PURPOSE To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures. METHODS A population of Caucasian women (30-90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA. RESULTS 1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9-5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77-3.76, p < 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20-2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p < 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p < 0.001). CONCLUSIONS REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.

中文翻译：

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射频回波多光谱法预测脆性骨折：一项为期 5 年的随访研究

目的 研究射频超声多谱仪 (REMS) 提供的 T 值在识别有发生骨质疏松性骨折风险的患者中的有效性。方法 2013 年至 2016 年招募的一群白人女性（30-90 岁）在轴向部位接受了双 X 射线吸收测定法 (DXA) 和 REMS 扫描。在长达 5 年的随访期间评估脆性骨折的发生率。之后，将发生和未发生骨折的患者按 1:2 的比例分为两个年龄匹配的组（分别为 F' 组和 NF' 组）。定量评估 REMS T 分数在区分两组方面的表现，并与 DXA 进行比较。结果共纳入 1516 名患者，1370 名完成随访（平均±标准差：3.7±0.8 年；范围：1.9-5。0 年）。骨折发生率为 14.0%。年龄匹配组分别包括 175 名骨折患者和 350 名未骨折患者（中位年龄 70.2 [四分位距：61.0-73.3] 和 67.3 [65.4-69.8] 岁，p 值 ns）。各组的身高、体重和 BMI（p 值 ns）也平衡。正如预期的那样，REMS T 评分（对于椎骨部位，F'组为 -2.9 [-3.6 至 -1.9]，NF'组为 -2.2 [-2.9 至 -1.2]）和 DXA T 评分（- F'组中的 2.8 [-3.3 至 -1.9]，NF' 组中的 -2.2 [-2.9 至 -1.4]）具有统计学意义（p 值 <0.001）。股骨颈也获得了类似的结果。考虑到 -2.5 的 T 分数截止值，REMS 识别 F 组患者的敏感性为 65.1%，特异性为 57.7% (OR = 2.6, 95% CI: 1.77-3.76, p < 0.001)，而 DXA显示灵敏度为 57。1% 和 56.3% 的特异性（OR = 1.7，95% CI：1.20-2.51，p 值 = 0.0032）。对于股骨颈，REMS 敏感性和特异性分别为 40.2% 和 79.9%，OR 为 2.81（95%CI：1.80-4.39，p < 0.001）。相反，DXA 的敏感性和特异性分别为 42.3% 和 79.3%，OR 为 2.68（95%CI：1.71-4.21，p < 0.001）。结论 REMS T 分数是基于人群的女性受试者样本中发生脆性骨折风险的有效预测指标，代表了在临床常规中增强骨质疏松症诊断的有希望的参数。显示灵敏度和特异性分别为 42.3% 和 79.3%，OR 为 2.68（95%CI：1.71-4.21，p < 0.001）。结论 REMS T 分数是女性受试者人群样本中发生脆性骨折风险的有效预测指标，代表了在临床常规中增强骨质疏松症诊断的有希望的参数。显示灵敏度和特异性分别为 42.3% 和 79.3%，OR 为 2.68（95%CI：1.71-4.21，p < 0.001）。结论 REMS T 分数是基于人群的女性受试者样本中发生脆性骨折风险的有效预测指标，代表了在临床常规中增强骨质疏松症诊断的有希望的参数。