骨定量超声测量及OSTA指数与绝经后妇女非椎骨骨折的关系

目的横断面社区研究分析绝经后妇女OSTA指数及多部位定量骨超声（quantitative ultasound,QUS）[超声速率（speed of sound,SOS）],探讨该两个指标预测非椎骨骨折的价值。方法采用以色列Sunlisht Omnisense7000P型QUS仪测量513例女性受试者非优势侧桡骨远端1／3、中指近节指骨及胫骨中段SOS。测量受检者身高、体重,计算OSTA指数,上门问卷形式询问骨折史。结果（1）271例绝经后妇女桡骨、指骨、胫骨SOS显著低于242例绝经前妇女,P〈0．001。（2）绝经后妇女非椎骨骨折组桡骨SOS低于无骨折组（P=0．044）,发生于绝经后的非椎骨骨折妇女,指骨SOS低于无骨折组（P=0．003）。（3）以OSTA〈-4、-4- -1、〉-1将绝经后妇女分为骨质疏松高、中、低风险3组。随骨质疏松风险增加,发生于绝经后的非椎骨骨折率明显升高（χ^2=6．370,P=0．041）,且桡骨、指骨、胫骨SOS显著下降。（4）OSTA取-1及指骨SOSt值取-1．95反映绝经后非椎骨骨折的敏感性分别为75％和81％,特异性分别为48％和40％,受试者工作特征曲线下面积（AUC）分别为0．64和0．66。两者结合敏感性为83％,特异性提高至84％,AUC为0．64。结论OSTA和QUS尤其是指骨SOS具有反映绝经后妇女非椎骨骨折的能力。这两种非常简单、廉价、无创伤性的检查方法有助于筛查高危骨折风险的绝经后妇女。     

定量超声在预测骨折风险上的价值

采用以色列Sunlight定量超声（Qus）Omnisense7000s型测定112例女性和62例男性受试者非优势桡骨远端1／3超声声速（SOS）,并测量身高、体质量,问卷调查年龄及其他临床资料。发现绝经后妇女桡骨SOS明显低于绝经前;女性骨折组桡骨SOS明显低于无骨折组;骨折的比数比女性组和男性组桡骨SOS分别为2．83和2．01;增龄是骨折的另一危险因素。认为桡骨SOS具有预测骨折风险的价值,QUS以其简便、无创、无辐射和价廉的优势,为骨质疏松和骨折筛查提供有力的工具。     

老年2型糖尿病患者骨密度及骨超声改变的观察

目的：探讨老年2型糖尿病患者跟骨定量超声（QUS）和腰椎骨密度（BMD）的改变，方法：采用QUS骨量分析系统检测94例老年2型糖尿病患者和90例健康对照者的跟骨超声传导速度（SOS），超声振幅衰减（BUA）及骨强度指数（STI），用双能X线骨吸收测量仪（DXA）测定前后位腰椎BMD，并同时进行了骨生化指标的检测。结果：2型糖尿病患者BMD（g/cm^2)男性L2为0．863，低于对照组的0．931（P＜0．05）；女性L2，L2－4分别为0．826和0．841，均低于对照组0．903和0．905（P＜0．01）；2型糖尿病患者跟骨BUA（dB/MHz)男，女分别为64．63，51．05，均低于对照组71．38和61．76（P＜0．01），糖尿病组STI男，女分别为83．12％和67．64％，低于对照组91．24％和69．03％（P＜0．05）。糖尿病组女性SOS（m/s)为1487．28低于对照组1502．34（P＜0．05）。结论：老年2型糖尿病患者跟骨BUA、SOS和腰椎前后位BMD均较正常对照组降低，提示有骨量丢失。     

定量超声技术在老年骨质疏松评估中的应用

目的探讨定量超声(QUS)技术在老年骨质疏松评估中的应用价值。方法回顾性分析海口市妇幼保健院2017年5月至2019年6月骨质疏松患者102例临床资料,根据骨密度水平将骨量减少的32例纳入B组,轻度骨质疏松35例纳入C组,重度骨质疏松35例纳入D组。并将常规体检的35例健康老年人群纳入A组,4组均接受QUS技术检测,对比各组超声声速(SOS)、超声频率衰减(BUA)、超声强度(SI)参数水平,并经双变量Pearson相关性分析检验,各指标与骨质疏松严重程度的相关性。结果 4组一般资料(年龄、性别、血压等)对比,差异无统计学意义(P0.05);经QUS技术检测,D组SOS、BUA、SI参数水平C组B组A组,差异均有统计学意义(P0.05);经双变量Pearson相关性分析检验证实,SOS、BUA、SI与患者骨质疏松严重程度均呈负相关性(r=-0.457、-0.802、-0.720,均P0.001)。结论 SOS、BUA、SI参数水平与骨质疏松严重程度呈负相关,即SOS、BUA、SI参数水平越低,骨质疏松越严重,故QUS技术检查能够用于老年骨质疏松患者的筛查及病情程度的判定。     

