率，但我們建議在臨床檢查中使用FRAX。