中老年男性骨质疏松(OP)危险分层与定量超声骨密度(QUS-BMD)及双能X线骨密度(DXA-BMD)的相关性

 目的   分析亚洲人骨质疏松(osteporsis,OP)自我筛查工具(osteoporosis self-assessment tool for Asian,OSTA)指数与骨密度(bone mineral density,BMD)的相关性,并探讨跟骨定量超声（quantitative ultrasound,QUS） 测定BMD对中老年男性OP的诊断价值。方法   对893例45岁以上男性研究对象行QUS-BMD检查,记录跟骨QUS-BMD及QUS-T值,测量身高、体重,计算OSTA指数,其中255例研究对象同时行双能X线(dual-energy X-ray absorptionmetry,DXA) BMD测定,按OSTA分层标准将受试者分为OP高、中、低风险组。比较各组间跟骨QUS BMD、QUS T以及各部位DXA BMD的差异,分析OSTA指数与髋部、腰椎DXA-BMD的相关性。根据WHO的OP诊断金标准(骨质疏松:T值≤-2.5,骨量减少:-2.50.05)。OP风险高、中、低危3组中OP患病例数分别为37例(48.7%)、17例(17.5%)和17例(20.7%),高危组中OP患病例数显著高于中、低危组(P<0.05)。Spearman相关分析示OSTA指数与股骨颈、全髋及全腰椎BMD呈显著正相关(P<0.05),相应的相关系数分别为0.448、0.439和0.141。跟骨QUS BMD和QUS T值在不同OP风险组间的差异无统计学意义(P>0.05)。跟骨QUS T值诊断OP的曲线下面积为0.753,最佳截断值为-1.3,相应的灵敏度和特异度分别为77.5%和61.4%。结论   随着OSTA指数升高,OP风险降低,股骨颈、全髋及全腰椎的BMD升高,OSTA指数与各部位DXA-BMD成线性正相关。OSTA指数和跟骨QUS-T值对诊断中老年男性OP症筛查具有一定的价值。

Association of osteoporosis (OP) risk stratification and QUS-BMD and DXA-BMD among middle-aged old males

Objective    To analyse the correlation between osteoporosis (OP) self-assessment tool for Asian (OSTA) index and bone mineral density (BMD),and to explore the value of calcaneal BMD detected by quantitative ultrasound (QUS) for diagnosing OP in elderly men.Methods    We underwent ultrasound bone density examination in 893 subjects aged above 45,recorded QUS-BMD and QUS-T,  completed height and weight measurements and calculated OSTA index,among which 255 cases got dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) examination.Then we devided all subjects into high,medium and low-risk groups according to the OSTA classify standard and compared the differences of QUS-BMD,QUS-T,and DXA-BMD between these groups and analyzed the correlation between OSTA index and DXA-BMD.We classified those who completed DXA test into 3 groups (OP,osteopenia and normal bone mass) according to the WHO OP diagnostic criteria and analyzed the value of QUS-T in identifying OP and low bone mass in elderly men.Results    The average age of the study population was (73.0±10.4) years.There were 71 cases of OP (27.8%),143 cases of osteopenia (56.1%) and 41 cases of normal bone mass (16.1%) among those who got DXA examination.BMD at femoral neck,total hip and total lumbar increased in groups of high,medium and low-risk for OP and had statistically significance between high-risk group and medium-risk group or low-risk group (P<0.05),while there was no significant difference between medium-risk group and low-risk group (P>0.05).The number of OP was 37 cases (48.7%),17 cases (17.5%) and 17 cases (20.7%) in high,medium and low-risk group,respectively,and the OP prevalence in high-risk group was higher than those in medium-risk group and low-risk group (P<0.05).Spearman correlation analysis showed that OSTA index was positively correlated with femoral neck,total hip and total spine BMD significantly (P<0.05),and the corresponding correlation coefficients were 0.448,0.439 and 0.141,respectively.QUS-BMD and QUS-T values were not statistically significant among different risk groups for OP (P>0.05).The area under the curve (AUC) of QUS-T for detecting OP was 0.753 with a sensitivity of 77.5% and a specificity of 61.4%,and the best cut-off value was -1.3.Conclusions    As OSTA index rised,the risk of osteoporosis decreased,BMD at femoral neck,total hip and total lumbar spine increased.The BMD values of femoral neck,total hip and total lumbar spine were linearly and positively correlated with OSTA.OSTA and QUS-T have certain value for detecting osteoporosis in elderly men.