老年膝关节退行性骨关节病患者骨强度与骨密度的相关性

目的研究老年退行性膝关节骨关节病患者骨强度与骨质密度(BMD)的相关程度。方法采用定量超声及双光子吸收技术分别测定研究组和对照组的BMD及骨强度值,再依据是否患有骨质疏松将研究组分为单纯组与合并症组。结果对照组研究对象胫骨超声速度检查(SOS)值与髋部BMD值相关性显著(P<0.05);研究组患者患肢股骨颈、股骨大转子、Ward三角处BMD值与胫骨SOS值之间存在正相关(r=0.249;0.289;0.321);研究组单纯患有退行性膝关节骨关节病患者与合并患有骨质疏松患者髋部BMD值间差异显著(P<0.05),胫骨超声密度值差异无统计学意义(P>0.05)。结论退行性膝关节骨关节病患者骨强度与BMD相关性较低,在临床诊断过程中,胫骨SOS值仅能作为骨强度的判断指标,无法进一步诊断骨质疏松,需要进一步借助其他辅助措施。     

老年男性慢性阻塞性肺疾病患者的骨代谢改变

目的　通过观察老年男性慢性阻塞性肺疾病 (COPD)患者骨代谢的改变 ,了解老年男性COPD患者骨质疏松 (OP)的发生及有关影响因素。　方法　测定老年男性COPD患者 39例及对照组30例的骨代谢生化指标、腰椎和右股骨的骨密度 (BMD)、跟骨定量超声 (QUS)参数以及血气、肺功能。　结果　COPD组超声振幅衰减 (BUA)及超声声速 (SOS)分别为 (6 0 2± 7 0 )dB/MHz与 (132 8 4±4 1 5 )m/s,明显低于老年对照组 (6 6 5± 4 9)dB/Mhz与 (15 0 5 8± 2 6 9)m/s ;股骨颈、大转子、Ward’s三角及 2～ 4腰椎 (L2～ 4)BMD也较老年对照组分别降低 2 3%、2 1%、34%和 2 5 % ;骨吸收指标尿羟脯氨酸与肌酐比值 (HOP/Cr)、尿钙与肌酐比值 (Ca/Cr)、血清甲状旁腺素 (PTH)高于对照组 (P <0 0 5 ) ;血清睾酮 (T)明显降低 ,且与对照组差异有显著性 (P <0 0 5 )。　结论　老年男性COPD患者表现为骨吸收亢进和骨密度降低 ,缺氧是其重要病因之一。     

北京地区健康女性跟骨超声速率的正常参考值及其分析

目的建立北京地区健康成年女性的跟骨骨超声速率(speed of sound,SOS)的正常参考值。方法用日本吉野电器公司生产的CM-100型跟骨骨超声测定仪对912名北京地区健康女性志愿者进行跟骨SOS测定,并对其中110名志愿者用双能X线骨密度仪(DXA)进行腰椎I_(2-4)和髋部的骨密度测定。结果健康女性跟骨SOS在26～30岁年龄组达到峰值[(1 533.4±34.2)m/s],达峰值后开始下降,46～50岁后下降速度加快。绝经期前、后跟骨SOS差异有统计学意义。跟骨SOS下降分为快速下降期、稳定下降期和再下降期。经DXA测定的骨密度值与跟骨SOS值相关(r=0.323～0.506,P0.01)。结论本研究建立了北京地区健康妇女跟骨SOS正常值,跟骨SOS和DEXA测定骨密度之间存在良好的相关性。     

骨定量超声测量的临床应用

骨定量超声测量(QUS)是一种诊断骨质疏松症和预测骨折风险的新技术,不但可反映骨密度,还可反映骨的微结构、弹性和脆性等骨结构特性。QUS使用的临床有效性主要体现在其对骨质疏松诊断、骨折风险预测及抗骨质疏松治疗疗效评估3个方面,具有广阔的应用前景。目前认为它更适合于大规模人群的筛查,但是在使用过程中必须充分估计误差对QUS准确性及精确性的影响。     

