目的 比较TVF模型与FRAX模型对骨折风险分层的预测效能。 方法 采用单中心前瞻性真实世界研究，纳入2022年4~6月南方医院骨质疏松门诊患者91例（最终73例完成1年随访），收集基线数据后通过FRAX分低危（53例）/高危（38例）两组，TVF分低（9例）、中（39例）、高危（25例）3组，每3个月随访实际骨折发生情况。 结果 两组模型中，最低骨密度T值、骨折史在风险分层间均存在显著差异（P<0.05），FRAX组年龄差异显著。FRAX高危组EQ-5D-5L生活质量评分中活动能力、日常活动及总分显著更低。实际骨折发生率：FRAX高危组22.6%（7/31）vs低危组0%（0/42）；TVF高危组24%（6/25）vs中危组2.5%（1/39）vs低危组0%（0/9）。 结论 TVF和FRAX均具有对骨折风险分层的效能，FRAX在某种程度上可区分患者的生活质量，但也存在低估骨折风险的可能性。TVF作为一种着重研究骨质疏松椎体骨折风险的模型，其有效性和简便适用性为未来的研究奠定了基础。
Abstract
Objective To compare the predictive efficacy of the vertebral fracture risk model (TVF) and fracture risk assessment tool (FRAX) in stratifying fracture risk among osteoporotic patients. Methods A single-center prospective real-world study included 91 patients from the Osteoporosis Clinic of Nanfang Hospital (April-June 2022), with 73 cases of completing 1-year follow-up. After collecting the baseline data, the patients were classified into two groups based on the FRAX model: low-risk group (53 cases) and high-risk group (38 cases), classified into three groups based on TVF model: low- (n=9), medium- (n=39), and high-risk (n=25) groups. Fracture incidence was followed-up every 3 months. Results Among the two groups of models, there were significant differences in bone mineral density T-scores and fracture history between the risk stratification groups (P<0.05), and the age difference was significant in the FRAX group. The FRAX high-risk group showed lower EQ-5D-5L scores in mobility (2.1±0.8 vs 1.3±0.6), daily activities (2.4±0.7 vs 1.5±0.5), and total scores (8.2±1.9 vs 6.1±1.5, P<0.05). Actual fracture incidence: 22.6% in FRAX high-risk group (7/31) vs 0%in low-risk group (0/42); 24% in TVF high-risk group (6/25) vs 2.5% in medium-risk group (1/39) vs 0% in low-risk group (0/9). Conclusions Both TVF and FRAX have the efficacy of stratifying fracture risk, to some extent, FRAX can distinguish the quality of life of patients, but there is also the possibility of underestimating the fracture risk. As a model that focuses on studying the risk of osteoporotic vertebral fractures, TVF's effectiveness and ease of application lay the foundation for future research.
关键词
椎体即刻骨折； /
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骨质疏松症； /
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绝经后妇女
Key words
Immediate vertebral fracture; /
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Osteoporosis; /
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Postmenopausal women
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参考文献
[1] Compston JE, McClung MR, Leslie WD. Osteoporosis[J]. Lancet, 2019, 393(10169):364-376. DOI: 10.1016/S0140-6736(18)32112-3
[2] Lems WF, Paccou J, Zhang J, et al. Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services[J]. Osteoporos Int, 2021, 32(3):399-411. DOI: 10.1007/s00198-020-05804-3
[3] Wang L, Yu W, Yin X, et al. Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study[J]. JAMA Netw Open,2021,4(8):e2121106. DOI: 10.1001/jamanetworkopen.2021. 21106
[4] Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050[J]. Osteoporos Int, 2015, 26(7):1929-1937. DOI: 10.1007/s00198-015-3093-2
[5] Watts NB, Manson JE. Osteoporosis and Fracture Risk Evaluation and Management: Shared Decision Making in Clinical Practice[J]. JAMA, 2017, 317(3):253-254. DOI: 10.1001/jama.2016.19087
[6] Naranjo A, Molina A, Rodriguez-Lozano C, et al. Implications of FRAX(R) adjusted for recent fracture on the indication of treatment in an FLS[J]. Arch Osteoporos, 2022, 17(1):114. DOI:10.1007/s11657-022-01157-y
[7] Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores[J]. BMJ, 2009, 339:b4229. DOI: 10.1136/bmj.b4229
[8] Rubin KH, Moller S, Holmberg T, et al. A New Fracture Risk Assessment Tool (FREM) Based on Public Health Registries[J]. J Bone Miner Res, 2018, 33(11):1967-1979. DOI: 10.1002/jbmr.3528
[9] Lin S, Luo Y, Xie Y, et al. The development and validation of a prediction model for imminent vertebral osteoporotic fracture in postmenopausal women[J]. Eur Spine J, 2024. DOI: 10.1007/s00586-024-08333-3
[10] Kanis JA, Johansson H, Harvey NC, et al. A brief history of FRAX[J]. Arch Osteoporos, 2018, 13(1):118. DOI: 10.1007/s11657-018-0510-0
[11] McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group[J]. N Engl J Med, 2001, 344(5):333-340. DOI: 10.1056/NEJM200102013440503
[12]Tuzun S, Akarirmak U, Kulaksiz B, et al. The association of FRAX with predictors of falls in the assessment of postmenopausal osteoporosis in Turkey: the fracture study of Turkey (FRACT study)[J]. Arch Osteoporos, 2024, 19(1):29. DOI: 10.1007/s11657-024-01387-2
[13]Bartosch P, Malmgren L. Can frailty in conjunction with FRAX identify additional women at risk of fracture - a longitudinal cohort study of community dwelling older women[J]. BMC Geriatr, 2022, 22(1):951. DOI: 10.1186/s12877-022-03639-7
[14]McCloskey E, Tan A, Schini M. Update on fracture risk assessment in osteoporosis[J]. Curr Opin Endocrinol Diabetes Obes, 2024, 31(4):141-148. DOI: 10.1097/MED.0000000000000871
[15]Leslie WD, Binkley N, Goel H, et al. FRAX(R) Adjustment Using Renormalized Trabecular Bone Score (TBS) from L1 Alone may be Optimal for Fracture Prediction: The Manitoba BMD Registry[J]. J Clin Densitom, 2023, 26(4):101430. DOI: 10.1016/j.jocd.2023.101430
[16]Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids[J]. Osteoporos Int, 2011, 22(3):809-816. DOI: 10.1007/s00198-010-1524-7
[17]Ye C, Leslie WD, Morin SN, et al. Adjusting FRAX Estimates of Fracture Probability Based on a Positive Vertebral Fracture Assessment[J]. JAMA Netw Open, 2023, 6(8):e2329253. DOI: 10.1001/jamanetworkopen.2023.29253
[18]Banefelt J, Akesson KE, Spangeus A, et al. Risk of imminent fracture following a previous fracture in a Swedish database study[J]. Osteoporos Int, 2019, 30(3):601-609. DOI: 10.1007/s00198-019-04852-8
基金
国家自然科学基金（82271616）；广州市科技计划项目（202103000052）
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