Modeling fracture prediction in spinal cord injury and disease

脊髓损伤和疾病的骨折预测建模

• 批准号: 8396325
• 负责人: LAURA D CARBONE
• 金额: --
• 依托单位: MEMPHIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-12-01 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396325
• 关键词: Address; Adverse effects; Bone Density; Bone necrosis; Caring; Chronic; Clinic; Clinical; Clinical Trials; Data; Data Set; Databases; Decision Making; Disease; Dual-Energy X-Ray Absorptiometry; Femoral Fractures; Fracture; Functional disorder; Future; Guidelines; Healthcare; Individual; Jaw; Lower Extremity Fracture; Measurement; Methods; Modeling; Morbidity - disease rate; Osteoporosis; Osteoporosis prevention; Outcome; Patient Care; Patients; Persons; Pharmacy facility; Population; Postmenopause; Prevention; Public Health; Radiology Specialty; Registries; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Spinal Cord; Spinal Cord Diseases; Spinal cord injury; System; Testing; Time; Veterans; Work; age related; austin; bone disuse atrophy; bone loss; clinical practice; clinical risk; cohort; data registry; design; experience; high risk; osteoporosis with pathological fracture; prevent; tool; treatment response

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: The purpose of this project is to create a working tool to estimate fracture risk in Veterans with SCI/D. This tool will help guide clinicians in decision making for which patients with SCI/D should be treated with pharmacological agents to prevent fracture. Project Background: More than 10% of all persons with a SCI/D receive care through the VA and care of Veterans with SCI/D is of central concern to the VA. We have identified that serious morbidities occur following osteoporotic fractures in Veterans with SCI/D. However, there is very little known concerning risk factors for osteoporotic fractures in SCI/D. A better understanding of risk factors for fractures in SCI/D would allow appropriate targeting of existing treatments for osteoporosis. Recently, serious side effects from pharmacological therapies for osteoporosis including osteonecrosis of the jaw and atypical femoral fractures have been reported. Thus, it has now become critically important to avoid overtreatment of patients at low risk for fracture. Tools which incorporate clinical factors and bone mineral density (BMD) measurements to estimate fracture risk have recently been developed for persons without SCI/D. However, since the pathophysiology of bone loss following SCI/D differs substantially from that of age related, postmenopausal, or even simple disuse osteoporosis, there is a need to develop a distinct model to predict fractures in SCI/D. As a first step towards developing a working model to predict fractures in SCI/D, it is critical to determine whether Dual Energy X-ray Absorptiometry (DXA)-derived BMD is indeed useful for predicting fractures. A second step in developing a working model to predict fractures in SCI/D is to determine which clinical risk factors can predict incident fractures. A final model that clearly and easily identifes which patients with SCI/D are at highest risk for fracture that can be used directly in the clinics would facilitate decision making for clinicians. Such a tool could avoid overtreatment and potential harm to those at low risk for fracture by treatments for osteoporosis, and confer the benefits of such treatments to those who are most likely to fracture. In this context, our working hypothesis is that clinical factors but not DXA-derived BMD will best predict fractures in persons with SCI/D. Our hypothesis will be examined in the following specific objectives. Specific Objective 1: Determine the utility of DXA to predict fractures in Veterans with SCI/D. We hypothesize that DXA-derived BMD will not be able to predict incident fractures in SCI/D. To test our hypothesis, using a retrospective cohort design, we will include Veterans in the SCD Registry in FY2002-2012 and determine whether DXA-derived BMD is able to predict incident fractures during the study period. Specific Objective 2: Determine the best model for non-axial fracture prediction in Veterans with SCI/D. We hypothesize that a set of clinical factors will predict incident fractures in SCI/D. To test our hypothesis, in a retrospective cohort design, we will include Veterans in the SCD Registry in FY2002-2012 and determine which clinical factors can predict risk for incident non-axial fractures through FY2012. Our final fracture prediction model will include BMD (only if BMD can predict fractures) and those clinical risk factors identified to predict incident fractures. The immediate objectives of this research are to determine whether DXA-derived BMD is a useful tool in predicting fractures in SCI/D and to develop a model to predict fractures in SCI/D. The long-term objectives are to use this model to guide treatment decisions for fracture prevention in persons with SCI/D. Project Methods: This project will utilize administrative datasets and chart review data. The resources at the VA including the VA Spinal Cord Disorders (SCD) Registry, the DSS Pharmacy and Radiology Systems, the Corporate Data Warehouse and the Austin National Patient Care Databases will provide the administrative data for this project.

