绝经后中国女性跟骨定量超声和双能X线检查骨质疏松症的对比研究

目的观察绝经后中国女性跟骨定量超声和双能X线检查骨质疏松症的效果比较。方法评估234名绝经后未接受过治疗的40～80岁女性的腰椎、双侧股骨颈和全髋关节部位的骨密度(bone mineral density,BMD)的DXA参数和左右跟骨的QUS参数。计算BMD和QUS参数的相关系数。生成接收器操作特性曲线,并评估曲线下面积(area under curve,AUC)来定义QUS的截止值。结果跟骨QUS能够识别右侧髋关节(AUC,0. 887)和左股骨颈(AUC,0. 824)的T值为-2. 5或更低的绝经后妇女。为了筛选目的,定义了右侧(1. 455)和左侧(1. 480)跟骨的QUS T值的截止值。结论与DXA这种标准的诊断方法相比,可以推荐QUS作为预筛选工具来减少DXA筛查的数量。     

DXA测量BMD与超声测量SOS的比较

目的　本文通过对同一个人的跟骨超声声速(SOS)测量与双能X线吸收法测量腰2-4,股骨近端骨密度(BMD)的临床对比来评价超声骨密度仪测量跟骨的SOS对诊断骨质疏松症的敏感性和与DXA测量BMD的相关性。方法　对523名8～87岁健康人群同时采用DXA测量L2-4,股骨近端(Neck,Ward三角,Troch)BMD和超声骨密度仪测量左跟骨SOS值并进行相关分析。对1006名3～87岁健康人群测量左右跟骨的SOS值。结果　SOS与DXA测量BMD的骨峰值(PBM)均出现在20～39岁,SOS的PBM男性为(1542.83±27.44)m/s,女性为(1531.02±29.96)m/s。40岁以后随着年龄的增加,二者均逐渐下降。健康成人中BMD与SOS的相关系数为0.3～0.6,骨质疏松患者BMD与SOS的相关系数(r=0.16～0.39)较健康人(r=0.33～0.61)低。左右足跟SOS无显著差异,DXA的BMD与SOS诊断骨质疏松症(OP)的符合率为60%。结论　DXA测量BMD与超声SOS为中等相关。建议在单独使用超声骨密度仪测量SOS来诊断OP时,应当参照临床症状和X线的检查全面考虑,以免造成漏诊或误诊。     

定量CT在类风湿关节炎合并骨质疏松诊断中的应用价值

目的 分析定量CT（QCT）在类风湿关节炎（RA）合并骨质疏松（OP）诊断中的特异性和灵敏度，以及QCT评定RA患者骨量流失的影响因素，探讨QCT在RA患者合并OP诊断和病情评估中的价值。方法 选取112例确诊的类风湿关节炎患者为研究对象，QCT组（56例），双能X线组（56例），两组患者分别采用QCT及DXA检测骨密度。收集患者的一般资料，包括年龄、性别、体质指数、病程（月）、既往疾病和用药情况。同时收集患者的RA相关临床表现、辅助检查及骨密度检查结果。采用受试者工作特征曲线（ROC曲线）分析QCT诊断OP的特异性和灵敏度，多重线性回归分析QCT组患者骨量流失与RA临床表现、辅助检查的相关性。结果 ①经过对比，两组的一般资料差异无统计学意义（P>0.05)；②DXA诊断类风湿关节炎患者合并骨质疏松的检出率为44.6 %，QCT测定类风湿关节炎患者合并骨质疏松的检出率为51.9 %。ROC曲线分析显示QCT对RA合并OP诊断的灵敏度为0.739，特异度为0.618；③QCT组研究对象的骨量流失与RA患者的临床表现、疾病活动指标无明显相关性（P>0.05），但与RA特异性抗体抗核周因子抗体（APF）相关。结论 QCT对RA合并OP的检出率高于DXA，有着较好的灵敏度和特异性，可作为RA合并OP诊断的重要手段。     

