Construction of a prediction model for lumbar fracture in patients with osteoporosis

doi:10.11958/20231883

Abstract

Abstract:

Objective To construct a prediction model for lumbar fracture in patients with osteoporosis (OP) based on lumbar bone mineral density measured by quantitative computed tomography (QCT) and bone metabolism indicators. Methods A total of 52 patients with OP and lumbar fracture (the fracture group) and 104 patients with OP without lumbar fracture (the non-fracture group) were selected as study subjects. The correlation between lumbar bone mineral density measured by QCT and serum procollagen type I C-propeptide (P1CP), N-terminal mid-fragment of osteocalcin (N-MID) and beta collagen degradation products (β-CTX) was analyzed. Logistic regression analysis was conducted to identify influencing factors of lumbar fracture. A prediction model was constructed and its predictive value was analyzed. Results Compared with the non-fracture group, the proportions of females and patients with fall history, β-CTX level and vitamin D/ calcium medication history were higher in the fracture group, and lumbar bone mineral density measured by lumbar QCT, P1CP and N-MID levels were lower (P<0.05). Pearson correlation analysis found that lumbar bone mineral density measured by QCT was positively correlated with serum levels of P1CP and N-MID, and negatively correlated with β-CTX (r=0.523, 0.506, -0.536, P<0.05). Multivariate Logistic regression analysis found that higher lumbar bone mineral density measured by QCT, P1CP, N-MID and history of taking vitamin D/calcium were protective factors for lumbar fracture, and igher β-CTX level was a risk factor (P<0.05). The sensitivity and specificity of the prediction model constructed based on Logistic regression analysis results for predicting lumbar fracture were 84.62% and 97.12%. The area under the curve was 0.926 (95%CI: 0.873-0.962). The prediction model had good calibration, and the agreement rate was 0.910. Conclusion OP patients with higher levels of QCT, P1CP and N-MID, and lower level of β-CTX have lower risk of lumbar fracture. Vitamin D and calcium can effectively prevent the occurrence of lumbar fracture in OP patients, especially in women.

Key words: osteoporosis, bonedensity, risk factors, Logistic models, lumbar fracture, bone metabolism

CLC Number:

R681.4

Figures/Tables 6

References 18

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组别	n		女性		年龄				BMI
组别	n		女性		≥60岁		<60岁		<24 kg/m²		≥24 kg/m²
未骨折组	104		61（58.7）		54（51.9）		50（48.1）		39（37.5）		65（62.5）
骨折组	52		39（75.0）		33（63.5）		19（36.5）		19（36.5）		33（63.5）
χ²			4.025^＊		1.871				0.014
组别		既往史								维生素D/钙剂
组别		吸烟		跌倒		糖尿病		高血压		维生素D/钙剂
未骨折组		20（19.2）		40（38.5）		28（26.9）		37（35.6）		67（64.4）
骨折组		11（21.2）		30（57.7）		17（32.7）		21（40.4）		24（46.2）
χ²		0.081		5.183^＊		0.562		0.343		4.760^＊

组别	n		女性		年龄				BMI
组别	n		女性		≥60岁		<60岁		<24 kg/m²		≥24 kg/m²
未骨折组	104		61（58.7）		54（51.9）		50（48.1）		39（37.5）		65（62.5）
骨折组	52		39（75.0）		33（63.5）		19（36.5）		19（36.5）		33（63.5）
χ²			4.025^＊		1.871				0.014
组别		既往史								维生素D/钙剂
组别		吸烟		跌倒		糖尿病		高血压		维生素D/钙剂
未骨折组		20（19.2）		40（38.5）		28（26.9）		37（35.6）		67（64.4）
骨折组		11（21.2）		30（57.7）		17（32.7）		21（40.4）		24（46.2）
χ²		0.081		5.183^＊		0.562		0.343		4.760^＊

组别	n	骨密度/ （mg/cm³）	P1CP/ （μg/L）	β-CTX/ （μg/L）	N-MID/ （μg/L）
未骨折组	104	63.11±12.31	11.85±1.39	0.51±0.06	35.63±4.65
骨折组	52	57.56±5.73	8.89±0.86	0.69±0.09	30.14±4.36
t		3.841^＊＊	16.245^＊＊	13.156^＊＊	7.106^＊＊

组别	n	骨密度/ （mg/cm³）	P1CP/ （μg/L）	β-CTX/ （μg/L）	N-MID/ （μg/L）
未骨折组	104	63.11±12.31	11.85±1.39	0.51±0.06	35.63±4.65
骨折组	52	57.56±5.73	8.89±0.86	0.69±0.09	30.14±4.36
t		3.841^＊＊	16.245^＊＊	13.156^＊＊	7.106^＊＊

变量	β	SE	Wald χ²	P	OR（95% CI）
性别	-0.749	0.377	3.944	0.047	0.473（0.226~0.990）
跌倒史	0.780	0.346	5.097	0.024	2.182（1.108~4.295）
骨密度值	-0.073	0.023	10.074	0.002	0.930（0.889~0.972）
P1CP	-2.331	0.416	31.465	<0.001	0.097（0.043~0.219）
β-CTX	3.271	0.637	26.368	<0.001	26.338（7.557~91.792）
N-MID	-0.288	0.054	28.577	<0.001	0.750（0.674~0.833）
维生素D/钙剂	-0.748	0.345	4.688	0.030	0.473（0.241~0.931）