[1]李克鹏,孟令辰,谷同同,等.老年二次脆性骨折风险自评预测模型建立及临床应用价值[J].陕西医学杂志,2024,(2):226-230.[doi:DOI:10.3969/j.issn.1000-7377.2024.02.017]
点击复制

老年二次脆性骨折风险自评预测模型建立及临床应用价值
分享到:

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2024年2期
页码:
226-230
栏目:
临床研究
出版日期:
2024-02-05

文章信息/Info

作者:
李克鹏孟令辰谷同同崔 阳
(保定市第二中心医院,河北 保定 072750)
关键词:
骨质疏松 二次脆性骨折 风险预测模型 列线图 老年人 预测因子
分类号:
R 683
DOI:
DOI:10.3969/j.issn.1000-7377.2024.02.017
文献标志码:
A
摘要:
目的:建立老年人二次脆性骨折临床预测模型,以利于对二次脆性骨折高风险的老年人进行针对性二级预防,为二次脆性骨折患者自评量表的建立提供参考。方法:对手术治疗的365例椎体骨质疏松性压缩骨折患者进行回顾性分析,提取患者体重指数、并发症情况、生活自理情况、抗骨质疏松治疗等信息。应用LASSO回归对自变量进行初筛,将筛选出的变量纳入多因素Logistic回归分析,进一步筛选出二次脆性骨折的预测因子,建立二次脆性骨折风险预测模型。使用C指数、绘制受试者工作者特征曲线、校准曲线图和决策曲线评估预测模型的区分度、一致性和临床实用性。结果:二次脆性骨折的预测模型中包含的预测因子包括性别(OR=0.55,95%CI:0.30~0.98)、自理能力(OR=2.01,95%CI:1.19~3.46)、心脏疾病(OR=2.11,95%CI:1.30~3.46)、胃肠道疾病(OR=1.77,95%CI:1.00~3.00)和抗骨质疏松治疗依从性(OR=3.40,95%CI:1.90~6.22)。该模型具有良好的区分度,C指数为0.75(95%CI:0.69~0.80),校准曲线图显示具有良好的一致,决策曲线分析显示,在阈概率大于11%和小于76%时,该风险预测模型具有临床实用价值。结论:建立了用于预测二次脆性骨折风险的列线图。该预测模型纳入了性别、自理能力、心脏疾病、胃肠道疾病和抗骨质疏松治疗依从性5个预测因子,可以方便地用于二次脆性骨折风险的预测。

参考文献/References:

