ORIGINAL ARTICLE

Comparison of Screening Strategies for Bone Mineral Density Measurement
Kemik Mineral Yoğunluğu Ölçümü İçin Tarama Stratejilerinin Karşılaştırılması
Received Date : 06 May 2019
Accepted Date : 26 Sep 2019
Available Online : 13 Dec 2019
Doi: 10.25179/tjem.2019-66793 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:206-212
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: No definite optimal strategy exists to identify candidates for bone mineral density (BMD) testing in postmenopausal women younger than 65 years. Therefore, this study aimed to compare different strategies used to identify suitable candidates for BMD testing. Material and Methods: In total, 187 postmenopausal women aged 50–64 years without a history of low-trauma fracture were included in this cross-sectional study. Screening strategies used for BMD testing were (1) The presence of at least one risk factor, (2) A Fracture Risk Assessment Tool (FRAX®) threshold score of 10% for major osteoporotic fracture risk, and (3) A FRAX® age-dependent assessment threshold for major osteoporotic fracture risk. Cochran’s Q test was used for comparison. The agreement between the strategies was assessed using kappa statistics. Results: The median (range) age was 57 (50-64) years. The median (range) 10-year predicted major osteoporotic fracture and hip fracture risks were 4.9% (2.3-13) and 0.4% (0.1-4.4), respectively. Furthermore, 59.4% of participants were candidates for BMD testing according to strategy (1), compared with 3.2% according to strategy (2), and 81.8% according to strategy (3) (Cochran’s Q pvalue< 0.001, p<0.05 for the 3 strategies in pairs). The value of kappa (agreement) between (2) and (1) was 0.04 and that between (2) and (3) was 0.01. The value between (1) and (3) was 0.39. Conclusion: Three strategies used in the selection of postmenopausal women younger than 65 years for BMD testing were in disagreement. The strategy of FRAX® threshold score of 10% does not seem appropriate for BMD screening. The FRAX® age-related assessment threshold strategy may be more appropriate for BMD screening but its effectiveness in terms of treatment and cost needs to be demonstrated in further studies.
ÖZET
Amaç: Altmış beş yaşından küçük postmenopozal kadınlarda, kemik mineral yoğunluğu (KMY) testi yapmaya aday olanları belirlemede kullanılan kesin bir optimal strateji mevcut değildir. Bu nedenle, bu çalışma, KMY testi yapılacak uygun adayları belirlemek için kullanılan farklı stratejileri karşılaştırmayı amaçlamıştır. Gereç ve Yöntemler: Bu kesitsel çalışmaya, yaş aralığı 50- 64 yıl olan, düşük yoğunluklu travmaya bağlı kırık öyküsü olmayan 187 postmenopozal kadın dâhil edildi. KMY testi için kullanılan tarama stratejileri; (1) En az 1 risk faktörü varlığı, (2) FRAX® (Fracture Risk Assessment Tool) tabanlı majör osteoporotik kırık riski için değerlendirme eşik değerinin % 10 olması ve (3) FRAX® tabanlı majör osteoporotik kırık riski değerlendirme eşik değerinin yaşa bağlı olması idi. Karşılaştırma için Cochran Q testi kullanıldı. Yöntemler arasındaki uyum kappa istatistiği kullanılarak değerlendirildi. Bulgular: Ortanca (dağılım aralığı) yaş 57 (50-64) yıl’dı. Ortanca (dağılım aralığı) 10 yıllık tahmini majör osteoporotik kırık ve kalça kırığı riskleri sırasıyla %4,9 (2,3-13) ve %0,4 (0,1-4,4) idi. Ayrıca, katılımcıların %59,4’ü strateji (1) göre KMY testi için adaydı, bu oran strateji (2)’ye göre %3,2 ve strateji (3)’e göre %81,8 idi (Cochran Q testi p değeri <0,001, ikişerli karşılaştırmalarda p değeri <0,05). Strateji (1) ve (2) arasındaki kappa (anlaşma) değeri 0,04 ve (2) ve (3) arasındaki değer 0,01 idi. (1) ve (3) arasındaki değer 0.39 idi. Sonuç: Altmış beş yaşından küçük postmenopozal kadınların KMY testi için seçiminde kullanılan üç strateji birbirleriyle uyumsuz bulundu. FRAX® ≥%10 eşik değer stratejisinin KMY taraması için uygun olmadığı görülmektedir. FRAX® yaşa bağlı değerlendirme eşiği stratejisi KMY taraması için daha uygun olabilir ancak tedavi ve maliyet açısından etkinliğinin ileriki çalışmalarda gösterilmesi gerekmektedir. Anahtar kelimeler: Postmenopozal kadın;
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