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Cải thiện dự đoán nguy cơ gãy xương bằng cách bổ sung dữ liệu gãy xương cột sống được xác định bằng VFA vào mật độ khoáng xương qua DXA và các yếu tố nguy cơ lâm sàng được sử dụng trong FRAX
Tóm tắt
Gãy xương cột sống (VF) là một dự đoán mạnh mẽ cho các gãy xương tiếp theo. Trong nghiên cứu này về phụ nữ lớn tuổi, VF được xác định bằng đánh giá gãy xương cột sống qua phương pháp tia X năng lượng kép (DXA) đã liên quan đến nguy cơ gia tăng của các gãy xương mới xảy ra và có tác động đáng kể đến xác suất gãy xương, hỗ trợ tính hữu ích của VFA trong thực hành lâm sàng. VF lâm sàng và tiềm ẩn có thể được xác định bằng VFA kết hợp với DXA. Mục tiêu của nghiên cứu này là điều tra mức độ mà VF được xác định bằng VFA cải thiện việc dự đoán nguy cơ gãy xương, độc lập với mật độ khoáng xương (BMD) và các yếu tố nguy cơ lâm sàng được sử dụng trong FRAX. Tổng cộng có 2852 phụ nữ, từ 75 đến 80 tuổi, từ nghiên cứu dựa trên quần thể tiềm năng SUPERB đã được đưa vào nghiên cứu này. Tại thời điểm đầu, BMD đã được đo bằng DXA, VF được chẩn đoán bởi VFA, và các bảng hỏi được sử dụng để thu thập dữ liệu về các yếu tố nguy cơ gãy xương. Các gãy xương mới xảy ra được ghi lại qua hồ sơ X-quang hoặc mã chẩn đoán. Một mở rộng của hồi quy Poisson đã được sử dụng để ước lượng mối liên hệ giữa VF được xác định bằng VFA và nguy cơ gãy xương, và xác suất gãy xương lớn do loãng xương (MOF) trong 5 và 10 năm đã được tính toán từ các chức năng nguy hiểm cho gãy xương và tử vong. Trong thời gian theo dõi trung vị 5,15 năm (IQR 4.3–5.9 năm), số lượng phụ nữ đã chết hoặc mắc MOF, VF lâm sàng hoặc gãy xương hông lần lượt là 229, 422, 160 và 124. Một VF được xác định bằng VFA có liên quan đến nguy cơ gia tăng của MOF mới xảy ra (tỉ lệ nguy cơ [HR] = 1,78; khoảng tin cậy [CI] 95% 1,46–2,18), VF lâm sàng (HR = 2,88; 95% [CI] 2,11–3,93), và gãy xương hông (HR = 1,67; 95% [CI] 1,15–2,42), đã được điều chỉnh theo tuổi tác, chiều cao, và trọng lượng. Đối với phụ nữ 75 tuổi, một VF được xác định bằng VFA có liên quan đến xác suất 10 năm MOF cao gấp 1,2–1,4 lần so với việc không tính đến VFA, tùy thuộc vào BMD. Việc xác định một VF tiềm ẩn bằng cách sử dụng VFA có tác động đáng kể đến xác suất gãy xương, cho thấy VFA là một phương pháp hiệu quả để cải thiện dự đoán gãy xương ở phụ nữ lớn tuổi.
Từ khóa
#gãy xương #gãy xương cột sống #VFA #mật độ khoáng xương #nguy cơ gãy xương #loãng xươngTài liệu tham khảo
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