Construction of a prediction model for lumbar fracture in patients with osteoporosis
Objective To construct a prediction model for lumbar fracture in patients with osteoporosis(OP)based on lumbar bone mineral density measured by quantitative computed tomography(QCT)and bone metabolism indicators.Methods A total of 52 patients with OP and lumbar fracture(the fracture group)and 104 patients with OP without lumbar fracture(the non-fracture group)were selected as study subjects.The correlation between lumbar bone mineral density measured by QCT and serum procollagen type I C-propeptide(P1CP),N-terminal mid-fragment of osteocalcin(N-MID)and beta collagen degradation products(β-CTX)was analyzed.Logistic regression analysis was conducted to identify influencing factors of lumbar fracture.A prediction model was constructed and its predictive value was analyzed.Results Compared with the non-fracture group,the proportions of females and patients with fall history,β-CTX level and vitamin D/calcium medication history were higher in the fracture group,and lumbar bone mineral density measured by lumbar QCT,P1CP and N-MID levels were lower(P＜0.05).Pearson correlation analysis found that lumbar bone mineral density measured by QCT was positively correlated with serum levels of P1CP and N-MID,and negatively correlated with β-CTX(r=0.523,0.506,-0.536,P＜0.05).Multivariate Logistic regression analysis found that higher lumbar bone mineral density measured by QCT,P1CP,N-MID and history of taking vitamin D/calcium were protective factors for lumbar fracture,and igher β-CTX level was a risk factor(P＜0.05).The sensitivity and specificity of the prediction model constructed based on Logistic regression analysis results for predicting lumbar fracture were 84.62%and 97.12%.The area under the curve was 0.926(95%CI:0.873-0.962).The prediction model had good calibration,and the agreement rate was 0.910.Conclusion OP patients with higher levels of QCT,P1CP and N-MID,and lower level of β-CTX have lower risk of lumbar fracture.Vitamin D and calcium can effectively prevent the occurrence of lumbar fracture in OP patients,especially in women.
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