Renovation of osteoporosis check-up and management according to fracture risk assessment using a novel three-dimensional structure index for the proximal femur

Research Project

Project/Area Number	18K19711
Research Category	Grant-in-Aid for Challenging Research (Exploratory)
Allocation Type	Multi-year Fund
Review Section	Medium-sized Section 58:Society medicine, nursing, and related fields
Research Institution	Kindai University
Principal Investigator	IKI Masayuki 近畿大学, 医学部, 教授 (50184388)
Co-Investigator(Kenkyū-buntansha)	藤田裕規近畿大学, 医学部, 講師 (10330797) 立木隆広中京学院大学, 看護学部, 准教授 (10734650) 由良晶子近畿大学, 医学部, 講師 (80142595)
Project Period (FY)	2018-06-29 – 2020-03-31
Project Status	Completed (Fiscal Year 2019)
Budget Amount *help	¥6,240,000 (Direct Cost: ¥4,800,000、Indirect Cost: ¥1,440,000) Fiscal Year 2019: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000) Fiscal Year 2018: ¥5,850,000 (Direct Cost: ¥4,500,000、Indirect Cost: ¥1,350,000)
Keywords	骨折リスク / 骨粗鬆症 / ３次元構造解析 / 骨粗鬆症検診 / 骨粗鬆症診療
Outline of Final Research Achievements	We have followed the JPOS cohort for 20 years, and assessed using these cohort data whether novel 3D bone architecture indices at the proximal femur at baseline improved the predictive ability of conventional areal bone mineral density (aBMD) for subsequent hip fracture risk. Trabecular volumetric BMD at the femoral neck showed the greatest area under ROC curve (AUC) among the 3D indices examined in this study, and nearly significantly greater AUC than AUC for aBMD at the femoral neck. Net reclassification improvement (NRI) indicated a significant improvement in predictive ability of hip fracture by aBMD at the femoral neck by adding the trabecular volumetric BMD at the femoral neck in the predictive model. These 3D indices can be used to improve the fracture risk assessment in clinical settings.
Academic Significance and Societal Importance of the Research Achievements	骨粗鬆症診療の目的は骨折予防であるので、検診でも患者の経過観察でも指標となるものは骨折リスクである。現状では骨折リスク評価のためにDXAによる面積骨密度が使われているが、骨折予測性能、特に感度が不十分である。今回検討した大腿骨近位部三次元構造指標の内、頸部海綿骨体積骨密度が通常の面積骨密度による骨折リスク評価性能を改善することが示された。これにより骨折予測の感度が向上するので、日常診療や検診での高骨折リスク者の見落としを少なくできると考えられる。