关键词: 骨质疏松症, 临床预测模型, 列线图, 无症状老年女性, 筛查, 早期诊断

Abstract: Objective  To construct and validate a nomogram clinical prediction model dedicated to predicting the exact probability of osteoporosis in asymptomatic postmenopausal elderly women. Methods  Asymptomatic postmenopausal elderly women were recruited into the training (n=319) and validation (n=104) groups. Their clinical characteristics and bone mineral density (BMD) results were collected and analyzed. Univariate and multivariate Logistic regression analysis were performed. Construction of general and dynamic nomogram clinical prediction models. Validate the model through receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) curves, and clinical impact curves. Results  Lower education level and lower body weight were independent risk factors. Based on age, education level, and weight, a nomogram clinical prediction model was constructed, which had moderate predictive value ［area under the curve （AUC）> 0.7］, good calibration, clinical benefit, and clinical impact. The constructed online dynamic nomogram (https://shibaolu.shinyapps.io/DynamicNomogram/) was interactive and easy to generalize Taking the critical value 0.452 obtained from the training group  as the standard for predicting osteoporosis in asymptomatic postmenopausal elderly women, the actual prediction results of the validation group showed that the prediction effect of the nomogram prediction model was relatively close to that of the training group (sensitivity = 0.82, specificity = 0.63), and the predicted results had a medium to high degree of consistency (Kappa value) with the actual results, indicating that the predictive model has certain clinical application value. Conclusions This nomogram clinical prediction model has good practical application value and good generalizability, which could help achieve early prediction, early diagnosis and early treatment of osteoporosis, thus contributing to the bone health of asymptomatic postmenopausal elderly women and promoting the development of public health.

Key words: osteoporosis, clinical prediction model, nomogram, asymptomatic elderly women, screening, early diagnosis