股骨上段几何结构在老年妇女髋部骨折发生中的作用

目的探讨股骨上段几何结构与老年女性髋部骨折之间的关系。方法髋部骨折老年妇女43例和无骨折的老年妇女48例,腰椎骨密度检测均提示骨质疏松,拍摄包括股骨上段的X线骨盆平片,分析其Singh指数、股骨头直径(HD)、股骨颈最窄处的宽度(ND)、股骨头中心至股骨轴的距离(NL)、颈干角(NSA)及股骨上段皮质骨厚度。结果骨折组股骨上段皮质骨厚度为（10.9±3.1）mm;对照组为（13.2±2.9）mm,两组之间差异有显著性(P＜0.05);骨折组的Singh指数Ⅲ度以下占86.05%,对照组为66.67%,两组之间差异有显著性(P＜0.05);而两组之间HD、ND、NL、NSA差异均无显著性(P＞0.05)。结论股骨上段骨皮质厚度和Singh指数对老年妇女髋部骨折发生有一定的影响。     

超声弹性成像技术在慢性乙型肝炎患者肝纤维化分级中的应用

目的 探讨超声弹性成像技术(ARFI)无创检测慢性乙型肝炎(CHB)患者肝纤维化分级的临床价值和诊断效能.方法 测定210例CHB患者(CHB组)和100例体检健康者(对照组)的声触诊组织量化值(VTQ),CHB组均经肝穿刺活组织检查进行肝纤维化病理分级,并对各级VTQ进行对比研究.结果 CHB组病理检查无S0级,S1、S2、S3、S4级的VTQ分别为(1.43 ±0.24)、(1.67±0.45)、(1.67±0.45)、(2.54±0.80) m/s,均高于对照组的(1.05±0.14) m/s,P均＜0.05; CHB组各级肝纤维化间比较,P均＜0.05.ROC曲线分析,当VTQ阈值为1.20、1.50、1.60、1.95 m/s时,分别诊断肝纤维化程度≥S1、≥S2、≥S3、≥S4级有较高的准确性、敏感度及特异性.结论 肝脏超声弹性成像的VTQ阈值可作为CHB肝纤维化分级的一种无创诊断方法,有助于临床CHB患者肝纤维化的早期诊断及疗效、预后评估.     

Bone status in rheumatoid arthritis assessed at peripheral sites by three different quantitative ultrasound devices

Rheumatoid arthritis (RA) is characterized by periarticular and generalized loss of bone mass. Quantitative ultrasound (QUS) has been introduced as a method for the assessment of bone status and fracture risk. In this cross-sectional study bone status was assessed by QUS at different peripheral sites in 27 women with RA (mean disease duration 15 years) and in 36 healthy women matched for age, height and weight. Speed of sound (SOS, m/s), broadband ultrasound attenuation (BUA, dB/MHz) and stiffness of the calcaneus were assessed by a Lunar Achilles device. Amplitude-dependent SOS (Ad-SOS, m/s) of the second to fifth phalanx was measured by a DBM Sonic 1200, and SOS of the distal forearm and third phalanx was measured by a Omnisense multisite scanner. Bone mass (g/cm² or g) of the hip, spine, distal forearm and total body was measured by dual-energy X-ray absorptiometry. QUS values were significantly reduced in RA at most sites (p<0.005–0.001), but between-group differences were small, and large overlaps between the groups were noticed. After correction for bone mass, the observed differences remained statistically significant for the calcaneus and distal radius (p<0.05). Independent associations between ultrasound measures and markers of disease activity were not demonstrated. In conclusion, bone status as assessed by QUS was compromised in RA, but whether ultrasound transmission may serve as a marker of disease progression and fracture risk in the individual patient remains to be clarified in prospective studies.Abbreviations BMC Bone mineral content - BMD Bone mineral density - BTS Bone tissue speed - BUA Broadband ultrasound attenuation - DMARD Disease-modifying antirheumatic drug - DXA Dual-energy X-ray absorptiometry - QUS Quantitative ultrasound - RA Rheumatoid arthritis - RMSCV Root mean square coefficient of variation - SOS Speed of sound     

