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开发和比较治疗决策工具的葡萄糖皮质醇诱导骨质疏松症的发展和比较

Jia-Feng Chen^1,2, Shan-Fu Yu¹, Wen-Chan Chiu¹

¹Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, Taiwan.

Diagnostics (Basel, Switzerland)

|February 24, 2024

概括

一个新的类固醇相关骨折评估 (SAFE) 工具准确地预测了长期使用葡萄皮糖类药物 (GCs) 的患者的骨折. 这种经过验证的工具有助于临床决策,防止GC诱导的骨损伤.

科学领域:

内分泌学和骨代谢骨质代谢
风湿病学和药理学方面的研究.

背景情况:

长期使用葡萄糖皮质激素 (GC) 是损害骨强度和骨折的重要危险因素.
现有的骨折预防指南缺乏对GC治疗患者的现实验证.
需要一个经过验证的工具来指导这一群体的治疗决策.

研究的目的:

开发和验证一种新的治疗决策工具,即类固醇相关骨折评估 (SAFE) 工具.
将SAFE工具的性能与现有指南进行比较:美国风湿病学会 (ACR),国际骨质疏松基金会和欧洲组织协会 (IOF-ECTS) 以及GC调整的骨折风险评估工具 (GC-FRAX).
评估SAFE工具对长期接受GC治疗的患者新脆弱性骨折的预测准确性.

主要方法:

一个单中心,观察性,病例控制的研究,利用台湾长光纪念医院 (2014-2021) 的注册表数据.
纳入标准:接受普得尼松 (≥2.5毫克/天或同等剂量) 治疗超过3个月的患者,年龄≥40岁,没有恶性瘤或正在接受抗骨质疏松症治疗.
参与者被分为导出和验证队列. 该SAFE工具是使用逻辑回归在衍生队列中开发的. 在验证队列中使用ROC曲线,AUC,灵敏度和特异性来评估性能.

主要成果:

总共有424名以前没有接受过治疗的受试者被录取; 19.6%的受试者在3年内出现了新的骨折.
该SAFE工具包括骨质疏松症,累积的GC剂量,BMI,以前的骨折和年龄 (≥70岁).
在验证组中,SAFE工具 (≥2分) 显示AUC为0.65,灵敏度/特异性/精度为75.9%/54.0%/58.9%,优于ACR,IOF-ECTS和GC-FRAX.

结论:

类固醇关联骨折评估 (SAFE) 工具是用于预测长期使用葡萄糖皮质激素治疗的患者的脆弱性骨折的验证工具.
与目前的建议相比,SAFE工具的准确性和特异性得到了提高,有助于预防骨折的临床决策.
该工具提供了一种实用的方法来管理接受葡萄糖皮质类药物的人的骨健康,在现实环境中解决了关键的未满足需求.

关键词:

皮质类固醇是什么骨折预防预防骨折骨折风险评估骨折风险评估骨折风险评估骨质疏松症是一种骨质疏松症.查检查查检查查检查查检查治疗治疗治疗治疗治疗治疗

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