Osteoporotic fracture risk prediction value of Fracture Risk Assessment Tool（FRAX?）in middle-aged and elderly people in Shanghai

doi:10.12114/j.issn.1007-9572.2020.00.090

Abstract

Abstract: Background　Osteoporotic fractures are one of the main causes of disability and death in elderly patient，and early prediction and timely intervention are important links of prevention and treatment.The Fracture Risk Assessment Tool（FRAX?） recommended by WHO is used to assess the 10-year major osteoporotic fracture probability（MOFP） and hip osteoporotic fracture probability（HOFP）.The fracture-related risk factors have been identified based on a number of independent large-sample prospective population studies and meta-analysis of large-sample studies in Europe，North America，Asia，Australia，etc，so they are representative.However，as large-scale epidemiological studies on the incidence of osteoporotic fractures and their influencing factors in Shanghai are ongoing，whether FRAX? predictions can accurately assess fracture risk in middle-aged and elderly people in Shanghai remains to be confirmed by further research.Objective　To predict the risk of osteoporotic fractures in middle-aged and elderly people in Shanghai using the Chinese version of FRAX?.Methods　Participants were 1 520 middle-aged and elderly Chinese people〔mean age was（65.5±9.6） years，range between 45 and 90〕 recruited from Department of Osteoporosis and Osteopathy，Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January to October 2013.The Chinese version of FRAX? was used to calculate the 10-year MOFP and HOFP.The diagnostic criterion for high-risk of osteoporosis fracture was defined as 10-year MOFP≥20% or 10-year HOFP≥3%.Results　Compared with men，women had higher median 10-year MOFP〔3.60%（2.80%） vs 2.10%（1.10%）〕，higher median 10-year HOFP〔0.80%（1.50%） vs 0.60%（0.70%）〕，and higher percentage of cases at high-risk for 10-year HOFP〔11.28%（87/771） vs 2.94%（22/749）〕（P<0.05）.But the percentage of cases at high-risk for 10-year MOFP in women was similar to that of men〔0.13%（1/771） vs 0.13%（1/749）〕（P>0.05）.Age-specific analysis showed that in men，the 10-year MOFP in age group of 50-59 was lower than that of age groups of 60-69，70-79 and 80-90（P<0.05）.The 10-year HOFP in age group of 50-59 was also lower than that of other three older age groups（P<0.05）.The 10-year HOFP in age group of 60-69 was lower than that of other two older age groups（P<0.05）.In women，either the 10-year MOFP or HOFP increased successively in age groups of 45-49，50-59，60-69，70-79 and 80-90（P<0.05）.BMI-specific analysis demonstrated that in men，the 10-year MOFP was lower in those with BMI≥28.0 kg/m2 compared with those with BMI<18.5，18.5-23.9 or 24.0-27.9 kg/m2.The 10-year HOPF decreased successively in those with BMI<18.5，18.5-23.9，24.0-27.9 and ≥28.0 kg/m2（P<0.05）.In women，the 10-year MOFP was lower in those with BMI≥28.0 kg/m2 compared with those with BMI<18.5 or 18.5-23.9 kg/m2（P<0.05）.Those with BMI 24.0-27.9 kg/m2 had lower 10-year MOFP than those with BMI <18.5 kg/m2（P<0.05）.Those with BMI 24.0-27.9 had lower 10-year HOFP than those with BMI<18.5 or 18.5-23.9 kg/m2（P<0.05），as did those with BMI≥28.0 kg/m2（P<0.05）.Those with BMI 18.5-23.9 kg/m2 showed lower 10-year HOFP than those with BMI<18.5 kg/m2（P<0.05）.Female was associated with higher age- and BMI-specific 10-year MOFP and 10-year HOFP（P<0.05）.Conclusion　High risk of osteoporotic fractures was observed in older postmenopausal women who had lower BMI.So special attention needs to be paid to this group.The Chinese version of FRAX? has clear value to predict osteoporotic fractures in middle-aged and old people in Shanghai.However，there may be a possibility that the detection rate of high-risk people is low and the risk is underestimated.

