发表机构
Weill Cornell Medicine; Indiana University School of Medicine; Indiana University; Regenstrief Institute（威尔康奈尔医学院; 印第安纳大学医学院; 印第安纳大学; 雷根斯特里夫研究所）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
该研究针对50岁以上成人，基于EHR和DXA数据构建多种生存预测模型，发现其区分度优于FRAX，为骨折风险预测提供了更优工具，但需进一步评估后才可临床应用。
AI 中文摘要
准确的骨折风险预测对骨质疏松症管理至关重要，但常用临床工具可能未充分利用电子健康记录（EHR）和双能X线吸收法（DXA）报告中的可用信息。我们在美国两个医疗系统中，针对有临床获取的DXA报告的50岁及以上成人，开发并外部验证了时间-事件骨折预测模型。开发队列来自纽约长老会/威尔康奈尔医学中心，外部验证队列来自印第安纳患者护理网络。预测变量包括人口统计学特征、生活方式因素、既往骨折、合并症、药物暴露、骨质疏松症治疗史，以及从放射学报告中提取的DXA衍生T值。结局指标为从索引DXA检查到首次脆性骨折发生的时间，该骨折通过结构化诊断代码识别。我们使用2种预设预测变量设置评估了 penalized Cox回归、随机生存森林、梯度提升生存模型和XGBoost生存模型，并将其区分度与临床报告的FRAX主要骨质疏松性骨折概率进行比较。开发队列包含11510名成人，其中858人发生脆性骨折；外部验证队列包含1932名成人，其中180人发生骨折。内部验证中，扩展Cox模型的平均Harrell C指数为0.779，而FRAX为0.653；外部验证中，对应Cox模型的Harrell C指数为0.714，FRAX为0.590，梯度提升生存模型的外部区分度最高，达0.725。在该接受DXA检测的人群中，结合EHR和DXA的模型比临床报告的FRAX评分表现出更好的区分度，但在临床应用前仍需进行校准评估、前瞻性评估和实施工作流程评估。
英文摘要
Accurate fracture risk prediction is important for osteoporosis management, but commonly used clinical tools may not fully use information available in electronic health records (EHRs) and dual-energy X-ray absorptiometry (DXA) reports. We developed and externally validated time-to-event fracture prediction models among adults aged 50 years or older with clinically obtained DXA reports in 2 US health care systems. The development cohort was derived from NewYork-Presbyterian/Weill Cornell Medical Center and the external validation cohort from the Indiana Network for Patient Care. Predictors included demographics, lifestyle factors, prior fracture, comorbidities, medication exposures, osteoporosis treatment history, and DXA-derived T-scores extracted from radiology reports. The outcome was time from index DXA to first incident fragility fracture identified from structured diagnosis codes. We evaluated penalized Cox regression, random survival forest, gradient-boosting survival, and XGBoost survival models using 2 prespecified predictor settings and compared discrimination with clinically reported FRAX major osteoporotic fracture probabilities. The development cohort included 11,510 adults, of whom 858 sustained incident fragility fractures; the external validation cohort included 1,932 adults, of whom 180 sustained fractures. In internal validation, the expanded Cox model achieved a mean Harrell C-index of 0.779, compared with 0.653 for FRAX. In external validation, the corresponding Cox model achieved a Harrell C-index of 0.714, compared with 0.590 for FRAX; gradient-boosting survival had the highest external discrimination (0.725). EHR- and DXA-enhanced models showed better discrimination than clinically reported FRAX scores in this DXA-tested population, but calibration assessment, prospective evaluation, and implementation workflow assessment are needed before clinical use.
Comments5 figures, 4 tables, 25 pages
