폐경 및 폐경 주변기 여성에서 골다공증을예측하는 위험지표들의 유용성
Performance of Risk Indices for Prediction of Osteoporosis in Post- and Perimenopausal women
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목적: 폐경 및 폐경 주변기 여성에서 골다공증 예측에 있어 기존에 발표된 위험지표들의 유용성을 평가한다. 연구 방법: 2002년 1월부터 2004년 6월까지 폐경기 클리닉을 방문한 45세 이상의 폐경 및 폐경 주변기 여성 1559명을 대상으로 이중 에너지 X-ray 흡수 계측법을 이용하여 대퇴골 경부의 골밀도 측정하였고 병력과 위험인자들도 평가하였다. 골밀도는 세계보건기구의 진단에 따라 정상, 골감소증, 골다공증의 3가지로 분류하였다. 6개의 위험지표들 (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) 각각의 민감도, 특이도, 양성예측도를 계산하였다. 또한 receiver operating characteristics (ROC) 분석을 이용하여 위험지표들의 골다공증 예측력을 평가하였다. 결과: 대퇴골 경부 골밀도를 기준으로 하면 골다공증과 골감소증의 유병률은 8.7%, 32.6%이며 요추 골밀도를 기준으로 하면 각각 16.0%, 30.1%로 나타났다. 또한 골다공증의 유병률은 연령이 증가하면서 증가하여 50대엔 1.6%, 60대 8.7%, 70대 43.0%, 80대 이상 64.1%로 나타났다. 대퇴골 경부 골밀도를 기준으로 골다공증 환자를 대상으로 한 경우, OSTA는 AUC 0.920, 민감도 93.4%, 특이도 75.4%, 양성예측도 26.6%였다. ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline의 AUC는 각각 0.896, 0.916, 0.871, 0.846, 0.856이었다. 결론: 위험지표들은 모두 다른 방법으로 유용성을 나타내고 있지만 골다공증을 예측하는데 모두 비슷한 민감도, 특이도, 양성예측도를 보이고 있었다. 그러나 이중 OSTA는 폐경 및 폐경 주변기 여성에서 골다공증을 예측하는데 도움을 받을 수 있는 간편하면서 가장 유용한 수단으로 판단된다.
Abstract
Objective: To examine the ability of published osteoporosis risk indices for prediction of osteoporosis in post- and perimenopausal women. Methods: Subjects included 1559 of post- and perimenopausal women, 45 year old and older, recruited from Menopause Clinic from January 2002 to June 2004. Their bone mineral density (BMD) of femur neck was determined by dual energy x-ray absorptiometry (DXA), and their historical and clinical risk factors were assessed. We employed the World Health Organization (WHO) diagnostic criteria of osteoporosis for calculating the T scores, using race/ethnic and gender-specific young adult mean values. We applied 6 published osteoporosis risk indices (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) to each subject. Also, the predictive abilities of risk indices were assessed using the area under receiver operating characteristic (ROC) curve. Results: The prevalence of osteoporosis and osteopenia was 8.7% and 32.6% for femur neck, 16.0% and 30.1% for lumbar spine, respectively. The prevalence of osteoporosis for femur neck was increased dramatically in the coming decades (1.6% for fifties, 8.7% for sixties, 43.0% for seventies, 64.1% for over eighties). ROC curve for predicting osteoporosis according to femur neck by OSTA showed the area under the curve (AUC) of 0.920. Sensitivity, specificity, and positive predictive value (PPV) were 93.4%, 75.4%, 26.6%, respectively. AUC for ORAI, SCORE, SOFSURF, ABONE, and NOF practice guideline was 0.896, 0.916, 0.871, 0.846, and 0.856, respectively. Conclusion: Validated risk indices have varying complexity, but similar sensitivity, specificity, and PPV for identifying individuals who are likely to have osteoporosis. However, OSTA is the most excellent risk index and simple tool.
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