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首页> 外文期刊>Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research >Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry
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Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry

机译：改善糖尿病骨折风险评估方法的比较：Manitoba BMD登记处

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ABSTRACT Type 2 diabetes is a risk factor for fracture independent of FRAX (fracture risk assessment) probability. We directly compared four proposed methods to improve the performance of FRAX for type 2 diabetes by: (1) including the rheumatoid arthritis (RA) input to FRAX; (2) making a trabecular bone score (TBS) adjustment to FRAX; (3) reducing the femoral neck T ‐score input to FRAX by 0.5 SD; and (4) increasing the age input to FRAX by 10 years. We examined major osteoporotic fractures (MOFs) and hip fractures (HFs) over a mean of 8.3 years observation among 44,543 women and men 40 years of age or older (4136 with diabetes) with baseline lumbar spine and hip DXA from 1999 through 2016. Controlled for unadjusted FRAX probability, diabetes was associated with an increased risk for MOFs and HFs. All four FRAX adjustments attenuated the effect of diabetes, but a residual effect of diabetes was seen on MOF risk after TBS adjustment, and on HF risk after the RA and TBS adjustments. Among those with diabetes, unadjusted FRAX risk underestimated MOF (observed/predicted ratio 1.15; 95% CI, 1.03 to 1.28), but this was no longer significant after applying the diabetes adjustments. HF risk was more severely underestimated (observed/predicted ratio 1.85; 95% CI, 1.51 to 2.20) and was only partially corrected with the diabetes adjustments (still significant for the RA and TBS adjustments). Among those with diabetes, there was moderate reclassification based upon a fixed MOF cut‐off of 20% (4.1% to 7.1%) or fixed HF cut‐off of 3% (5.7% to 16.5%). Net reclassification improvement increased for MOF with each of the diabetes adjustments (range 3.9% to 5.6% in the diabetes subgroup). In conclusion, each of the proposed methods for addressing limitations in the ability of FRAX to assess fracture risk in individuals with diabetes was found to improve performance, though no single method was optimal in all settings. ? 2018 American Society for Bone and Mineral Research.
机译：摘要2型糖尿病是骨折的危险因素，与骨折（断裂风险评估）概率无关。我们直接比较了四种提出的方​​法，以改善2型糖尿病的糖尿病的性能：（1）包括对Frax的类风湿性关节炎（RA）; （2）使骨骼分数（TBS）调整为Frax; （3）将股骨颈T-CORE输入的股骨颈部缩小为FAX 0.5 SD; （4）将年龄增加10年内。在1999年至2016年至2016年，我们将44,543名妇女和男性（4136人）中的44,543名妇女和男性（4136人）之间的平均观察患者的主要骨质疏松骨折（MOF）和髋关节骨折（HFS）检查了8.3岁。受控对于不调整的传染性概率，糖尿病与MOF和HFS的风险增加有关。所有四种Frax调整减毒了糖尿病的效果，但在TBS调节后的MOF风险和RA和TBS调整后的HF风险上会看到糖尿病的残留效果。在糖尿病的那些中，未经调节的传染风险低估MOF（观察到/预测比率1.15; 95％CI，1.03至1.28），但在施用糖尿病调整后，这不再重要。 HF风险更严重低估（观察/预测比率1.85; 95％CI，1.51至2.20），并且仅与糖尿病调整部分纠正（RA和TBS调整仍然很重要）。在糖尿病的那些中，基于固定的MOF切断的预重分度为20％（4.1％至7.1％）或固定的HF截止值3％（5.7％至16.5％）。对于MOF的净重新分类改善，每种糖尿病调整（糖尿病亚组中的范围为3.9％至5.6％）。总之，发现每种提出的方​​法，用于解决Frax能力的限制，以评估患有糖尿病个体的骨折风险的骨折风险，但在所有设置中没有单一方法都是最佳的。还2018年美国骨骼和矿物学研究。

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