OSTA对2型糖尿病绝经妇女骨质疏松症筛查效果评价

目的评估亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)对2型糖尿病绝经妇女骨质疏松症(Osteoporosis,OP)的筛查效果,为分级诊疗中各级医疗机构,特别是基层医疗单位使用OSTA指数预测2型糖尿病绝经妇女骨质疏松症提供临床证据。方法选取2015年1月至2016年6月在我院内分泌科住院的2型糖尿病绝经妇女151名,采用双能X线吸收法(DXA)测量腰椎(L_(1-4))和股骨颈骨密度,计算OSTA指数,判断OSTA指数预测2型糖尿病绝经妇女骨质疏松症的价值。结果随年龄增长,受试者腰椎、股骨颈骨密度逐渐下降,OP检出率分别为28.5%、25.2%。OSTA各级风险中高风险指数在腰椎、股骨颈骨质疏松症检出率中最高,均为61%。OSTA中风险指数在腰椎和股骨颈OP检出率中较低,在骨量减少检出率中较高,分别是49.2%、50.8%。选取腰椎、股骨颈作为诊断的检测部位,OSTA指数预测OP的最佳截点分别是-2.9、-3.3时,对应的受试者工作特征曲线下面积最大(P=0.000)。结论 OSTA能较好的筛查出2型糖尿病绝经妇女骨质疏松症,可用于分级诊疗中基层医疗单位诊断骨质疏松症,建议OSTA最佳干预界值为-2.9。     

放射吸收法测量手指骨密度对于骨质疏松的诊断价值

目的 评价放射吸收法(radiographic absorptiometry, RA)测量指骨骨密度(bone mineral density, BMD)的准确性和对骨质疏松的诊断价值.方法 选取志愿者80例(男性30例,女性50例),分别用RA和双能X线骨密度仪(dual energy X-ray absorptiometry, DXA)测量非优势手的2、3、4指中节指骨BMD值和T值 (n=80),用DXA测量正位腰椎(n=77)、左侧近段股骨(股骨颈、股骨粗隆及全股骨)(n=78)的BMD值和T值.分别以DXA测量正位腰椎T值、左侧近段股骨T值、RA测量指骨T值进行骨质疏松诊断(T值≥-1.0SD为骨量正常,-2.5SD相似文献   

定量超声和双能X线骨密度测定诊断骨质疏松的比较

目的通过对同一个人的跟骨超声强度（STI）测量与双能X线吸收法（DEXA）测量腰2-4、股骨近端骨密度（BMD）的临床对比,评价定量超声骨质测量仪（QUS）跟骨STI的测量,对诊断骨质疏松（OP）的敏感性和与DEXA测量BMD的相关性.方法对3266名20～89岁健康人群同时采用DEXA测量L2-4、右股骨近端（Neck、Ward、Troch）BMD和QUS测量右跟骨STI值进行相关分析.结果峰值骨量男性STI与BMD均出现在20～29岁,女性STI出现在20～29岁,BMD则出现在30～39岁;随年龄的增加腰椎、股骨近端BMD及超声强度均下降,女性在50岁后,男性在70岁后有个显著下降过程;OP检出率两种仪器无明显差异.在健康人中BMD与STI的相关系数（R=0.21-0.26）,骨质疏松患者BMD与STI的相关系数（R=0.14-0.24）.结论DEXA测量的BMD与QUS测量的STI无相关关系.这表明QUS主要测量骨的结构,而DEXA则是测量骨量的变化,两者相辅相承,共同测量能更好地监测骨质疏松、预测OP性骨折的发生.     

腰椎脂肪定量MR （IDEAL-IQ）技术在骨质疏松症中的应用

目的 初步研究MR（IDEAL-IQ）技术测量的腰椎椎体骨髓脂肪分数（FF）在骨质疏松症临床诊断中的应用价值。方法 收集2018年6月至2018年11月在我院同时行腰椎脂肪定量MR检查与双能X线骨密度检查的患者,测量椎体（L1~4）脂肪分数和骨密度(常规用T值),进行Spearman相关分析。根据T值,将患者分为骨量正常组、骨量减少组和骨质疏松组。用单因素方差分析FF值在3组间的差异,用Mann-Whitney非参数检验分析每两组间差异,最后基于受试者工作特征曲线（ROC曲线）分析FF值对骨质疏松症的诊断效能。结果 总共收集病例55例,其中47例纳入数据分析。脂肪分数（FF）与骨密度值呈负相关（r= –0.66,P<0.05）,随着椎体骨密度的增高,脂肪分数降低。骨质疏松组与其他两组之间差异均有统计学意义（P<0.05）,骨量减少组与正常组之间的P值为0.1,差异没有统计学意义,ROC曲线下面积（AUC）为0.79,选择阈值48.05%来诊断骨质疏松症,灵敏度为0.871,特异性为0.625。结论 MR IDEAL-IQ技术通过快速精准评估腰椎椎体骨髓脂肪含量的变化,能够为骨质疏松症的诊断提供有价值的信息。     

