Abstract：
The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults. We included English-language, controlled or prospective cohort studies that enrolled US adults aged >40 years and reported tool performance predicting incident fractures within individual race and ethnicity groups for up to 10 years. From 4838 identified references, six reports met eligibility criteria, all in women. Just three, all from one study, included results in non-white individuals. In these three reports, non-white women experienced relatively few major osteoporotic fractures (MOFs), especially hip fractures, and risk thresholds for predicting fractures in non-white women were derived from risks in the overall, predominantly white study population. One report suggested the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) overestimated hip fracture similarly across race and ethnicity groups (black, Hispanic, American Indian, Asian, white) but overestimated MOF more in non-white than White women. However, these three reports were inconclusive regarding whether discrimination of FRAX or the Garvan calculator without BMD or of FRAX with BMD for MOF or hip fracture differed between white versus black women. This uncertainty was at least partly due to imprecise hip fracture estimates in black women. No reports examined whether ratios of observed to predicted hip fracture risks within each race or ethnicity group varied across levels of predicted hip fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
摘要：
美国骨与矿物研究协会（ASBMR）专业实践委员会负责ASBMR骨折风险临床算法工作组，以审查有关当前基于种族和种族区分骨折风险的方法是否必要和有效的证据。为了帮助解决这些指控，我们进行了一项系统的文献综述,调查了计算器在预测美国中年和老年成年人种族和族裔群体内和跨种族和族裔群体的意外骨折方面的表现.我们包括英语，纳入美国40岁以上成年人的对照或前瞻性队列研究,报告工具性能可预测个体种族和种族群体内的骨折发生率长达十年。从4838个确定的参考文献中，六份报告符合资格标准，所有在女人。只有三个,全部来自一项研究，包括非白人个体的结果。在这三份报告中，非白人女性经历了相对较少的主要骨质疏松性骨折（MOF），尤其是髋部骨折,预测非白人女性骨折的风险阈值来自总体风险，主要是白人研究人群。一份报告建议，骨折风险评估工具（FRAX）没有骨矿物质密度（BMD）高估髋部骨折，在种族和种族群体中相似（Black，西班牙裔,美洲印第安人,亚洲人,白人），但非白人女性比白人女性更高估了严重的骨质疏松性骨折（MOF）。然而,对于无BMD的FRAX或Garvan计算器,或有BMD的FRAX对MOF或髋部骨折的区别性,这3份报告尚无定论.这种不确定性至少部分是由于黑人女性的髋部骨折估计不准确。没有报告检查每个种族或种族群体中观察到的髋部骨折风险与预测的髋部骨折风险的比率是否在预测的髋部骨折风险水平之间存在差异。本文受版权保护。保留所有权利。
