以色列Clalit研究所Noa Dagan团队研究发现，使用计算机断层扫描技术自动进行机会性骨质疏松性骨折风险评估，可以帮助裂缝风险评估工具（FRAX）充分利用。相关论文2020年1月13日在线发表在《自然—医学》上。

他们根据常规的腹部或胸部（CT）扫描评估了机会性骨折风险自动评估的可行性。使用三个自动生成的骨成像生物标志物（椎骨压缩性骨折（VCF），模拟的DXA T评分和腰椎小梁密度）以及年龄和性别的CT元数据创建了基于CT的预测因子。在2012年之前（索引日期），对48,227名年龄在50-90岁且有CT的个体（51.8％的女性）进行了队列评估，采用无骨矿物质密度（BMD）输入的FRAX（FRAXnb）和基于CT的5年骨折风险预测因子。将预测结果与2012-2017年（随访期）主要骨质疏松性骨折和髋部骨折的结果进行比较。与FRAXnb相比，主要的基于骨质疏松性骨折的CT预测因子在曲线下（AUC）、敏感性和阳性预测值（PPV）表现出更好的受体工作特征区域（分别为+1.9%，+2.4%和+0.7%）。基于髋部骨折CT的预测指标的AUC、敏感性和PPV量度均不劣于FRAXnb，其非劣质性为1%。当FRAXnb输入不可用时，可以基于单个腹部或胸部CT完全自动地进行骨折风险的初始评估，这通常可用于筛选候选对象。

据介绍，未被充分利用来诊断骨质疏松性骨折高风险患者的方法，包括双能X射线骨密度仪（DXA）和诸如骨折风险评估工具（FRAX）等风险预测器。

附：英文原文

Title: Automated opportunistic osteoporotic fracture risk assessment using computed tomography scans to aid in FRAX underutilization

Author: Noa Dagan, Eldad Elnekave, Noam Barda, Orna Bregman-Amitai, Amir Bar, Mila Orlovsky, Eitan Bachmat, Ran D. Balicer

Issue&Volume: 2020/01

Abstract: Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)36, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 5090 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 20122017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8. A retrospective analysis of existing computed tomography scans shows the feasibility of an automated process for evaluating osteoporotic fracture risk that could be used as an initial screening tool when FRAX inputs are unavailable.

DOI: 10.1038/s41591-019-0720-z

Source:https://www.nature.com/articles/s41591-019-0720-z