腰椎体积CT值对诊断骨质疏松症的应用价值

目的 评估基于双层光谱CT腰椎扫描获得的椎体体积HU值在骨质疏松诊断中的应用价值。方法 回顾性收集2022年10月至2023年3月北京积水潭医院脊柱外科门诊患者91例。所有患者均接受过腰椎双层光谱CT扫描,包括QCT。同时测量纳入患者L1和L2椎体的体积HU值和基于QCT扫描的体积骨密度值。依据腰椎QCT骨密度诊断骨质疏松症的标准将研究对象分为骨量正常组、低骨量组和骨质疏松组,比较3组患者的一般情况,分析体积HU值与QCT测量的体积骨密度的关系。使用ROC曲线分别计算体积HU值诊断骨量减少和骨质疏松最佳诊断阈值以及使用逻辑回归模型确定性别、年龄和体积HU值与骨质疏松发生的关系。结果 L1和L2的平均体积HU值与QCT测量的BMD之间有极好的相关性（r= 0.941, P<0.001）;ROC诊断骨量减少和骨质疏松的最佳阈值分别为154.73 HU（灵敏度为92.9 %）和106.52 HU（灵敏度为86.6 %）;年龄和基于双层光谱CT测量的体积HU值与骨质疏松的发生显著相关（P<0.001）,OR值分别为1.172和0.928。结论 基于双层光谱CT测量的体积HU值和QCT测量的体积BMD之间有较好的相关性;基于腰椎体积HU值的阈值能准确预测骨量异常减低和骨质疏松,因此,体积HU值可以作为临床机会性筛查骨质疏松的补充手段。     

绝经后女性血常规指标与骨髓脂肪含量、骨密度相关性研究

目的 探讨绝经后女性血常规指标与骨髓脂肪含量、骨密度相关性。方法 选取72名绝经后女性(年龄55～79岁),测量受试者身高、体重、红细胞计数、白细胞计数、血小板计数,计算体质量指数（body mass index,BMI）,运用磁共振波谱成像(magnetic resonance spectroscopy,MRS)扫描L3椎体骨髓脂肪含量(fat fraction,FF),通过双能X线吸收检测(dual-energy X-ray absorptiometry,DXA)扫描获取受试者腰椎(L1~4)、左股骨颈及全身骨密度(bone mineral density,BMD)值。评价MRS扫描可重复性,分析红细胞计数、白细胞计数、血小板计数与FF值及BMD值相关性,运用多元逐步回归分析FF值的独立相关因素。结果 L3椎体FF值测量可重复性变异系数(CV)为2.86 %。红细胞计数、白细胞计数、血小板计数与FF呈负相关（P<0.01）;红细胞计数、白细胞计数、血小板计数与腰椎（L1~4）骨密度、左股骨颈骨密度无相关性,与全身骨密度呈负相关（P<0.05）。进一步多元逐步回归分析结果表明：校正了年龄、身高、体重、BMI后,红细胞计数、白细胞计数、血小板计数是影响FF的独立负性相关因素（P<0.05,R2=0.518）。结论 血常规指标（红细胞计数、白细胞计数、血小板计数）与FF及绝经后女性骨密度有一定的相关性,对绝经后女性骨质疏松症的早期诊断与防治有一定指导作用。     

