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目的:评估亚洲骨质疏松自我评价工具(OSTA)对城区中老年人群骨质疏松、骨量低下的筛查效果,为OSTA在国内应用效果评价提供依据。方法:对2013年7月到2015年6月到本单位体检的40~89岁居民进行BMD检测和OSTA评估。通过一致性检验对OSTA评估和DXA检测结果符合程度进行分析;以-1为OSTA分界点,通过灵敏度、特异度、约登指数、受试者特征工作曲线下面积(AUC)对OSTA筛查骨质疏松(T值≤-2.5)或筛查骨量异常(T值<-1)的准确性进行评估。采用SPSS 13.0统计软件包进行t检验和χ~2检验。结果:共调查检测444名对象,其中男性74名(16.67%),女性370名(83.33%)。共检出骨质疏松症175例(39.41%),骨量减少210例(47.30%)。OSTA评估“中风险”139名(31.31%),“高风险”35名(7.88%)。OSTA三分类评估和BMD检测结果一致性Kappa值为0.069;二分类Kappa值为0.141。OSTA评估与股骨颈BMD检测结果的一致率为0.129,要高于与腰椎BMD一致率0.090。以-1为OSTA分界点,OSTA筛查骨量异常的灵敏度为43.86%~47.08%,特异度为79.10%~91.53%,约登指数为26.18%~35.43%,AUC为0.631~0.677;筛查骨质疏松灵敏度升高为57.14%~66.98%,特异度降低为69.54%~72.66%,约登指数27.40%~36.77%,AUC为0.637~0.684。OSTA对股骨颈骨质疏松筛查准确性高于腰椎。调整OSTA分界点对筛查的准确性无明显影响。结论:OSTA评估结果与DXA检测结果一致性较差,OSTA对骨质疏松的筛查效果不理想,调整OSTA分界点也无法改善;不同部位OSTA筛查效果存在差异。
OBJECTIVE: To evaluate the screening effect of OSTA on osteoporosis and bone mass in middle-aged and elderly people in urban area, and provide a basis for the evaluation of OSTA application in China. Methods: BMD test and OSTA assessment were conducted among residents aged 40 ~ 89 years from July 2013 to June 2015 in this unit. The agreement between OSTA assessment and DXA test results was analyzed by consistency test. Using -1 as the OSTA cut-off point, the sensitivity, specificity, Youden index, area under the receiver operating characteristic curve (AUC) Loose osteoporosis (T-value ≤-2.5) or the accuracy of screening for abnormal bone mass (T-value <-1). SPSS 13.0 statistical package was used for t test and χ ~ 2 test. Results: A total of 444 subjects were investigated, including 74 males (16.67%) and 370 females (83.33%). A total of 175 cases (39.41%) of osteoporosis were detected and 210 cases (47.30%) of osteopenia were detected. OSTA assessed 139 (31.31%) of “moderate risk” and 35 (7.88%) of “high risk”. The Kappa value of consistency between the OSTA triad and BMD test was 0.069, and the Kappa value of the second classification was 0.141. The concordance rate between OSTA and femoral neck BMD was 0.129, which was higher than that of lumbar spine BMD 0.090. The sensitivity and specificity of OSTA in screening bone anomalies ranged from 43.86% to 47.08% and from 79.10% to 91.53%, respectively, with a Youden index of 26.18% to 35.43% and AUC ranging from 0.631 to 0.677, with -1 as the OSTA cutoff point. The sensitivity of osteoporosis increased from 57.14% to 66.98%, the specificity decreased from 69.54% to 72.66%, the Youden index from 27.40% to 36.77%, and the AUC from 0.637 to 0.684. OSTA screening femoral neck osteoporosis accuracy is higher than the lumbar spine. Adjusting the OSTA cutoff point has no significant effect on the accuracy of the screening. Conclusion: The results of OSTA are not consistent with those of DXA. The screening effect of OSTA on osteoporosis is not satisfactory and the OSTA cutoff point can not be improved. There are differences in OSTA screening results among different sites.