Prediction of Incident Osteoporosis in Association with Bone Mineral Density and Related Risk Factors
Date Issued
2012
Date
2012
Author(s)
Lee, Jiun-Shiou
Abstract
Background
Osteoporosis is a common disease and is also one of the most important risk factors responsible for fracture. It is very rare to study the incidence of osteoporosis by using the population-based and community-based data. Moreover, the accuracy of predicting of Incident osteoporosis in association with bone mineral density (BMD) and related risk factors also has been barely addressed.
Purpose
By using community-based intergrated screening data, we aimed to (1) estimate the incidence of osteoporosis by age and sex; (2) study the accuracy of predicting incident osteoporosis by using the quantitative ultrasound and the optimal cut off point based on the receiver operating characteristics (ROC) curve; (3) determine if there is a dose-response relationship between the baseline QUS measurement or time-dependent repeated QUS measurements and incident osteoporosis.
Materials and Methods
The study design is based on a prospective community-based cohort study consisting of people who were aged 40 years or over and participated in the community-based intergrated screening between 1999 and 2004. After excluding cases who had been already diagnosed as osteoporosis before the date of first screening date (prevalent cases), a total number of 40916 people (male: 17286, female: 23630) were enrolled. In each round of screening, the QUS measurement, physical, biochemical lab data and questionnares of risk factors of participants were collected. The accuracy of predicting incident osteoporosis by using QUS measurements was assessed by using receiver operating characteristics (ROC) curve. The odds and harzard ratio of QUS measurements and related risk factors were estimated by using logistic regression model and proportional hazards regression model, repectively. The dose-response relationship between incident osteoporosis and baseline QUS measurement or time-dependent repeated QUS measurements was also evaluated with or without adjusting for other significant risk factors.
Results
The incidence of osteoporosis was 32.65 per 1000 person-years and was higher in females (49.13 per 1000 person-years) than males (11.17 per 1000 person-years). The sensitivity of QUS was 55.69%, the specificity is 66.00% and the area under receiver operating curve is 0.65 (95%CI:0.61-0.66) while the cut-off point value was set at -2 pf BMD. As incremental unit of BMD lead to a 12%(OR:0.88 95%CI:0.84-0.91) reduction of incident osteoporosis. Compared with 0-20 percentage group, there was a dose-response relationship between QUS measurement and incident osteoporosis. After adjusting for related risk factors, an increase in one unit of QUS measurement lead to 3% (95%CI of HR:0.94-1.01) and 5% (95%CI of HR:0.92-0.99) of developing incident osteoporosis by using time-independent model and time-dependent model, respectively. By combing QUS measurements with risk factors, such as age, sex and menopause status, the AUC was 0.79 using time-independent model and 0.78 using time dependent model, both of which suggest the adequacy of model accuracy.
Conclusion
The results of this large community-based prospective cohort study provide the strong evidence on a dose-response relationship between QUS measurements and incident osteoporosis. Besides, combing QUS measurements with related risk factors has good accuracy of predicting incident osteoposis. This study suggests that baseline continuous QUS may be used for stratifying the risk of osteoporosis in the underlying population community-based screening so people can have earlier and in-time treatment when necessary.
Subjects
Incident Osteoporosis
Bone Mineral Density
Receiver Operating Curve
Dose-Response Effect
Type
thesis
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