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目的比较骨折风险评价工具(FRAX)和Garvan nomogram法(Garvan)对国内中老年人群骨折风险的评估效果。方法选取2013年7月—2015年6月江东区东柳街道社区卫生服务中心体检或就诊的50~89岁居民,检测骨密度(BMD),调查及随访骨折相关情况;分性别、BMD、是否实际发生骨折、引用参数(BMD、体重或BMI)和评估部位(髋部或任意部位)比较两种方法评估的骨折风险。结果共纳入422人,其中男性71人,女性351人,平均年龄(64.07±8.15)岁。除引用BMI或体重评估髋部骨折方式外,Garvan评估骨折风险均高于FRAX(P<0.05)。FRAX及Garvan评估女性10年内任意部位骨折风险均高于男性(均P<0.01);两种方法评估准确性均为女性高于男性。FRAX及Garvan评估骨折风险均随BMD减少呈递增趋势(P<0.05)。引用BMD参数时,FRAX及Garvan对骨质疏松者髋部及任意部位的骨折评估AUC在0.77~0.80,准确性中等。经过1年随访发生骨折9例,发生率为2.13%。两种方法对骨折与未骨折对象的评估骨折风险比较差异均无统计学意义(P>0.05);对1年骨折的评估风险AUC均<0.70,准确性较低。结论 FRAX及Garvan对骨质疏松患者骨折评估风险较高;两种方法的评估准确性无明显差别。
Objective To compare the risk assessment of fractures in middle-aged and elderly people in China by using FRAX and Garvan nomogram. Methods From July 2013 to June 2015, 50 to 89-year-old residents aged 50-89 years old from the Dongliu Community Health Service Center in Jiangdong District were enrolled in this study. Their bone mineral density (BMD) was measured and the related fractures were followed up. The sex, BMD, Actual fracture, reference parameters (BMD, body weight or BMI) and assessment sites (hip or any site) were compared by two methods to assess fracture risk. Results A total of 422 people were enrolled, including 71 males and 351 females, with an average age of 64.07 ± 8.15 years. Garvan evaluated fracture risk higher than FRAX (P <0.05), except for a reference BMI or weight assessment of hip fracture. FRAX and Garvan evaluated the risk of fractures of any part of the female in 10 years was higher than that of the male (all P <0.01). The accuracy of the two methods was higher in women than in men. The risk of fractures evaluated by FRAX and Garvan increased with the decrease of BMD (P <0.05). When referring to the BMD parameters, FRAX and Garvan evaluated the fracture between the hip and any part of the osteoporotic population at a mean AUC of 0.77 to 0.80 with medium accuracy. After one year of follow-up fracture occurred in 9 cases, the incidence was 2.13%. There was no significant difference between the two methods in evaluating the fracture risk of fractured and non-fractured objects (P> 0.05). The AUC of fracture risk assessment in one year was less than 0.70, with a lower accuracy. Conclusion FRAX and Garvan are at a higher risk of fracture assessment in patients with osteoporosis; there is no significant difference between the two methods in assessing the accuracy.