Key words: Osteoporotic fractures, Hip fractures, Fracture Risk Assessment Tool, Middle aged and aged, Shanghai

摘要： 背景　骨质疏松性骨折是老年患者致残和致死的主要原因之一，早期预测和尽早干预是防治的重要环节。WHO推荐的骨折风险评估工具（FRAX?）用于评估患者未来10年主要骨质疏松性骨折概率（MOFP）和髋部骨质疏松性骨折概率（HOFP），危险因素的确定基于欧洲、北美、亚洲、澳大利亚等多个独立大样本前瞻性研究和大样本荟萃分析，具有一定代表性。但上海地区的骨质疏松性骨折发生率及影响因素的大样本流行病学研究正在进行中，FRAX?预测结果能否准确预估上海地区中老年人群的骨折风险尚有待进一步证实。目的　利用FRAX?中国版本预测上海地区中老年人的骨质疏松性骨折发生风险。方法　选取2013年1—10月在上海交通大学附属第六人民医院骨质疏松和骨病专科就诊的中老年人1 520例，年龄45~90岁，平均年龄（65.5±9.6）岁。采用FRAX?中国版本计算中老年人的10年MOFP和HOFP，以10年MOFP≥20%和10年HOFP≥3%为骨质疏松性骨折高危人群。结果　男性中老年人的10年MOFP中位值为2.10%（1.10%），高危者占比为0.13%（1/749），10年HOFP中位值为0.60%（0.70%），高危者占比为2.94%（22/749）；女性中老年人的10年MOFP中位值为3.60%（2.80%），高危者占比为0.13%（1/771），10年HOFP中位值为0.80%（1.50%），高危者占比为11.28%（87/771）。女性中老年人10年MOFP、10年HOFP及10年HOFP高危者占比高于男性（P<0.05），但男性和女性中老年人10年MOFP高危者占比无统计学差异（P>0.05）。考虑不同年龄段：男性10年MOFP，50~59岁者低于60~69、70~79、80~90岁者（P<0.05）；男性10年HOFP，50~59岁者低于60~69、70~79、80~90岁者，60~69岁者低于70~79、80~90岁者（P<0.05）；女性 10年MOFP和HOFP，45~49、50~59、60~69、70~79、80~90岁者依次升高（P<0.05）。考虑不同BMI分段：男性10年MOFP，BMI≥28.0 kg/m2者低于BMI<18.5、18.5~23.9、24.0~27.9 kg/m2者（P<0.05）；男性10年HOPF，BMI<18.5、18.5~23.9、24.0~27.9、≥28.0 kg/m2者依次降低（P<0.05）；女性10年MOFP，BMI≥28.0 kg/m2者低于BMI<18.5、18.5~23.9 kg/m2者，BMI 24.0~27.9 kg/m2者低于BMI<18.5 kg/m2者（P<0.05）；女性10年HOFP，BMI 24.0~27.9、≥28.0 kg/m2者低于BMI<18.5、18.5~23.9 kg/m2者，BMI 18.5~23.9 kg/m2者低于BMI<18.5 kg/m2者（P<0.05）。同年龄段、同BMI分段女性中老年人的10年MOFP和HOFP均高于男性（P<0.05）。结论　高龄、低BMI的绝经后女性具有较高的骨质疏松性骨折风险，需重点监测；FRAX?中国版本对上海地区中老年人的骨质疏松性骨折发生风险具有一定的预测价值，但存在高危患者检出率低、低估发生风险的可能。

关键词: 骨质疏松性骨折, 髋骨折, 骨折风险评估工具, 中老年, 上海

ZHAO Xiao,ZHANG Zhenlin. Osteoporotic fracture risk prediction value of Fracture Risk Assessment Tool（FRAX?）in middle-aged and elderly people in Shanghai[J]. Chinese General Practice, 2020, 23(19): 2429-2434. DOI: 10.12114/j.issn.1007-9572.2020.00.090.
赵啸,章振林. 基于骨折风险评估工具（FRAX?）的上海地区中老年人骨质疏松性骨折发生风险研究[J]. 中国全科医学, 2020, 23(19): 2429-2434. DOI: 10.12114/j.issn.1007-9572.2020.00.090.

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