63例QCT腰椎骨骨密度测量与DTX-200双能X前臂骨骨密度测量对比分析

目的 对比同一组检测者,使用DTX-200双能x线骨密度仪测量前臂骨骨密度(hone mineral density,BMD)与QCT测量腰椎骨骨密度的测定结果,发现不同设备,不同部位骨密度测量的差异性和相关性.方法 选取志愿者63例(男性19例,女性43例),分别用DTX-200双能X线骨密度仪测量前臂骨BMD值和T值(n=63),再用QCT测量腰椎骨的BMD值和T值(n=63).分别以QCT测量腰椎骨T值、DTX-200双能X线测量前臂骨T值,进行骨质疏松症诊断(诊断标准1994年WHO制定,T值≥-1.0SD为骨量正常,-2.5SD＜T值＜-1.0SD为骨量减低,T值≤-2.5SD为骨质疏松).用SPSS13.0软件对DTX-200和QCT测量的BMD值和T值,年龄进行相关性分析,对两组骨质疏松诊断结果分别进行一致性分析.结果 两种设备的检测结果BMD均与年龄呈负相关性,相同年龄段QCT测得的BMD较DTX-200测得的BMD要低,40岁以后更为明显,DTX-200与QCT测量的BMD值的相关系数=0.554(P＜0.01),二者骨质疏松症总体诊断符合率为52.4%.结论 DTX-200双能X线测量前臂骨BMD值与QCT测量腰椎骨BMD值密切相关,目前直接使用WHO制定的诊断标准,对QCT与DTX-200的测量结果进行骨质疏松症的诊断是否合适有待进一步探讨,不同的检测设备,不同的检查部位应有不同的诊断标准或换算系数.     

Evaluation of calcaneal quantitative ultrasound in a primary care setting as a screening tool for osteoporosis in postmenopausal women.

Screening of osteoporosis by quantitative ultrasound (QUS) has become widely available in Europe, but no clear strategies for its clinical use have been established. The aim of this study was to validate the use of QUS in a cross-sectional study carried out in three primary care centers. Measurements of calcaneal QUS and bone mineral density (BMD) at proximal femur were obtained by dual-energy X-ray absorptiometry (DXA). Osteoporosis was diagnosed by DXA T-score 相似文献   

Utility of heel ultrasound bone density in men.

In women, heel ultrasound (US) bone mineral density (BMD) has been shown to predict fracture risk, but the usefulness of this screening tool in men is not known. We measured the heel quantitative ultrasound index (QUI( in a convenience sample 185 of men (136 Caucasian, 1 Asian, and 48 African-American) with an average age of 63 yr (range of 25-85) undergoing BMD of the spine and hip by dual X-ray absorptiometry (DXA) to determine whether the heel measurement could predict central BMD. The average DXA T-score was -0.97, -1.20, and -1.61 for the spine, total hip, and femoral neck, respectively. The mean heel US BMD T-score (using the only available T-score, which was defined for Caucasian postmenopausal women) was -0.92. There were significant correlations among the various DXA measurements and the heel US BMD T-score (r = 0.373-0.483, p < 0.001). We defined arbitrarily osteopenia as a spine, total hip, or femoral neck T-score by DXA of < -1.5. We also made two different arbitrary definitions of osteoporosis by DXA: < -2.0 and < -2.5. Using these numbers as disease definitions, we determined the specificity, sensitivity, as well as positive and negative predictive values of using the heel US T-score to predict osteopenia or osteoporosis. Using various cutoffs for the heel T-score, we found that increasing the cutoff toward 0 increased the sensitivity but lowered the specificity. No cutoff was found that provided both good sensitivity and specificity. By analyzing the men by ethnic and age groups, we found that the best set of receiver operating characteristic (ROC) curves was derived from data using heel US to predict osteopenia and osteoporosis in men younger than age 65, although the areas under the ROC curve were approx 0.8. In conclusion, despite a strong correlation between the heel QUI and the spine and hip BMD by DXA, no heel T-score could predict osteopenia or osteoporosis with satisfactory sensitivity and specificity. It is possible that the use of risk factor assessment plus heel QUI might have better predictive value, and further studies are needed to determine whether heel QUI or other US determination is an independent risk factor for fracture in men.     

