OSTA评分与BMI对腰椎退变性疾病患者骨质疏松的预测价值

Predictive values of Osteoporosis Self-Assessment Screening Tool for Asians(OSTA) score and body mass index(BMI) in patients with lumbar degenerative disease and osteoporosis

中文关键词:  腰椎退变性疾病  骨质疏松  亚洲人骨质疏松自我筛查工具评分  身体质量指数

英文关键词:Lumbar degenerative disease  Osteoporosis  OSTA score  BMI

中文摘要:

  【摘要】 目的：探讨腰椎退变性疾病患者中骨质疏松及骨量减少的流行病学特征，并评估亚洲人骨质疏松自我筛查工具（Osteoporosis Self-Assessment Screening Tool for Asians，OSTA）评分、身体质量指数（body mass index，BMI）对该人群中骨质疏松的预测价值。方法：回顾性分析2020年1月~2022年12月于我院骨科治疗的腰椎退变性疾病患者432例，其中男性120例，年龄72.0±5.4岁；女性312例，年龄67.2±31.1岁，患者均在入院前3个月内或入院后于我院接受双能X线吸收仪（dual-energy X-ray absorptiometry，DXA）检查及腰椎CT扫描。根据患者年龄、身高、体质量数据计算患者OSTA评分及BMI，使用卡方检验比较不同年龄、性别患者骨质疏松及骨量减少的发病率，构建受试者工作特征（receiver operating characteristics，ROC）曲线并计算曲线下面积（area under curve，AUC）、确定最佳截断值，并计算该截断值下的灵敏度、特异性、阳性预测值及阴性预测值。结果：根据DXA检查结果，骨质疏松患病率在65岁以上男性与50岁以上女性患者中分别为14.17%及37.50%，骨量减少患病率分别为52.50%及48.08%，腰椎与髋部DXA诊断符合率为60.2%。在不同年龄组别女性患者中，骨质疏松或骨量减少的患病率高年龄组大于低年龄组，但差异并无统计学意义；65岁以上女性患者骨质疏松患病率高于男性患者，差异有统计学意义（P<0.000）。在DXA判定为骨量减少或正常的297例患者中，11.78%的患者在CT检查中达到了骨质疏松的诊断标准。OSTA评分预测男性及女性腰椎退变性疾病患者骨质疏松的灵敏度均为55.56%，阴性预测值分别为89.04%及79.19%，对于骨质疏松的预测价值有限；BMI在男性及女性腰椎退变性疾病患者中的AUC分别为0.672及0.668，灵敏度分别为77.78%及73.50%，阴性预测值分别为93.10%及76.69%，对骨质疏松具有一定的预测价值。在经CT值修正骨质疏松诊断后，OSTA评分及BMI在男性及女性患者群体中的筛查效能均有提升。结论：腰椎退变性疾病患者群体骨质疏松的流行病学特征为患病率高于普通人群，其中女性骨质疏松患病率明显高于男性。OSTA评分在该人群中对骨质疏松的预测价值有限，而BMI可作为该人群骨质疏松的初筛工具之一。

英文摘要:

  【Abstract】 Objectives: To analyze the epidemiological characteristics of osteoporosis and osteopenia in patients with lumbar degenerative diseases, and to evaluate the predictive values of Osteoporosis Self-Assessment Screening Tool for Asians(OSTA) score and body mass index(BMI) for osteoporosis in this population. Methods: The clinical data of 432 patients with lumbar degenerative diseases admitted to the Department of Orthopedics of Huashan Hospital from January 2020 to December 2022 were analyzed retrospectively, including 120 males with an average age of 72.0±5.4 years and 312 females with an average age of 67.2±31.1 years old. All the patients underwent dual-energy X-ray absorptiometry(DXA) examination and lumbar CT scan in our hospital within 3 months before admission or after admission. OSTA score and BMI were calculated based on patient′s age, height, and weight. Chi-square test was used to compare the incidence rates of osteoporosis and osteopenia in patients of different ages and genders. Receiver operating characteristics(ROC) curve was constructed and the area under the curve(AUC) was calculated. After determining the optimal cutoff value, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated at this cutoff value. Results: According to the DXA examination results, the prevalence rates of osteoporosis in male patients over 65 years old and female patients over 50 years old were 14.17% and 37.50% respectively, and the prevalence rates of osteopenia were 52.50% and 48.08% respectively. The diagnostic compliance rate of lumbar and total hip DXA was 60.2%. In female patients of different age groups, the prevalence of osteoporosis or osteopenia increased in older age group, but the difference was not statistically significant. The prevalence of osteoporosis in women over 65 years old was greater than in men over 65 years old(P=0.000). Among the 297 patients diagnosed with osteopenia or normal bone mass by DXA, 11.78% of them met the diagnostic criteria for osteoporosis in CT examination. The sensitivity of the OSTA score in predicting osteoporosis in male and female patients with lumbar degenerative disease was both 55.56%, and the negative predictive values were 89.04% and 79.19%, respectively, indicating limited predictive value for osteoporosis. The AUC of BMI in male and female patients with lumbar degenerative disease were 0.672 and 0.668 respectively, with sensitivities of 77.78% and 73.50%, and the negative predictive values of 93.10% and 76.69% respectively. The BMI had certain predictive value for osteoporosis. After correcting the diagnosis of osteoporosis with lumbar CT examination, the screening efficacy of OSTA score and BMI improved in both male and female patient populations. Conclusions: The epidemiological characteristics of osteoporosis in patients with lumbar degenerative diseases are high prevalence and low treatment rate. The prevalence of osteoporosis in women is significantly higher than that in men. The OSTA score has limited value in predicting osteoporosis, while BMI can be used as one of the initial screening tools for osteoporosis in this population.