J Bone Miner Res:在老年人中鉴定的骨微结构表型与不同水平的骨质疏松性骨折风险相关

2022-01-26 医路坦克 MedSci原创

骨微结构表型的鉴定是关于如何利用HR-pQCT图像数据评估老年人群骨骼健康的新颖和创新的观点。骨表型加强了骨脆性可以以不同形式表现的前提,并且应该考虑结构和密度特性之间的复杂相互作用。

      骨质疏松症是一种与年龄有关的疾病,其特征是骨强度受损,导致骨折风险增加。骨质疏松性脆性骨折的终生风险非常高,估计女性为40-50%,男性为13-22%,由于人口老龄化,预计骨质疏松性骨折的数量将急剧增加。骨折预防至关重要,但骨质疏松症仍未得到充分诊断和治疗。目前的诊断依赖于通过双X射线吸收测定法(DXA)测量的股骨颈(FN)或腰椎区域骨矿物质密度(aBMD),尽管低aBMD与更大的骨折风险相关,它缺乏灵敏度,因为它确实考虑了有助于骨强度的骨结构信息。

      高分辨率外周定量计算机断层扫描(HR-pQCT)提供有关骨宏观结构和微结构的附加信息,我们最近的前瞻性研究表明,使用HR-pQCT测量的骨参数在评估骨折风险时为FN aBMD提供附加预测信息。然而,解释是具有挑战性的,因为评估HR-pQCT参数单独忽略了参数之间的复杂相互作用,并且没有考虑到骨脆性可能以不同形式表现出来。先前的研究已经提出存在与骨形状相关的与年龄相关的骨丢失的不同轨迹,表明在很大程度上依赖于aBMD的骨折风险评估的“一刀切”方法可能不合适。单中心研究还探索了使用HRpQCT来鉴定与骨折相关的骨微结构特性簇,尽管有希望,但由于样本量小和缺乏前瞻性骨折信息,这些研究受到限制。

     鉴定骨特性的常见组合(我们称之为骨表型),其易于发生更高的骨折风险,有可能增强我们对骨质疏松症在整个人群中的表现以及改善患者特异性骨折风险评估的理解。因此,本研究的目的是使用具有大型多中心HR-pQCT数据集的聚类分析来鉴定群体中骨微架构的常见表型。使用该队列的前瞻性骨折数据,我们旨在确定某些骨表型是否与较高的骨折风险相关。此外,我们将研究是否存在每种表型独特的骨折风险的主要成像生物标志物。

     在这项研究中,我们提出有骨特性的常见组合,称为表型,易患不同程度的骨折风险。使用来自40-96岁之间的跨国队列(n=5873,71%女性)的HR-pQCT数据,我们采用模糊c均值聚类(一种无监督的机器学习方法)来识别骨微体系结构的表型。鉴定了三个簇,并且使用HR-pQCT参数的部分相关性分析,我们将簇表征为低密度,低体积和健康的骨表型。大多数男性与健康的骨表型有关,而女性则更多地与低体积或低密度骨表型有关。每种表型对于主要骨质疏松性骨折(MOF)和任何事件性骨质疏松性骨折具有显着不同的累积危险(p<0.05)。在调整协变量(队列,性别和年龄)后,低密度随后是低体积表型与MOF的关联性最高(风险比分别为2.96和2.35),并且在对股骨颈aBMD进行额外调整时保持显着关联(风险比分别为1.69和1.90)。此外,在每种表型内,鉴定了不同的骨折成像生物标志物。

    骨微结构表型的鉴定是关于如何利用HR-pQCT图像数据评估老年人群骨骼健康的新颖和创新的观点。骨表型加强了骨脆性可以以不同形式表现的前提,并且应该考虑结构和密度特性之间的复杂相互作用,以便建立针对患者的骨质疏松症治疗方法。

文献来源:Whittier DE,  Samelson EJ,  Hannan MT,Bone microarchitecture phenotypes identified in older adults are associated with different levels of osteoporotic fracture risk.J Bone Miner Res 2021 Dec 25;

 

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    2022-08-13 apoenzyme
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    2022-01-27 tastas
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    2022-01-27 Eleven17

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