Assessment of a New Quantitative Ultrasound Calcaneus Measurement: Precision and Discrimination of Hip Fractures in Elderly Women Compared with Dual X-ray Absorptiometry

The incidence of osteoporotic hip fracture increases in postmenopausal women with low hip bone mineral density (BMD). Dual X-ray absorptiometry (DXA) is the most commonly used technique for the assessment of bone status and provides good measurement precision. However, DXA affords little information about bone architecture. Quantitative ultrasound (QUS) systems have been developed to evaluate bone status for assessment of fracture risk. Our study was designed to assess a new QUS system from Hologic, the Sahara; to compare it with a previous model, the Walker-Sonix UBA 575+; and to investigate whether it is able to discriminate between women with and without fracture. Using both ultrasound devices, the measurements were performed at the heels of 33 postmenopausal women who had recently sustained hip fracture. A control group of 35 age-matched postmenopausal women was recruited for comparison. The total, neck and trochanter femoral BMD values were assessed using DXA for both groups. QUS and DXA measurements were significantly lower in fractured patients (p<0.005) than in the control group. The short-term, mid-term and standardized short-term precisions were used to evaluate the reproducibility of the two QUS systems. The Sahara showed a better standardized coefficient of variation for broadband ultrasound attenuation (BUA) than did the UBA 575+ (p<0.001). The correlation of BUA and speed of sound (SOS) between the two QUS devices was highly significant, with an r value of 0.92 for BUA and 0.91 for SOS. However, the correlation between DXA and ultrasound parameters ranged from 0.28 to 0.44. We found that ultrasound measurements at the heel were significant discriminators of hip fractures with odds ratios (OR) ranging from 2.7 to 3.2. Even after adjusting the logistic regressions for total, neck or trochanter femoral BMD, QUS variables were still significant independent discriminators of hip fracture. The areas under the ROC curves of each ultrasound parameter ranged from 0.75 to 0.78, and compared very well with femoral neck BMD (p>0.05). In conclusion, our study indicated that the calcaneal QUS variables, as measured by the Sahara system can discriminate hip fracture patients equally as well as hip DXA. Received: 29 October 1999 / Accepted: 7 September 1999     

Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study

Identifying women with osteoporosis remains a clinical challenge, as it may not be feasible or cost-effective to recommend dual-energy X-ray absorptiometry (DXA) for all postmenopausal women. In this regard, quantitative ultrasound (QUS) has emerged as an attractive screening tool because of the (relatively) low cost and because QUS and DXA-assessed BMD appear to be equally predictive of future (hip) fracture risk. The objective of this study was to compare the ability of calcaneal QUS to identify osteoporosis with two alternative potential screening methods: digital X-ray radiogrammetry (DXR) and radiographic absorptiometry (RA). We enrolled a total of 221 postmenopausal community-dwelling Caucasian women aged 50–75 years. Bone mineral density (BMD) was measured at the lumbar spine and the total hip regions using DXA. Calcaneal ultrasound attenuation and velocity were assessed using QUS and metacarpal and phalangeal bone density were estimated by the use of DXR and RA, respectively. Receiver operating characteristic (ROC) curves were constructed by calculating the specificity and sensitivity of QUS, DXR, and RA at different cut-point values in discriminating osteoporosis, as defined by a T-score below –2.5 at the spine or hip using DXA, and the areas under the curves (AUCs) were computed. The sensitivity for identifying women with osteoporosis was 67.6% [95% confidence interval (CI), 50.2–82.0%] using QUS and was 76.9% (95% CI, 60.7–88.8%) and 82.9% (95% CI, 67.9–92.8%), respectively, using DXR and RA. The negative predictive value (NPV, the proportion of patients with a negative test who have no osteoporosis) was 90% for QUS, compared with an NPV of 94% for both DXR and RA. These data suggest that metacarpal DXR and phalangeal RA may be as effective as calcaneal QUS for targeting DXA testing in high-risk postmenopausal women.     

How well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine or hip? A cost-effectiveness analysis.