[1] 李洺,赵宇,马丁,等.女性绝经后骨质疏松症患者血清铁蛋白、同源拮抗物表达水平及临床意义[J].陕西医学杂志,2020,49(10):1266-1269.
[2] 朱洁云,高敏,宋秋韵,等.中国老年人骨质疏松症患病率的Meta分析[J].中国全科医学,2022,25(3):346-353.
[3] 杨进,荔琦,常春峰.脊柱骨质疏松骨折患者椎体成形术后再骨折发生率及危险因素研究[J].陕西医学杂志,2020,49(12):1573-1576.
[4] AN N,LIN J S,FEI Q.Beijing friendship hospital hsteoporosis self-assessment tool for elderly male(BFH-OSTM)vs fracture risk assessment tool(FRAX)for identifying painful new osteoporotic vertebral fractures in older Chinese men:A cross-sectional study[J].BMC Musculoskelet Disord,2021,22(1):596.
[5] 周婷,刘韬滔,孙超,等.中国城乡社区中老年人群跌倒状况调查及相关因素分析[J].中国医药,2023,18(11):1655-1659.
[6] 王天成,章维新,王道成,等.唑来膦酸联合骨化三醇治疗对老年骨质疏松性胸腰椎压缩骨折经皮椎体成形术后再骨折的效果观察[J].中国医刊,2023,58(7):730-734.
[7] 穆佐洲,邵海龙.手术入路对骨质疏松性胸腰椎骨折术后并发症的影响及术后再骨折危险因素分析[J].陕西医学杂志,2022,51(7):848-851,855.
[8] 刘志刚,秦琳,张挥武.温针灸联合经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折疗效及对患者骨密度和血钙的影响[J].陕西中医,2020,41(6):823-826.
[9] BANEFEL J,AKESSON K E,SPANGEU U S A,et al.Risk of imminent fracture following a previous fracture in a Swedish database study[J].Osteoporos Int,2019,30(3):601-609.
[10] SHETTY S,JOHN B,MOHAN S,et al.Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis[J].Arch Osteoporos,2020,15(1):25.
[11] 李鸿,徐无忌.加味身痛逐瘀汤治疗骨质疏松椎体压缩性骨折经皮穿刺椎体成形术后残余痛临床研究[J].陕西中医,2019,40(11):1545-1547,1551.
[12] HADJI P,SCHWEIKERT B,KLOPPMANN E,et al.Osteoporotic fractures and subsequent fractures:Imminent fracture risk from an analysis of German real-world claims data[J].Arch Gynecol Obstet,021,304(3):703-712.
[13] 白曼莫,王炳南,禹志军,等.固脊通督方辅助治疗老年骨质疏松胸腰椎压缩性骨折疗效及对患者血清Leptin、PINP水平的影响[J].陕西中医,2020,41(10):1449-1451.
[14] LI Q,LONG X,WANG Y,et al.Development and validation of a nomogram for predicting the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures[J].BMC Musculoskelet Disord,2021,22(1):957.
[15] BALASUBRAMANIAN A,ZHANG J,CHEN L,et al.Risk of subsequent fracture after prior fracture among older women[J].Osteoporos Int,2019,30(1):79-92.
[16] KAMITANI T,YAMAMOTO Y,FUKUMA S,et al.Association between the discrepancy in self-reported and performance-based physical functioning levels and risk of future falls among community-dwelling older adults:The locomotive syndrome and health outcomes in aizu cohort study(LOHAS)[J].Am Med Dir Assoc,2019,20(2):195-200.
[17] KAMIDE N,SATO H,SAKAMOTO M,et al.The effect of the interaction between fall-related self-efficacy and gait function on the occurrence of falls in community-dwelling older people[J].Aging Clin Exp Res,2021,33(10):2715-2722.
[18] 陈仁山,肖惠珍,刘宁,等.参芪扶正注射液抑制ERK1/2、GATA4信号通路改善小鼠心力衰竭实验研究[J].陕西中医,2022,43(1):8-12.
[19] 盛莉,王晓娜,肖文凯,等.老年心血管疾病合并衰弱评估与管理中国专家共识[J].中华老年多器官疾病杂志,2023,22(7):481-491.
[20] MAJUMDAR S R,EZEKOWITZ J A,LIX L M,et al. Heart failure is a clinically and densitometrically independent risk factor for osteoporotic fractures:Population-based cohort study of 45509 subjects[J].Clin Endocrinol Metab,2012,97(4):1179-1186.
[21] MODI A,SEN S,ADACHI J D,et al.The impact of GI events on persistence and adherence to osteoporosis treatment:3-,6-,and 12-month findings in the MUSIC-OS study[J].Osteoporos Int,2018,29(2):329-337.
[22] OH H J,RYU K H,PARK B J,et al.Osteoporosis and osteoporotic fractures in gastrointestinal disease[J].Bone Metab,2018,25(4):213-217.
[23] 段亚威,柴昊,安一方,等.原发性骨质疏松症的疗效评价[J].中华骨质疏松和骨矿盐疾病杂志,2021,14(2):199-206.
[24] CHEN Y C,LIN W C.Poor 1st-year adherence to anti-osteoporotic therapy increases the risk of mortality in patients with magnetic resonance imaging-proven acute osteoporotic vertebral fractures[J].Patient Prefer Adherence,2017,11:839-843.
[25] 安忠诚,陈晨,董黎强,等.经皮椎体后凸成形术后邻近节段再骨折的危险因素分析[J].中华全科医学,2022,20(4):591-593,712.

