DXA、BTM联合FRAX评估甲状腺乳头状癌术后绝经后女性患者骨折风险的临床研究

Clinical Study on the Assessment of Fracture Risk in Postmenopausal Women Patients after Papillary Thyroid Carcinoma Surgery by DXA, BTM Combined with FRAX

摘要: 目的：探讨骨密度(DXA)、骨代谢标志物(BTM)联合骨折风险评估工具(FRAX)评估甲状腺乳头状癌术后绝经后女性患者未来10年骨折风险。方法：我院2024年1月至2024年7月期间，门诊和住院的甲状腺乳头状癌术后绝经后女性患者72例。获取患者的基本信息、骨密度(DXA)、骨代谢标志物(BTM)，并通过骨折风险评估工具(FRAX)计算未来10年内主要骨质疏松性骨折风险概率和髋部骨折风险概率。将研究对象分为BTM高骨转换组和BTM低骨转换组。根据骨折发生风险判定：高风险标准为主要骨质疏松性骨折概率 ≥ 20%或髋部骨折概率 ≥ 3%。结果：(1) BTM高转换组的ALP水平高于低转换组，而腰椎BMD和股骨颈BMD 则低于低转换组，差异具有统计学意义(P < 0.05)。(2) 高转换组中骨质疏松(T ≤ −2.5)和骨量减少(−2.5 < T < −1)的比例高于低转换组，而骨密度正常(T ≥ −1)的比例则低于低转换组，差异具有统计学意义(P < 0.05)。(3) BTM高转换组FRAX高风险的比例高于低转换组。结论：对于甲状腺乳头状癌术后激素替代治疗的绝经后女性患者，采用DXA、BTM联合FRAX对患者进行骨折风险综合评估，预测骨质疏松及骨折风险准确性更高。

Abstract: Objective: To explore bone mineral density (DXA), bone metabolism markers (BTM), and the fracture risk assessment tool (FRAX) in evaluating the 10-year fracture risk of postmenopausal women with thyroid papillary carcinoma after surgery. Methods: From January 2024 to July 2024, 72 postmenopausal women patients with papillary thyroid carcinoma who underwent surgery in our hospital were included. Basic information, bone mineral density (DXA), and bone turnover markers (BTM) of the patients were obtained. The probabilities of major osteoporotic fractures and hip fractures within the next 10 years were calculated using the fracture risk assessment tool (FRAX). The research subjects were divided into the BTM high bone turnover group and the BTM low bone turnover group. Based on the assessment of fracture risk: the high-risk criterion was defined as the probability of major osteoporotic fractures being ≥ 20% or the probability of hip fractures being ≥ 3%. Result: (1) The ALP level in the BTM high conversion group was higher than that in the low conversion group, while the lumbar spine BMD and femoral neck BMD were lower than those in the low conversion group, and the differences were statistically significant (P < 0.05). (2) The proportions of osteoporosis (T ≤ −2.5) and osteopenia (−2.5 < T < −1) in the high conversion group were higher than those in the low conversion group, while the proportion of normal bone density (T ≥ −1) was lower than that in the low conversion group, and the differences were statistically significant (P < 0.05). (3) The proportion of high-risk in FRAX in the BTM high conversion group was higher than that in the low conversion group. Conclusion: For postmenopausal women patients with papillary thyroid carcinoma undergoing hormone replacement therapy, using the combination of DXA, BTM and FRAX to conduct a comprehensive assessment of fracture risk for these patients results in higher accuracy in predicting osteoporosis and fracture risk.