CAJ | 학술논문

目的：评估应用不同模式骨折风险评估工具（ FRAX?）预测不同临床危险因子及股骨颈骨密度（ BMD）的T值情况下的绝经后女性10年骨折概率的差异，探讨各种模式筛选骨质疏松性骨折高危患者的能力。方法收集2011年2-8月在上海交通大学附属第六人民医院骨质疏松与骨病专科门诊就诊、年龄50~90岁、自然绝经且绝经时间＞1年、诊断为低骨量的女性患者769例，应用FRAX?的中国大陆、中国台湾、韩国、中国香港模式，计算骨折概率〔主要骨质疏松性骨折概率（ MOF）和髋部骨折概率（ HF）〕，同时综合年龄、身高和体质量，设定固定人群，计算单一危险因子、不同年龄和不同股骨颈BMD的T值条件下绝经后女性的10年骨折概率，筛选达到骨质疏松性骨折高危患者诊断标准的个体。结果 FRAX?中国大陆模式MOF、HF低于其他3种模式（ P＜0.01）。不同模式FRAX?设定年龄70岁绝经后女性，股骨颈BMD的T值为-2.0 SD，体质量60 kg，身高160 cm的人群，在无骨折危险因子的条件下，中国大陆模式10年MOF为4.6％、HF为1.4％，中国台湾模式分别为10.0％、3.2％，韩国模式分别为7.4％、2.3％，中国香港模式分别为9.0％、2.6％。各种骨折危险因子都增加了绝经后女性10年骨折概率。在55岁时，4种模式10年骨折概率相差不大，但在65、75、85岁时，中国大陆模式明显低于其他3种模式。4种模式的10年骨折概率均随着股骨颈BMD的T值升高而下降。结论 FRAX?中国大陆模式低估了10年骨折概率，不能早期发现骨折高风险人群。
목적：평고응용불동모식골절풍험평고공구（ FRAX?）예측불동림상위험인자급고골경골밀도（ BMD）적T치정황하적절경후녀성10년골절개솔적차이，탐토각충모식사선골질소송성골절고위환자적능력。방법수집2011년2-8월재상해교통대학부속제륙인민의원골질소송여골병전과문진취진、년령50~90세、자연절경차절경시간＞1년、진단위저골량적녀성환자769례，응용FRAX?적중국대륙、중국태만、한국、중국향항모식，계산골절개솔〔주요골질소송성골절개솔（ MOF）화관부골절개솔（ HF）〕，동시종합년령、신고화체질량，설정고정인군，계산단일위험인자、불동년령화불동고골경BMD적T치조건하절경후녀성적10년골절개솔，사선체도골질소송성골절고위환자진단표준적개체。결과 FRAX?중국대륙모식MOF、HF저우기타3충모식（ P＜0.01）。불동모식FRAX?설정년령70세절경후녀성，고골경BMD적T치위-2.0 SD，체질량60 kg，신고160 cm적인군，재무골절위험인자적조건하，중국대륙모식10년MOF위4.6％、HF위1.4％，중국태만모식분별위10.0％、3.2％，한국모식분별위7.4％、2.3％，중국향항모식분별위9.0％、2.6％。각충골절위험인자도증가료절경후녀성10년골절개솔。재55세시，4충모식10년골절개솔상차불대，단재65、75、85세시，중국대륙모식명현저우기타3충모식。4충모식적10년골절개솔균수착고골경BMD적T치승고이하강。결론 FRAX?중국대륙모식저고료10년골절개솔，불능조기발현골절고풍험인군。
Objective The aim of the present study was to evaluate the probability difference of osteoporotic fracture 10 years after postmenopausal predicted by different national version of the WHO fracture risk assessment tool( FRAX? )in case of different clinical risk and bone mineral density( BMD)T value of the femoral neck,and to explore the screening ability of pa-tients at high risk of osteoporotic fracture. Methods 769 cases visiting the department of osteoporosis and bone diseases in the Sixth Affiliated People's Hospital of Shanghai Jiaotong University from February to August,2011 who were 50-90,natural men-opause and at least one year,diagnosed with low bone mass were collected and calculated the probability of fracture( MOF and HF) during these 10 years by different FRAX? versions from Chinese Mainland,Taiwan,South Korea and Hong Kong,China and the fracture probability under the conditions of single risk factor,different ages and femoral neck BMD T value. The individu-als which achieved the diagnostic criteria of high risk with osteoporotic fractures were screened. Results 10-year fracture proba-bility of MOF and HF which was calculated by FRAX? version of Chinese Mainland version was significantly lower than those of Taiwan,South Korea and Hong Kong,China(P<0. 01). Under the condition that the age was 70,femoral neck BMD T value was-2. 0 SD,body weight was 60 kg and the height was 160 cm set by different FRAX? and in no case of fracture risk factors, MOF of HF of ten years were 4. 6% and 1. 4%( Chinese Mainland Model),10. 0% and 3. 2%( Taiwan Model),7. 4% and 2. 3%(South Korea Model),9. 0% and 2. 6%(Hong Kong,China Model). All kinds of facture risk factors increased the probability. At the age of 55,no obvious difference was found,but at 65,75 and 85 the fracture probability was significantly lower judged by Chinese Mainland Model than the other three. In addition,the probability of 10 years all decreased with the in-crease of femoral neck BMD T value by the four models. Conclusion The FRAX? of Chinese Mainland Model underestimates the 10-year fracture probability. It can not early detect the individuals with highly fracture risk.