目的 在不使用骨密度的情况下探讨无锡地区相对健康绝经后女性最佳FRAX®干预阈值,旨在不浪费过多资源的前提下有效地识别出患有骨质疏松症(osteoporosis,OP)的潜在人群.方法 将在作者医院随机招募的符合纳排标准的124名50岁以上健康绝经后女性作为研究对象,以65岁为分界年龄分为50～65岁组(n=86)和＞65岁组(n=38).收集受试者年龄、体质量指数(body mass index,BMI)、既往骨质疏松性骨折史、慢性病史等个人信息.使用FRAX®软件得出受试者髋部骨折的概率(probability of hip fractures,PHF)、主要骨质疏松性骨折概率(probability of major osteopo-rotic fractures,PMOF),以骨密度T值是否小于-2.5为状态变量,不输入骨密度T值的PHF、PMOF为检验变量,运用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析其临床筛选OP的效能,确定无锡地区相对健康绝经后中老年女性最佳干预阈值.结果 50～65岁组OP患者39人(45.35％),＞65岁组OP患者23人(60.53％).ROC曲线分析结果显示,50～65岁组PHF AUC为0.771,灵敏度为0.718,特异度为0.681,最佳阈值为0.7％;PMOF AUC为0.748,灵敏度为0.667,特异度为0.723,最佳阈值为3.4％.＞65岁组受试者PHF AUC为0.554,灵敏度为0.783,特异度为0.400;PMOF AUC为0.546,灵敏度为0.826,特异度为0.400,＞65岁组PHF、PMOFAUC接近0.5,说明预测的准确性较低.按照《原发性骨质疏松症诊疗指南》推荐PHF、PMOF阈值划分骨折风险,50～65岁组全为骨折低风险人群,＞65岁组30人为低风险、8人为高风险人群,此结果低估了本研究患者的骨折风险.结论 推荐PHF为0.7％、PMOF为3.4％为无锡地区50～65岁健康绝经后女性FRAX®干预阈值,大于该阈值者建议进行骨密度检测,适当给予治疗措施;对于无锡地区65岁以上健康绝经后女性建议直接进行骨密度检测.
Intervention Threshold of FRAX? Without Bone Mineral Density in Healthy Postmenopausal Women in Wuxi Area Based on ROC Curve
Objective To explore the optimal intervention threshold of FRAX® for postmenopausal women with relative health in Wuxi area without using bone mineral density,aiming to effectively identify potential populations with osteoporosis(OP)without wasting too many resources.Methods A total of 124 healthy postmenopausal women aged 50 years and above who met the inclusion criteria were randomly recruited from the author's hospital,they were divided into the 50-65-year-old group(n=86)and＞65-year-old group(n=38)taking the age of 65 as the cutoff point.Personal in-formation such as age,body mass index(BMI),history of osteoporotic fractures and history of chronic diseases were col-lected from the subjects.The FRAX® software was used to calculate the probability of hip fractures(PHF)and probabil-ity of major osteoporotic fractures(PMOF)for the subjects.Using whether the T-score of bone density was less than-2.5 as the state variable and the PHF and PMOF without incorporating the T-score of bone mineral density as the diag-nostic variables,the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the efficiency of clinical screening for OP and determine the optimal intervention threshold for middle-aged and elderly postmenopausal women with relative health in Wuxi area.Results There were 39 patients with OP(45.35％)in the 50-65-year-old group and 23 patients with OP(60.53％)in the＞65-year-old group.ROC curve showed that AUC of PHF in 50-65-year-old group was 0.771,the sensitivity was 0.718,the specificity was 0.681 and the best threshold value was 0.7％;the AUC of PMOF was 0.748,the sensitivity was 0.667,the specificity was 0.723 and the best threshold was 3.4％.The AUC of PHF in＞65-year-old group was 0.554,the sensitivity was 0.783 and the specificity was 0.400;the AUC of PMOF was 0.546,the sensitivity was 0.826 and the specificity was 0.400,the AUC of PHF and PMOF in＞65-year-old group was nearly 0.5,which indicating that the accuracy of the prediction was low.According to Guidelines for the Diagnosis and Treatment of Primary Osteoporosis,the threshold of PHF and PMOF were recommended to determine the risk of fracture,all the patients in 50-65-year-old group were at low risk of fracture,there were 30 patients at low risk of fracture and 8 patients at high risk of fracture in＞65-year-old group,the fracture risk of the patients in this study was underestimated.Conclusion PHF 0.7％and PMOF 3.4％are recommended as FRAX® intervention thresholds for healthy postmenopausal women aged 50-65 in Wuxi area,if the threshold is higher than this value,bone mineral density testing is recommended and appropriate treatment measures are underwent;for postmenopausal women aged over 65 with relative health,it is recommended to directly undergo bone mineral density test.
Postmenopausal osteoporosisFRAX®Probability of hip fracturesProbability of major osteoporotic fracturesThresholdHealth postmenopausal women
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