应用FRAX骨折风险预测工具模拟评估不同国家人群骨折风险的临床研究
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摘要
目的应用FRAX工具模拟评估中国、日本、德国三国人群的10年内重要部位骨折概率(PMOF)及10年内髋部骨折概率(PHF),分析比较不同国家的骨折风险性差异,分析比较各国骨折风险与年龄、性别的变化关系。方法收集2976例受检者FRAX骨折风险评估危险因素11项及股骨颈骨密度BMD,应用FRAX骨折风险评估网站分别模拟评估中国、日本、德国三国模式下PMOF、PHF,采用两独立样本t检验及Mann-Whitney U检验分别对三国数据进行两两比较,并观察三国PMOF、PHF性别间差异及随年龄的变化趋势。结果 1)三国不论男性、女性,均表现为PMOF在40～49岁中国最小、德国最大,50岁以上中国最小、日本最大,且差异有统计学意义。PHF在40岁～59岁日本最小、德国最大,60岁以上中国最小、德国最大,且差异有统计学意义。(2)三国不论男性、女性,PMOF、PHF均随年龄的增长而增长,仅中国在80岁以上年龄组两者概率有所下降。三国50岁以后女性10年内骨质疏松性骨折概率均大于男性,且女性PMOF、PHF概率增长的速度明显大于男性。结论骨质疏松性骨折的发生概率存在地域差异,在同等条件下,欧洲国家发生骨质疏松性骨折的概率大于亚洲国家,发达国家骨折的概率大于发展中国家。骨质疏松性骨折的发生概率随年龄增长而增长,女性较男性更易发生骨质疏松性骨折。
Objective Using the FRAX tool to simulate the evaluation of 10 years probability of major osteoporotic fracture(PMOF) and 10 years probability of hip fracture(PHF) for populations in China, Japan, and Germany, to analyze and compare fracture risk differences in different countries, and to analyze and compare the relationship between fracture risk and age and gender in each country. Methods 2 976 subjects were assessed for 11 risk factors for FRAX fracture risk assessment and bone mineral density(BMD). The FRAX fracture risk assessment website was used to simulate the evaluation of PMOF and PHF in China, Japan, and Germany. Two independent samples t test and Mann-Whitney U tests were used for pairwise comparison the data of the three countries, and to observe the gender differences and trends with age in PMOF and PHF in the three countries. Results 1) In both man and women in the three countries, PMOF was the lowest in China and the highest in Germany in those aged 40 to 49 years, PMOF was the lowest in China and the highest in Japan in those aged over 50 years, and the differences were statistically significant. PHF was the lowest in Japan and the highest in Germany in those aged 40 to 59 years, PHF was the lowest in China and the highest in Germany in those aged over 60 years, and the differences were statistically significant.(2) Regardless of men and women, in the three countries PMOF and PHF all increased with age, and only the probability in the 80+ age group in China had decreased. In all three countries, the 10 years probability of osteoporotic fractures in women aged over 50 years was higher than that of men, and the increase in the probability of PMOF and PHF with age in women was significantly faster than that of men. Conclusion There are regional differences in the probability of osteoporotic fracture. Under the same conditions, the probability of osteoporotic fracture in European countries is greater than that in Asian countries. The probability of fracture in developed countries is greater than that in developing countries. The incidence of osteoporotic fractures increases with age, women are more likely to have osteoporotic fractures than men.
Objective Using the FRAX tool to simulate the evaluation of 10 years probability of major osteoporotic fracture(PMOF) and 10 years probability of hip fracture(PHF) for populations in China, Japan, and Germany, to analyze and compare fracture risk differences in different countries, and to analyze and compare the relationship between fracture risk and age and gender in each country. Methods 2 976 subjects were assessed for 11 risk factors for FRAX fracture risk assessment and bone mineral density(BMD). The FRAX fracture risk assessment website was used to simulate the evaluation of PMOF and PHF in China, Japan, and Germany. Two independent samples t test and Mann-Whitney U tests were used for pairwise comparison the data of the three countries, and to observe the gender differences and trends with age in PMOF and PHF in the three countries. Results 1) In both man and women in the three countries, PMOF was the lowest in China and the highest in Germany in those aged 40 to 49 years, PMOF was the lowest in China and the highest in Japan in those aged over 50 years, and the differences were statistically significant. PHF was the lowest in Japan and the highest in Germany in those aged 40 to 59 years, PHF was the lowest in China and the highest in Germany in those aged over 60 years, and the differences were statistically significant.(2) Regardless of men and women, in the three countries PMOF and PHF all increased with age, and only the probability in the 80+ age group in China had decreased. In all three countries, the 10 years probability of osteoporotic fractures in women aged over 50 years was higher than that of men, and the increase in the probability of PMOF and PHF with age in women was significantly faster than that of men. Conclusion There are regional differences in the probability of osteoporotic fracture. Under the same conditions, the probability of osteoporotic fracture in European countries is greater than that in Asian countries. The probability of fracture in developed countries is greater than that in developing countries. The incidence of osteoporotic fractures increases with age, women are more likely to have osteoporotic fractures than men.