相似文献/References:

[1]郭向东,马 波△.2型糖尿病患者血清胰岛素水平与骨代谢关联研究*[J].陕西医学杂志,2019,(1):77.
 GUO Xiangdong,MA Bo..Association between serum insulin level and bone metabolismin patients with type 2 diabetes mellitus[J].,2019,(2):77.
[2]郭晓昀 ,赵秋艳,刘 娟△ ,等.基于微信公众平台延续康复管理在椎体成形术后的效果观察*[J].陕西医学杂志,2019,(6):715.
[3]李 杰,邱裕生△.骨水泥灌注空心椎弓根螺钉内固定治疗不稳定性胸腰椎骨折合并骨质疏松临床疗效研究[J].陕西医学杂志,2019,(8):1021.
 LI Jie,QIU Yusheng..Polymethylmethacrylate augmented pedicle screw instrumentation fixation combined for osteoporotic thoracolumbar unstable fractures[J].,2019,(2):1021.
[4]王荣锋,郁 昊,蒋新建.老年糖尿病患者血清25羟维生素D水平与骨质疏松相关性研究[J].陕西医学杂志,2019,(8):1032.
 WANG Rongfeng,YU Hao,JIANG Xinjian..The relationship between serum 25 hydroxy vitamin D and osteoporosis in elderly diabetic patients[J].,2019,(2):1032.
[5]王 荣,贾爱华,刘新艳 ,等.IGF1及其相关性因素对2型糖尿病并发骨质疏松的影响研究[J].陕西医学杂志,2019,(9):1163.
 WANG Rong,JIA Aihua,LIU Xinyan,et al.The effect of IGF1 and its related factors in type 2 diabetes complicated with osteoporosis[J].,2019,(2):1163.
[6]李 鹏,佘新安,赵东军,等.骨髓间充质干细胞对大鼠骨质疏松股骨干骨折早期愈合影响的实验研究[J].陕西医学杂志,2021,50(7):793.[doi:DOI:10.3969/j.issn.1000-7377.2021.07.006]
 LI Peng,SHE Xin'an,ZHAO Dongjun,et al.Effect of bone marrow mesenchymal stem cells on early healing of femoral shaft fracture in osteoporotic rats[J].,2021,50(2):793.[doi:DOI:10.3969/j.issn.1000-7377.2021.07.006]
[7]王建武,李晓妮,赵 强,等.调控miR-152对骨质疏松大鼠模型骨生物力学、骨重建平衡及骨组织Hedgehog信号通路的影响[J].陕西医学杂志,2022,51(8):944.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.009]
 WANG Jianwu,LI Xiaoni,ZHAO Qiang,et al.Effect of regulating miR-152 on bone biomechanics,bone remodeling balance and Hedgehog signal pathway in osteoporosis rat model[J].,2022,51(2):944.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.009]
[8]王 猛,党星波,周永春,等.地舒单抗治疗老年性骨质疏松疗效及对患者骨密度、骨代谢的影响[J].陕西医学杂志,2023,52(10):1395.[doi:DOI:10.3969/j.issn.1000-7377.2023.10.025]
 WANG Meng,DANG Xingbo,ZHOU Yongchun,et al.Efficacy of denosumab in treatment of senile osteoporosis and its effect on bone mineral density and bone metabolism[J].,2023,52(2):1395.[doi:DOI:10.3969/j.issn.1000-7377.2023.10.025]
[9]方 宇,董重阳,高斌礼,等.微小RNA-214靶向调控PTEN对成骨细胞MC3T3-E1增殖、分化、矿化的影响及机制研究[J].陕西医学杂志,2023,52(12):1619.[doi:DOI:10.3969/j.issn.1000-7377.2023.12.001]
 FANG Yu,DONG Chongyang,GAO Binli,et al.Effects of miR-214 on proliferation,differentiation and mineralization of osteoblast MC3T3-E1 by targeting PTEN and its mechanism[J].,2023,52(2):1619.[doi:DOI:10.3969/j.issn.1000-7377.2023.12.001]

备注/Memo

备注/Memo:
基金项目:河北省医学科学研究立项课题(20232023); 河北省保定市科技计划课题(2141ZF214)
更新日期/Last Update: 2024-02-05