乌克兰模型骨折风险评估(FRAX®)在肝硬化患者中伴有骨矿物质密度受损的特殊性:其诊断和预后价值

N. Drobinska, O. Abrahamovych, M. Abrahamovych, S. Tolopko, S. Guta, R. Ivanochko
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Stratification into groups was based on information about bone condition. 72 patients were included into an experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Control group (CG) included 18 patients without IBMD. The peculiarities of the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorders were established (significant differences between frequency of features in groups and substantial stochastic associations of features with IBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value, predictive value, likelihood ratio) of the detected features for IBMD in general, osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LC in the case of applying the identified features. The results. It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EG and CG, including EG B and CG, and EG A and EG B; between the frequency of cases of normal body weight, as well as overweight in EG and CG, including EG B and CG. The evaluation thresholds according to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EG B and CG and in EG A and EG B; the intermediate values of fracture risk – in EG A and CG; the values below the lower evaluation threshold – in EG and CG, as well as in EG A and CG and in EG B and CG, including. Bone disorders had a substantial direct stochastic association in the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight and values above the upper evaluation threshold. All manifestations of bone disorders had substantial negative stochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis with short height (indicates that features are inherent for normal bone mineral density). It was found out that fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease being detected, or deny it in the case they are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders being present in patient with LC. The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, and excluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® model are highly specific for osteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® model are medium-specific for osteopenia, but can be more useful for excluding osteopenia if they are absent. The overweight, especially the values below the lower evaluation threshold, will most likely indicate normal bone mineral density. Conclusions. 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引用次数: 1

摘要

介绍。肝硬化(LC)患者骨质疏松性骨折的问题及干预的评估阈值至今仍不明确。乌克兰骨折风险评估模型(FRAX®)从未在乌克兰LC患者中实施。研究的目的。探讨乌克兰骨折风险评估模型的特点及其在肝硬化伴骨密度受损患者中的诊断和预后价值。材料和方法。90例LC患者(27例女性,63例男性,年龄18 - 66岁)被随机分配到研究中。分组是基于骨骼状况的信息。将72例患者纳入实验组(EG,骨矿物质密度受损患者(IBMD)),实验组分为2个亚组,EG A(骨质减少患者,46例)和EG B(骨质疏松患者,26例)。对照组(CG) 18例无IBMD。根据乌克兰FRAX®模型(2019),确定LC合并骨疾病患者骨折危险因素和评估阈值的特殊性(研究各组特征频率之间的显著差异以及特征与IBMD或其表现之间的大量随机关联)。揭示一般IBMD,特别是骨质减少和骨质疏松症的检测特征的诊断特征(诊断价值、预测值、似然比),然后确定在应用识别特征的情况下,所有LC患者中某些骨骼疾病的检测后概率。结果。结果发现,虽然大多数危险因素在骨骼疾病患者中发生的频率更高,但只有EG和CG(包括EG B和CG,以及EG A和EG B)的既往骨折频率存在显著差异;正常体重的病例发生频率之间,以及超重的EG和CG,包括EG B和CG。根据乌克兰FRAX®模型的评价阈值也有显著差异:高于评价阈值的值-在EG B和CG以及EG A和EG B中;EG A和CG为骨折风险的中间值;在EG和CG、EG A和CG以及EG B和CG中低于较低评价阈值的值,包括。骨病在以下情况下有实质性的直接随机关联:一般的IBMD -与先前的骨折,正常体重和高于最高评估阈值的值;骨质减少-既往骨折,体重正常,骨折风险中等值;骨质疏松症-既往骨折,体重正常,且值高于评估上限。所有骨骼疾病的表现都与超重和低于下评价阈值的值以及矮身高骨质疏松症有显著的负随机关联(表明这些特征是正常骨密度所固有的)。研究发现,根据乌克兰FRAX®模型,骨折危险因素和评估阈值主要是单向量标记,因为它们可以确认被检测到的疾病,或者在没有它们的情况下否认它。先前的骨折对IBMD,特别是骨质疏松症具有高度特异性,可用于确认LC患者是否存在这些疾病。正常体重对IBMD和骨质疏松症具有中等特异性,但如果IBMD存在,则可以更有用地指示IBMD,并排除骨质疏松症。根据乌克兰FRAX®模型,高于最高评价阈值的值对骨质疏松症具有高度特异性,可以确认骨质疏松症的存在。根据乌克兰FRAX®模型,骨折风险的中间值对于骨质减少是中等特异性的,但如果不存在骨质减少,则可以更有用地排除骨质减少。超重,特别是低于较低评价阈值的值,很可能表明骨密度正常。结论。使用乌克兰骨折风险评估模型(FRAX®)具有一定的特殊性,可以作为检测或排除肝硬化患者骨矿物质密度受损的有价值的工具。
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Peculiarities of the Ukrainian model of Fracture Risk Assessment (FRAX®) among patients with liver cirrhosis accompanied by impaired bone mineral density: its diagnostic and prognostic value
Introduction. The problem of osteoporotic fractures and the evaluation thresholds for intervention in patients with liver cirrhosis (LC) remains obscure so far. Ukrainian model of fracture risk assessment (FRAX®) has never been implemented among patients with LC in Ukraine. The aim of the study. To find out the peculiarities of the Ukrainian model of Fracture Risk Assessment, its diagnostic and prognostic value for implementation among patients with liver cirrhosis accompanied by impaired bone mineral density. Materials and methods. 90 patients with LC (27 women and 63 men aged 18 to 66 years) were randomly assigned into the study. Stratification into groups was based on information about bone condition. 72 patients were included into an experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Control group (CG) included 18 patients without IBMD. The peculiarities of the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorders were established (significant differences between frequency of features in groups and substantial stochastic associations of features with IBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value, predictive value, likelihood ratio) of the detected features for IBMD in general, osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LC in the case of applying the identified features. The results. It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EG and CG, including EG B and CG, and EG A and EG B; between the frequency of cases of normal body weight, as well as overweight in EG and CG, including EG B and CG. The evaluation thresholds according to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EG B and CG and in EG A and EG B; the intermediate values of fracture risk – in EG A and CG; the values below the lower evaluation threshold – in EG and CG, as well as in EG A and CG and in EG B and CG, including. Bone disorders had a substantial direct stochastic association in the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight and values above the upper evaluation threshold. All manifestations of bone disorders had substantial negative stochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis with short height (indicates that features are inherent for normal bone mineral density). It was found out that fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease being detected, or deny it in the case they are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders being present in patient with LC. The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, and excluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® model are highly specific for osteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® model are medium-specific for osteopenia, but can be more useful for excluding osteopenia if they are absent. The overweight, especially the values below the lower evaluation threshold, will most likely indicate normal bone mineral density. Conclusions. The use of the Ukrainian model of Fracture Risk Assessment (FRAX®) has certain peculiarities and can be valuable tool for detecting or excluding impaired bone mineral density in patients with liver cirrhosis.
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