引文
[1] Li P Q, Zhang X J, Wu J X, et al. Changes of bone mineral density and its related factors in 80 patients with diabetes mellitus[J]. Si Chuan Medical Journal,2001,22(10): 900-901.
[2] Dominguez L J, Muratore M, Quarta E, et al. Osteoporosis and diabetes[J]. Reum atismo,2004,56(4): 235-241.
[3] 刘素香. 国外骨折风险评估工具FRAX的应用进展[J].中国骨质疏松杂志, 2016,22(11):1488-1490.LIU Suxiang. Application progress of fracture risk assessment tool FRAX in foreign countries[J].Chin J Osteoporos, 2016,22(11):1488-1490.
[4] Huang P J, Li C P, Wang J, et al. The incidence of osteoporosis and analysis of bone metabolic and biochemical markers in patients with type-2 diabetes mellitus[J].Chin J Osteoporos,2011,17(4): 300-303.
[5] 蔡舒婷,孙雯,刘红. 骨折风险评估工具(FRAX) 在评价绝经后女性骨密度的临床意义[J].中国骨质疏松杂志,2017,23(2): 177-182.CAI Shuting, SUN Wen,LIU Hong.Clinical Significance of FRAX on evaluating of bone mineral density in postmenopausal women[J].Chin J Osteoporos,2017,23(2): 177-182.
[6] 杨丹,栗平,赵平. 探讨骨质疏松性骨折的相关影响因素及预防[J].中国骨质疏松杂志, 2014,20(2):.152-155.Yang Dan, LI Ping, ZHAO Ping. The investigation of the related influencing factors of osteoporotic fractures and the related prevention measures[J].Chin J Osteoporos, 2014,20(2):.152-155.
[7] Brown SA, Sharpless JL. Osteoporosis: an under-appreciated complication of diabetes[J]. Clinical Diabetes, 2004, 22(1):10-20.
[8] Leidig G, Ziegler R. Diabetes mellitus a risk for osteoporosis[J]. Exp Clin Endocrinol Diabetes, 2001, 109 (2):S493-S514.
[9] 马宗军, 王一农. 骨质疏松症流行病学研究现状[J].国际骨科学杂志, 2007,28(5):315-316.Ma Zongjun Wang Yinong. The status quo of epidemiology of osteoporosis[J].IInternational Journal of Orthopedics, 2007,28(5):315-316.
[10] Melton LJ.Who has Osteoporosis? A conflict between clinical and public health perspective[J].J Bone Miner Res,2000,15(12):2309-2314.
[11] Chin KY. A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk[J]. Postgrad Med. 2017,129(7):734-746.
[12] 刘明珠. 从全球的角度看亚洲骨质疏松症的流行病学[J].国外医学内分泌分册, 2004,24(4):222-224.Liu Mingzhu. Global Epidemiology of Osteoporosis in Asia[J].Section Endocrinol Foreign Med Sci, 2004,24(4):222-224.
[13] 彭绩, 梁渊, 卢祖询. 骨质疏松危险因素的 meta 分析[J]. 中国公共卫生, 2004, 20(5): 585-6.Peng Ji, Liang Yuan, Lu Zuxun. Meta-analysis on risk factors of osteoporosis[J]. Chin J Public Health,2004, 20(5): 585-6.
[14] 黄际远, 宋文忠. 双能 X 射线骨密度测定在骨质疏松诊治中的应用[J]. 实用医院临床杂志, 2008, 5(5):127-128.Huang Jiyuan, Song Wenzhong. Double energy X-ray bone densitometry for the diagnosis and treatment of osteoporosi [J]. Practical Hospital Clinical Journal, 2008, 5(5):127-128.
[15] Couris CM, Chapurlat RD, Kanis JA, et al. FRAX, probabilities and risk of major osteoporotic fracture in France[J]. Osteoporos Int, 2012, 23(9):2321-2327.
[16] 张建新, 王和鸣, 张生, 等. 泉州市农村老年性骨质疏松性骨折的流行病学调查[J]. 中国骨质疏松杂志, 2007, 13(12):860-863.Zhang JX, Wang HM, Zhang S, et al. Epidemiological survey of the senile osteoporosis fracture in the village of Quanzhou city[J]. Chin J Osteoporos, 2007, 13(12):860-863.