描述（由申请人提供）： 对退伍军人的医疗保健的预期影响：该项目的目的是创建一种工作工具，以估计SCI/D的退伍军人骨折风险。该工具将帮助指导临床医生对患有SCI/D的患者应用药理学剂治疗以防止骨折的决策。项目背景：超过10％的SCI/D的人通过VA接受护理，而SCI/D的退伍军人的照顾是VA的核心关注点。我们已经确定在具有SCI/D的退伍军人的骨质疏松性裂缝后发生严重的病毒。但是，关于骨质疏松性骨折的危险因素鲜为人知。更好地了解SCI/D中骨折的危险因素将允许适当靶向现有的骨质疏松症。最近，据报道，药理学疗法对骨质疏松症的严重副作用，包括颌骨和非典型股骨骨折的骨质病。因此，现在避免过度治疗骨折风险低的患者变得至关重要。 最近已经为没有SCI/D的人开发了结合临床因素和骨矿物质密度（BMD）测量以估算骨折风险的工具。但是，由于SCI/D后骨质流失的病理生理学与相关年龄，绝经后甚至简单的废除骨质疏松症的病理生物生物学有很大不同，因此有必要开发出一个独特的模型来预测SCI/D中的断裂。作为开发工作模型以预测SCI/D断裂的第一步，确定双能X射线吸收仪（DXA）衍生的BMD是否确实对预测裂缝确实有用。开发工作模型以预测SCI/D骨折的第二步是确定哪些临床风险因素可以预测入射骨折。一个清晰可轻松地识别哪些SCI/D患者的最终模型是直接在诊所中使用的骨折风险最高的风险，将有助于临床医生的决策。这种工具可以避免通过治疗骨质疏松症治疗骨折风险低的人过度治疗和潜在伤害，并将这种治疗的益处赋予最有可能骨折的人。在这种情况下，我们的工作假设是，临床因素而不是DXA衍生的BMD可以最好地预测SCI/D的人的断裂。我们的假设将在以下特定目标中进行审查。具体目标1：确定DXA预测SCI/d退伍军人裂缝的效用。我们假设DXA衍生的BMD将无法预测SCI/D中的事件骨折。为了检验我们的假设，使用回顾性队列设计，我们将在2002-2012财年的SCD注册中包括退伍军人，并确定DXA衍生的BMD是否能够预测研究期间的入射裂缝。特定目标2：确定具有SCI/D的退伍军人的非轴向断裂预测的最佳模型。我们假设一组临床因素将预测SCI/D中的入射骨折。为了检验我们的假设，在回顾性队列设计中，我们将在2002-2012财年的SCD注册中包括退伍军人，并确定哪些临床因素可以预测2012财年的非轴向骨折的风险。我们的最终断裂预测模型将包括BMD（仅当BMD可以预测骨折）和确定可预测入射骨折的临床风险因素。这项研究的直接目的是确定DXA衍生的BMD是否是预测SCI/D断裂的有用工具，并开发了一个模型以预测SCI/D中的裂缝。长期目标是使用此模型指导SCI/D患者预防裂缝的治疗决策。项目方法：此项目将利用管理数据集并图表审核数据。 VA的资源包括VA脊髓疾病（SCD）注册表，DSS药房和放射系统，公司数据仓库和奥斯汀国家患者护理数据库，将为该项目提供管理数据。