Dual energy X-ray absorptiometry (DXA) is widely accepted as the reference method for diagnosis and monitoring of osteoporosis and for assessment of fracture risk, especially at hip. However, axial-DXA is not suitable for mass screening, because it is usually confined to specialized centers. We propose a two-step diagnostic approach to postmenopausal osteoporosis: the first step, using an inexpensive, widely available screening technique, aims at risk stratification in postmenopausal women; the second step, DXA of spine and hip is applied only to potentially osteoporotic women preselected on the basis of the screening measurement. In a group of 110 healthy postmenopausal woman, the capability of various peripheral bone measurement techniques to predict osteoporosis at spine and/or hip (T-score < -2.5SD using DXA) was tested using receiver operating characteristic (ROC) curves: radiographic absorptiometry of phalanges (RA), ultrasonometry at calcaneus (QUS. CALC), tibia (SOS.TIB), and phalanges (SOS.PHAL). Thirty-three women had osteoporosis at spine and/or hip with DXA. Areas under the ROC curves were 0.84 for RA, 0.83 for QUS.CALC, 0.77 for SOS.PHAL (p < 0.04 vs RA) and 0.74 for SOS.TIB (p < 0.02 vs RA and p = 0.05 vs QUS.CALC). For levels of sensitivity of 90%, the respective specificities were 67% (RA), 64% (QUS.CALC), 48% (SOS.PHAL), and 39% (SOS.TIB). In a cost-effective two-step, the price of the first step should not exceed 54% (RA), 51% (QUS.CALC), 42% (SOS.PHAL), and 25% (SOS.TIB). In conclusion, RA, QUS.CALC, SOS.PHAL, and SOS.TIB may be useful to preselect postmenopausal women in whom axial DXA is indicated to confirm/exclude osteoporosis at spine or hip.     

肌肉含量指标对绝经后女性骨质疏松症发生风险的预测价值分析

目的 评价肌肉含量指标与骨密度(bone mineral density, BMD)的关联性,筛选预测绝经后女性骨质疏松(osteoporosis, OP)发生风险的最佳部位肌肉指标及其截止点。方法 选取2018年1月至2021年10月贵州医科大学附院健康管理中心的1366名绝经后女性,采用DXA和BIA测量BMD和四肢骨骼肌含量(ASM),以ASM算出各肌肉含量指标：ASMI、ASM_BMI及SMI。应用ROC曲线及Logistic回归分析验证肌肉指标对OP风险的预测能力及评估关联强度。结果 OP组的肌肉含量低于非OP组,除腰椎BMD间的SMI和股骨颈、腰椎BMD间的内脏脂肪面积及大粗隆、全髋BMD间的ASM_BMI差异无统计学意义(P>0.05),各部位不同BMD间脂肪、肌肉含量指标差异均有统计学意义(P<0.05)。Pearson分析显示,各部位BMD与SMI呈负相关(r=-0.095、-0.122、-0.195、-0.177);与ASM、ASM、ASM_BMI呈正相关(r=0.369、0.298、0.085...     

Bone Mineral Density Referral for Dual-Energy X-Ray Absorptiometry Using Quantitative Ultrasound as a Prescreening Tool in Postmenopausal Women from the General Population: A Cost-Effectiveness Analysis

The aim of our study was to assess, from the perspective of the National Health Services in Spain, the cost-effectiveness of quantitative ultrasound (QUS) as a prescreen referral method for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) in postmenopausal women of the general population. Using femoral neck DXA and heel QUS. We evaluated 267 consecutive postmenopausal women 65 years and older and attending primary care physician offices for any medical reason. Subjects were classified as osteoporotic or nonosteoporotic (normal or osteopenic) using the WHO definition for DXA. Effectiveness was assessed in terms of the sensitivity and specificity of the referral decisions based on the QUS measurement. Local costs were estimated from health services and actual resource used. Cost-effectiveness was evaluated in terms of the expected cost per true positive osteoporotic case detected. Baseline prevalence of osteoporosis evaluated by DXA was 55.8%. The sensitivity and specificity for the diagnosis of osteoporosis by QUS using the optimal cutoff thresholds for the estimated heel BMD T-score were 97% and 94%, respectively. The average cost per osteoporotic case detected based on DXA measurement alone was € 23.85. The average cost per osteoporotic case detected using QUS as a prescreen was €22.00. The incremental cost-effectiveness of DXA versus QUS was €114.00 per true positive case detected. Our results suggest that screening for osteoporosis with QUS while applying strict cufoff values in postmenopausal women of the general population is not substantially more cost-effective than DXA alone for the diagnosis of osteoporosis. However, the screening strategy with QUS may be an option in those circumstances where the diagnosis of osteoporosis is deficient because of the difficulty in accessing DXA equipment. ECOSAP DXA Substudy Group Investigators: Mercedes Abizanda and Arthur Cervera (Centro de Atención Primaria Gran Vía, Barcelona, Spain); Cristina Carbonell, Adoración Cama, and Carmen Olmos (Area Básica de Salud Vía Roma, Barcelona, Spain); Rosa M. Alcolea, Teresa Rama, and Elena Galindo (Area Básica de Salud Llefiá, Badalona, Barcelona, Spain); Angel Pérez–Romero (Department of Medical Research, Eli Lilly and Company, Madrid, Spain). This research was supported by an unrestricted grant of the Medical Research Department, Eli Lilly and Company, Spain.     

