不同骨质疏松风险评估工具的筛检效果评价

目的通过对7种骨质疏松风险评估工具的对比,评价其社区与临床应用价值,为预防和筛查骨质疏松提供科学依据。方法共纳入299名40周岁以上的中老年人,其中女性均已绝经,应用双能X线骨密度仪测量其骨密度值并诊断是否患有骨质疏松症,计算各个工具得分,比较变量、灵敏度、特异度和曲线下面积(area under the curve,AUC)。结果绝经后妇女的各个工具得分均有统计学意义(P0.05),亚洲人骨质疏松自评工具(osteoporosis self-assessment tool for asian, OSTA)的灵敏度为96.3%,特异度为6.3%,AUC为0.710;骨质疏松风险评估工具(osteoporosis risk assessment instrument, ORAI)的灵敏度为90.1%,特异度为12.7%, AUC为0.661;骨质疏松风险简单评估(simple calculated osteoporosis risk estimation, SCORE)的灵敏度为25.9%,特异度为81.9%, AUC为0.686;骨质疏松危险指数(osteoporosis index of risk, OSIRIS)的灵敏度为90%,特异度为30.8%, AUC为0.734;骨质疏松预筛选风险评估(osteoporosis prescreening risk assessment, OPERA)的灵敏度为38.2%,特异度为84%, AUC为0.658;美国骨质疏松基金会快速诊断法(National Osteoporosis Foundation, NOF)的灵敏度为90.4%,特异度为26.6%, AUC为0.652。仅NOF筛检的中老年男性骨质疏松具有统计学意义(P0.05),NOF的灵敏度为93.5%,特异度为25.8%, AUC为0.697;而男性骨质疏松症风险评估(male osteoporosis risk estimation score, MORES)筛检的灵敏度为74.1%,特异度为29.0%,AUC为0.575,不具有统计学意义(P=0.190)。结论 OSTA的灵敏度最高,且仅有2个变量,使用最为简便,适合筛检大样本人群;OSIRIS灵敏度和特异度均较好,用于临床筛检更为准确;ORAI和NOF灵敏度较高,适合筛检阳性人群;SCORE和OPERA特异度较好,适合筛检阴性人群;NOF可用于筛检中老年男性骨质疏松。

Evaluation of screening value of different osteoporosis risk assessment tools

Objective The community and clinical application value of seven kinds of osteoporosis risk assessment tools was evaluated to provide scientific basis for the prevention and screening of osteoporosis. Methods A total of 299 middle-aged and elderly people over 40 years old were included, among which all the women were postmenopausal, and their osteoporosis was diagnosed by dual-energy X-ray absorptiometry. The tools scores were calculated, and the variables, sensitivity, specificity and area under the curve (AUC) were compared. Results The scores of various tools of postmenopausal women were statistically significant (P<0.05), and the sensitivity of Osteoporosis Self-assessment Tool for Asian (OSTA) was 96.3%, the specificity was 6.3%, and the area under the curve (AUC) was 0.710. The sensitivity of Osteoporosis Risk Assessment Instrument (ORAI) was 90.1%, the specificity was 12.7%, and AUC was 0.661. The sensitivity of Simple Calculated Osteoporosis Risk Estimation (SCORE) was 25.9%, the specificity was 81.9%, and AUC was 0.686. The sensitivity of Osteoporosis Index of Risk (OSIRIS) was 90%, the specificity was 30.8%, and AUC was 0.734. The sensitivity of Osteoporosis Prescreening Risk Assessment (OPERA) was 38.2%, the specificity was 84%, and AUC was 0.658. The sensitivity of National Osteoporosis Foundation (NOF) was 90.4%, the specificity was 26.6%, and AUC was 0.652. Only NOF screening of elderly men showed statistical significance (P < 0.05). The sensitivity of NOF was 93.5%, the specificity was 25.8%, and AUC was 0.697. The sensitivity of MORES was 74.1%, the specificity was 29.0%, and AUC was 0.575, did not reach statistical significance (P = 0.190). Conclusions OSTA is the most convenient (only two variables) and sensitive for screening large sample populations. OSIRIS had good sensitivity and specificity, and was the most accurate in clinical screening. ORAI and NOF were highly sensitive and suitable for screening positive population. SCORE and OPERA had good specificity and were appropriate for screening negative population. NOF could be used for screening osteoporosis in elderly men.