[17] Sharma D, Larriera AI, Palacio-Mancheno PE, et al. The effects of estrogen deficiency on cortical bone microporosity and mineralization[J]. Bone. 2018, 110:1-10.
[2] Dominguez L J, Muratore M, Quarta E, et al. Osteoporosis and diabetes[J]. Reum atismo,2004,56(4): 235-241.
[3] 刘素香. 国外骨折风险评估工具FRAX的应用进展[J].中国骨质疏松杂志, 2016,22(11):1488-1490.LIU Suxiang. Application progress of fracture risk assessment tool FRAX in foreign countries[J].Chin J Osteoporos, 2016,22(11):1488-1490.
[4] Huang P J, Li C P, Wang J, et al. The incidence of osteoporosis and analysis of bone metabolic and biochemical markers in patients with type-2 diabetes mellitus[J].Chin J Osteoporos,2011,17(4): 300-303.
[5] 蔡舒婷,孙雯,刘红. 骨折风险评估工具(FRAX) 在评价绝经后女性骨密度的临床意义[J].中国骨质疏松杂志,2017,23(2): 177-182.CAI Shuting, SUN Wen,LIU Hong.Clinical Significance of FRAX on evaluating of bone mineral density in postmenopausal women[J].Chin J Osteoporos,2017,23(2): 177-182.
[6] 杨丹,栗平,赵平. 探讨骨质疏松性骨折的相关影响因素及预防[J].中国骨质疏松杂志, 2014,20(2):.152-155.Yang Dan, LI Ping, ZHAO Ping. The investigation of the related influencing factors of osteoporotic fractures and the related prevention measures[J].Chin J Osteoporos, 2014,20(2):.152-155.
[7] Brown SA, Sharpless JL. Osteoporosis: an under-appreciated complication of diabetes[J]. Clinical Diabetes, 2004, 22(1):10-20.
[8] Leidig G, Ziegler R. Diabetes mellitus a risk for osteoporosis[J]. Exp Clin Endocrinol Diabetes, 2001, 109 (2):S493-S514.
[9] 马宗军, 王一农. 骨质疏松症流行病学研究现状[J].国际骨科学杂志, 2007,28(5):315-316.Ma Zongjun Wang Yinong. The status quo of epidemiology of osteoporosis[J].IInternational Journal of Orthopedics, 2007,28(5):315-316.
[10] Melton LJ.Who has Osteoporosis? A conflict between clinical and public health perspective[J].J Bone Miner Res,2000,15(12):2309-2314.
[11] Chin KY. A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk[J]. Postgrad Med. 2017,129(7):734-746.
[12] 刘明珠. 从全球的角度看亚洲骨质疏松症的流行病学[J].国外医学内分泌分册, 2004,24(4):222-224.Liu Mingzhu. Global Epidemiology of Osteoporosis in Asia[J].Section Endocrinol Foreign Med Sci, 2004,24(4):222-224.
[13] 彭绩, 梁渊, 卢祖询. 骨质疏松危险因素的 meta 分析[J]. 中国公共卫生, 2004, 20(5): 585-6.Peng Ji, Liang Yuan, Lu Zuxun. Meta-analysis on risk factors of osteoporosis[J]. Chin J Public Health,2004, 20(5): 585-6.
[14] 黄际远, 宋文忠. 双能 X 射线骨密度测定在骨质疏松诊治中的应用[J]. 实用医院临床杂志, 2008, 5(5):127-128.Huang Jiyuan, Song Wenzhong. Double energy X-ray bone densitometry for the diagnosis and treatment of osteoporosi [J]. Practical Hospital Clinical Journal, 2008, 5(5):127-128.
[15] Couris CM, Chapurlat RD, Kanis JA, et al. FRAX, probabilities and risk of major osteoporotic fracture in France[J]. Osteoporos Int, 2012, 23(9):2321-2327.
[16] 张建新, 王和鸣, 张生, 等. 泉州市农村老年性骨质疏松性骨折的流行病学调查[J]. 中国骨质疏松杂志, 2007, 13(12):860-863.Zhang JX, Wang HM, Zhang S, et al. Epidemiological survey of the senile osteoporosis fracture in the village of Quanzhou city[J]. Chin J Osteoporos, 2007, 13(12):860-863.
[17] Sharma D, Larriera AI, Palacio-Mancheno PE, et al. The effects of estrogen deficiency on cortical bone microporosity and mineralization[J]. Bone. 2018, 110:1-10.