健康和骨折女性骨矿密度及其骨折阈值的测定

目的初步确定天津市女性骨矿密度（ＢＭＤ）正常参考值范围，探讨骨质疏松的诊断标准及骨折危险阈值。方法用双能Ｘ线吸收法（ＤＥＸＡ）对４５２例健康女性和５５例绝经后骨折患者ＢＭＤ进行测定。结果腰椎２～４、股骨和全身ＢＭＤ峰值分别在３０～３９、２０～２９和４０～４９岁。ＢＭＤ与年龄、绝经年限呈负相关（均为Ｐ＜０．０１），以绝经后最初５年的降低率最高；ＢＭＤ与身高呈正相关，６０岁以上妇女的体重和脂肪量与各部位ＢＭＤ呈正相关（Ｐ＜０．０５或０．０１）。以２０～４０岁女性腰椎ＢＭＤ均值减２．５标准差（ｓ）为界限值（０．８３ｇ／ｃｍ２），５５例骨折患者中４６例（８３．６％）腰椎ＢＭＤ低于界限值。结论该界限值作为女性骨质疏松诊断标准和脊椎骨折危险阈值可能较为合理。     

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound

BACKGROUND: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear. METHODS: A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device. RESULTS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined. CONCLUSIONS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.     

Urinary excretion of pyridinium crosslinks of collagen in patients with osteoporosis and the effects of bone fracture.

Values for the urinary excretion of pyridinium crosslinks of collagen, pyridinoline and deoxypyridinoline, in a group of 30 elderly women with femoral fractures associated with osteoporosis and a group of 20 women without recent fracture but with overt or suspected osteoporosis were compared with 27 control subjects matched for age. Relative to the control group, the excretion of the crosslinks was significantly higher in the group with fractures and the group with osteoporosis. Fractures contributed markedly to the excretion of pyridinium crosslinks as the patients with fractures showed significantly higher excretion of pyridinoline and deoxypyridinoline than the group without recent fractures. This was confirmed by the fact that excretion of pyridinium crosslinks in patients with accidental bone fractures was significantly higher than for healthy control subjects matched for age and sex. The crosslinks appear to provide valid indices of bone resorption, but the effects of bone fracture must be considered in the clinical application of this technique.     

In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography

CONTEXT: Assessment of trabecular microarchitecture may enhance the prediction of fracture risk and improve monitoring of treatment response. A new high-resolution peripheral quantitative computed tomography (HR-pQCT) system permits in vivo assessment of trabecular architecture and volumetric bone mineral density (BMD) at the distal radius and tibia with a voxel size of 82 microm3. OBJECTIVE AND PATIENTS: We determined the short-term reproducibility of this device by measuring 15 healthy volunteers three times each. We compared HR-pQCT measurements in 108 healthy premenopausal, 113 postmenopausal osteopenic, and 35 postmenopausal osteoporotic women. Furthermore, we compared values in postmenopausal osteopenic women with (n = 35) and without previous fracture history (n = 78). DESIGN AND SETTING: We conducted a cross-sectional study in a private clinical research center. INTERVENTION AND MAIN OUTCOME MEASURE: We took HR-pQCT measurements of the radius and tibia. Femoral neck and spine BMD were measured in postmenopausal women by dual-energy x-ray absorptiometry. RESULTS: Precision of HR-pQCT measurements was 0.7-1.5% for total, trabecular, and cortical densities and 2.5-4.4% for trabecular architecture. Postmenopausal women had lower density, trabecular number, and cortical thickness than premenopausal women (P < 0.001) at both radius and tibia. Osteoporotic women had lower density, cortical thickness, and increased trabecular separation than osteopenic women (P < 0.01) at both sites. Furthermore, although spine and hip BMD were similar, fractured osteopenic women had lower trabecular density and more heterogeneous trabecular distribution (P < 0.02) at the radius compared with unfractured osteopenic women. CONCLUSION: HR-pQCT appears promising to assess bone density and microarchitecture at peripheral sites in terms of reproducibility and ability to detect age- and disease-related changes.     

Calcaneus ultrasound in males: normative data in the Croatian population (ECUM study)