Screening with ultrasound of the heel may contribute to the prevention in osteoporosis

<正> Objective:To calibrate a Quantitative Ultrasonography(QUS)system against densitometryby defining the sensitivity and specificity of the method,and to propose a series of QUS interpre-tation thresholds to classify the individual risk with regards to the risk of developing osteoporosisin later life.Methods:Subjects were recruited in New York City over a 1-year period.Women with amen-orrhea for at least 12 months were defined as postmenopausal,and all other women as premeno-pausal.Bone mineral density(BMD)was measured with a dual energy X-ray absorptiometer(DXA)and QUS performed with the calcaneus of broadband ultrasound attenuation(BUA)andspeed of sound(SOS)using the Lunar Achilles system.Statistical analysis was performed usingSPSS software Version 10.0.Results:Two hundred twenty-eight premenopausal and menopausal women were recruited.Most of the participants were Hispanic,Caucasian and African-American in this study.All thesubjects had DXA and QUS examined and T-score was got from both.The statistical resultsshowed that the T-score of QUS has a significant relationship with that of DXA(spine:r=0.557,P<0.0001;femur:r=0.611,P<0.0001).Both QUS and DXA T-score has a significant andnegative relationship with age(QUS:r=-0.241,P<0.0001;Spine:r=-0.277,P<0.0001;femur:-0.296,P<0.0001).When T-score of heel ultrasound -1.5 was set as the interpreta-tion threshold,the osteoporosis patients with T-score of DXA-femur scan(100%)and DXA-spine(77.10%)less than -2.5 were detected.As well,the specificities of T-score -1.5 ofQUS for DXA-femur and DXA-spine were 67.5% and 72.8%,respectively.In addition,if we set-1.0 of T-score of QUS as the cutoff,74.80% and 79.60% of the osteopenia based on DXA ofspine and femur were identified.The specificities were 59.4% and 57.7%.Conclusions:QUS of the calcaneus may be an effective method for providing risk stratifica-tion for osteoporosis,and for the closely associated future risk for fragility-fracture.     

Hand Ultrasound for Osteoporosis Screening in Postmenopausal Women

There is a need for low-cost screening methods to detect low bone mass (osteopenia or osteoporosis) in postmenopausal women. The utility of quantitative ultrasonography (QUS) of the hand was assessed for osteoporosis screening using the WHO criteria. Bone mineral density (BMD) was measured in 206 postmenopausal Mexican-American women at the total hip and lumbar spine by dual-energy X-ray absorptiometry (DXA). The amplitude-dependent speed of sound (AD-SoS) was measured in the phalanges by QUS. Subjects identified by DXA as having osteopenia or osteoporosis had significantly lower AD-SoS values in comparison with normals. Estrogen users had significantly higher spine and hip BMD and AD-SoS values compared with non-estrogen users. The areas under the receiver operating characteristic (ROC) curves (AUC) for AD-SoS to screen for osteoporosis (T-score ≤−2.5) at the spine or hip were 0.73 for all subjects, 0.74 for estrogen users and 0.68 for non-estrogen users. The AUC for non-estrogen users to screen for osteopenia (T-score −1 to −2.5) was 0.77. Performance comparisons of AD-SoS with SCORE (a risk factor questionnaire) and body weight showed AUC values of 0.73, 0.69 and 0.65, respectively. QUS was the superior screening test when considering both the AUC and the shape of the ROC curves. For non-estrogen users, the group at higher risk for osteoporosis, QUS correctly identified 31% as normal, and 62% as having low bone mass and needing DXA referral; and the remaining 7% were false negatives. These data suggest phalangeal QUS can be effectively used for screening osteoporosis in postmenopausal women. Received: 2 April 1998 / Accepted: 27 July 1999