Fracture Risk Assessment without Race/Ethnicity Information

被引：26

作者：

Ishii, Shinya ^{[1
]}

Greendale, Gail A. ^{[2
]}

Cauley, Jane A. ^{[3
]}

Crandall, Carolyn J. ^{[2
]}

Huang, Mei-Hua ^{[2
]}

Danielson, Michelle E. ^{[3
]}

Karlamangla, Arun S. ^{[2
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Geriatr Med, Bunkyo Ku, Tokyo 1138655, Japan

[2] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Div Geriatr, Los Angeles, CA 90095 USA

[3] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15260 USA

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2012年 / 97卷 / 10期

基金：

美国国家卫生研究院;

关键词：

BONE-MINERAL DENSITY; HIP FRACTURE; OSTEOPOROSIS; MASS; BMD; FRAGILITY; STRENGTH; GEOMETRY; HEALTH; SITES;

D O I：

10.1210/jc.2012-1997

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context: Dual-energy x-ray absorptiometry-derived bone mineral density (BMD) does not explain interracial differences in fracture risk; thus, BMD-based fracture risk assessment requires patient race/ethnicity information and ethnicity-specific BMD reference databases. Objective: The objective of the study was to investigate whether composite femoral neck strength indices, which integrate dual-energy x-ray absorptiometry-derived femoral neck size, femoral neck BMD, and body size, will allow fracture risk assessment without requiring race/ethnicity information. Design: This was a prospective cohort study. Setting and Participants: A total of 1940 community-dwelling women aged 42-53 yr from four race/ethnicity groups (968 Caucasian, 512 African-American, 239 Japanese, and 221 Chinese) were followed up for 9 yr. Outcome Measurements: Self-reported, nondigital, noncraniofacial fractures were measured. Results: Two hundred and two women (10.4%) sustained fractures and 82 (4.3%) had minimum-trauma fractures. Each SD increment in any of the strength indices was associated with a 34-41% reduction in fracture hazard over 9 yr (each P < 0.001). Race/ethnicity predicted fracture hazard independent of BMD(P = 0.02) but did not predict fracture hazard independent of any of the composite indices (P = 0.11-0.22). Addition of race/ethnicity did not improve risk discrimination ability of the strength indices, but did significantly improve the discrimination ability of BMD. The discrimination ability of BMD with race/ethnicity was not statistically different from that of any of the strength indices without race/ethnicity. Conclusions: Composite strength indices of the femoral neck can predict fracture risk without race/ethnicity information as accurately as bone mineral density does in combination with race/ethnicity information and therefore would allow risk prediction in people of mixed race/ethnicity and in groups without a BMD reference database. (J Clin Endocrinol Metab 97: 3593-3602, 2012)

引用

页码：3593 / 3602

页数：10

共 40 条

[1] Approximate is better than "exact" for interval estimation of binomial proportions [J].