Limited number of dual X-ray absorptiometry (DXA) devices in Croatia makes this diagnostic technique unavailable to the majority of the population. Quantitative ultrasound (QUS) of the calcaneus could be an alternative tool for assessing fracture risk. However, age-specific normative data should be obtained before using the QUS in everyday clinical practice. The aim of our Epidemiology of Calcaneus Ultrasound in Males (ECUM) study is to establish the normative QUS data in a healthy sample of Croatian males. A total of 1002 male participants, aged 20-99, recruited in different Croatian counties, were included in the study. In each subject broadband ultrasound attenuation (BUA), speed of sound (SOS) and quantitative ultrasound index (QUI) of the left calcaneus were measured using the Sahara ultrasound device (Hologic). The coefficients of variation were 2.85 for BUA, 0.37 for SOS and 2.49 for QUI. Significant declining with age was found for all three parameters, BUA (p<0.001), SOS (p<0.001) and QUI (p<0.001), with respective r values 0.14, 0.27 and 0.23. The peak SOS (1,562.8+/-28.5 m/sec) and QUI (103.6+/-16.5) values were observed in the third decade, whereas the peak BUA value (86.2+/-19.2 db/MHz) was observed in the fourth decade. A subgroup of 103 participants, aged 20-29, was used to estimate young adult mean and SD for QUI and calculate the T-scores. Using the World Health Organization diagnostic criteria the rates of osteoporosis (T-score<-2.5) in the males aged 50 and older was 5.8%. However, when we used the cut-off value of the T-score<-1.8, as previously suggested, prevalence of osteoporosis in Croatian males >50 yr was 16.2%. Although further studies might improve our understanding of the QUS role in the fracture prediction, we hope that the results presented here will improve the clinical management of osteoporosis in males.     

An adequate threshold for body mass index to detect underweight condition in elderly persons: the Italian Longitudinal Study on Aging (ILSA)

BACKGROUND: The present study aims at defining a body mass index (BMI) threshold for risk of being underweight in elderly persons on the basis of the BMI distribution in a large Italian population-based sample and on its ability to predict short-term mortality. METHODS: At baseline (1992), BMI was obtained for 3110 (1663 males and 1447 females) persons aged 65-84 participating in the Italian Longitudinal Study on Aging (ILSA). BMI and risk factors (age, sex, education, smoking status, disability, and disease status) have been considered for their potential association with 4-year all-cause mortality. Information on vital status at 1995 was obtained for 2551 participants. RESULTS: The fifth centile of BMI was well approximated by a value of 20 for both sexes. Also in both sexes, at a BMI value of 24 the a posteriori probability of death started to increase, doubling at a value of 22 for men and 20 for women. Crude mortality was 14.6% for men and 9.8% for women. The hazard ratios and confidence intervals (CIs) comparing mortality for each BMI two-unit class to the 26-28 class, after adjusting for confounding variables, showed significantly higher rates only for BMI values below 20 (2.9; 95% CI, 1.2-7.0), although a consistent increase in hazard ratio (1.6; 95% CI, 0.9-3.0) already appeared for the 20-22 BMI group. CONCLUSIONS: Our study confirms that low BMI is an independent predictive factor of short-term mortality in elderly persons. A BMI value of 20 kg/m2 seems to be a reliable threshold for defining underweight elderly persons at high risk. Nevertheless, more careful clinical and nutritional management should also be applied to elderly persons with higher BMI values.     

Associations between short one‐leg standing time and speed of sound of calcaneal bone in a general population: The Shimanami Health Promoting Program (J‐SHIPP) study

Aim: Loss of bone mass is a major cause of fracture in the elderly. One‐leg standing (OLS) time has been postulated to be predictive of reduced bone mass. Here, we conducted a cross‐sectional study to clarify whether OLS time measurements are associated with the speed of sound (SOS) of calcaneal bone independent of muscle mass in the lower extremity, a major confounding factor for the association, in a community‐dwelling population of middle‐aged to elderly subjects. Methods: The study subjects consisted of 770 apparently healthy middle‐aged to elderly community‐residents. Quantitative assessment of calcaneal bone was done using a quantitative ultrasound technique. OLS time with eyes open was measured with a maximum time of 60 s. Femoral muscle cross‐sectional area (CSA) was measured from a computed tomography image. Results: Subjects who could not stand 60 s on one leg (n = 192) showed significantly lower SOS (1487 ± 20, 1501 ± 24 m/s, P < 0.001). In addition, femoral muscle CSA was positively associated with SOS (male, r = 0.148, P < 0.01; female, r = 0.204, P < 0.001). However, multiple regression analysis adjusted for age, sex and muscle CSA identified short OLS time less than 60 s as an independent determinant of SOS in both male (P < 0.001) and female (P < 0.05) subjects. OLS time was significantly associated with posturograph‐measured mobility of the center of gravity. However, multiple regression analysis showed no significant correlation between balance impairment and SOS (P > 0.1). Conclusion: OLS time less than 60 s was significantly associated with reduced SOS independent of age, sex and muscle mass in the lower extremity.