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）： 对退伍军人医疗保健的预期影响：该项目的目的是创建一个工作工具来估计 SCI/D 退伍军人的骨折风险。该工具将有助于指导临床医生决定哪些 SCI/D 患者应接受药物治疗以预防骨折。项目背景：超过 10% 的 SCI/D 患者通过 VA 接受护理，患有 SCI/D 退伍军人的护理是 VA 的核心关注点。我们发现患有 SCI/D 的退伍军人在发生骨质疏松性骨折后会出现严重的并发症。然而，对于 SCI/D 中骨质疏松性骨折的危险因素知之甚少。更好地了解 SCI/D 骨折的危险因素将有助于对现有的骨质疏松症治疗方法进行适当的定位。最近，据报道骨质疏松症药物治疗会产生严重副作用，包括颌骨坏死和非典型股骨骨折。因此，避免对骨折风险低的患者进行过度治疗现在变得至关重要。 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) 测量来估计骨折风险的工具。然而，由于 SCI/D 后骨丢失的病理生理学与年龄相关的、绝经后的、甚至简单的废用性骨质疏松症的病理生理学有很大不同，因此需要开发一种独特的模型来预测 SCI/D 中的骨折。作为开发预测 SCI/D 骨折工作模型的第一步，确定双能 X 射线吸收法 (DXA) 衍生的 BMD 是否确实可用于预测骨折至关重要。开发预测 SCI/D 骨折的工作模型的第二步是确定哪些临床危险因素可以预测骨折事件。最终模型可以清楚、轻松地识别哪些 SCI/D 患者骨折风险最高，并且可以直接在诊所使用，这将有助于临床医生做出决策。这样的工具可以避免骨质疏松症治疗对骨折风险低的人的过度治疗和潜在伤害，并使最有可能骨折的人受益于这种治疗。在这种情况下，我们的工作假设是临床因素而非 DXA 衍生的 BMD 能够最好地预测 SCI/D 患者的骨折。我们的假设将在以下具体目标中得到检验。具体目标 1：确定 DXA 在预测 SCI/D 退伍军人骨折方面的效用。我们假设 DXA 衍生的 BMD 无法预测 SCI/D 中发生的骨折。为了检验我们的假设，我们使用回顾性队列设计，将退伍军人纳入 2002-2012 财年的 SCD 登记册中，并确定 DXA 衍生的 BMD 是否能够预测研究期间的骨折事件。具体目标 2：确定 SCI/D 退伍军人非轴向骨折预测的最佳模型。我们假设一组临床因素可以预测 SCI/D 中的骨折事件。为了检验我们的假设，在回顾性队列设计中，我们将在 2002-2012 财年将退伍军人纳入 SCD 登记册，并确定哪些临床因素可以预测 2012 财年发生非轴向骨折的风险。我们最终的骨折预测模型将包括 BMD（仅当 BMD 可以预测骨折时）和那些确定用于预测骨折事件的临床风险因素。本研究的直接目标是确定 DXA 衍生的 BMD 是否是预测 SCI/D 骨折的有用工具，并开发预测 SCI/D 骨折的模型。长期目标是使用该模型来指导 SCI/D 患者预防骨折的治疗决策。项目方法：该项目将利用管理数据集和图表审查数据。 VA 的资源，包括 VA 脊髓疾病 (SCD) 登记处、DSS 药房和放射系统、企业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。