Ability of ultrasound bone profile score (UBPS) to discriminate between fractured and not fractured osteoporotic women

In this study, we evaluated the ability of different quantitative ultrasound (QUS) parameters (speed of sound, SOS, coefficient of variation, CV, = 0.34% and broadband ultrasound (US) attenuation, BUA, CV = 3.25% measured at the heel by an Hologic Sahara unit; Ad-Sos and ultrasound bone profile score (UBPS) at the proximal phalanges by an Igea DBM Sonic 1200 unit, Ad-Sos CV = 0.57%) to detect differences between osteoporotic patients with vertebral fractures and osteoporotic patients without fractures. We examined 87 women with primary osteoporosis: 53 women with femoral neck bone mineral density (BMD) T scores less than -2.5 SD and no vertebral fractures and 34 women with one or more vertebral fractures, regardless of T score values. Considering all the patients together, the correlations between QUS parameters and BMD resulted in statistical significance (p < 0.05) only for BUA and femoral neck BMD. Lumbar and femoral neck BMD did not statistically differ between the two groups, while UBPS, which is a quality control of measurement and is correlated with bone quality, was significantly higher in women without fractures than those with fractures; the other QUS parameters were not statistically different. Our data indicate that, among QUS parameters, only UBPS is able to detect differences among osteoporotic patients with and without vertebral fractures.     

Performance of Five Phalangeal QUS Parameters in the Evaluation of Gonadal-Status,Age and Vertebral Fracture Risk Compared with DXA

The aim of this cross-sectional study was to study the value of five different quantified ultrasound (QUS) parameters—amplitude-dependent speed of sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), fast-wave amplitude (FWA), bone transmission time (BTT) and signal dynamic (SDY)—measured at the phalanges of the hand in discriminating women with vertebral fracture and their relationship with some determinants of bone mass, in particular age and gonadal status compared with lumbar spine and hip dual-energy x-ray absorptiometry (DXA). We included 791 women aged 35–84 y, divided into premenopause, early menopause and late postmenopause groups on the basis of gonadal status and years since menopause (YSM). The presence of vertebral fracture was evaluated radiographically. All QUS parameters were very sensitive to changes in early postmenopause, with a doubled decrease in early postmenopausal with respect to late postmenopause. In particular AD-SoS and BTT decreases were markedly high in the early postmenopause group. In the late menopause group, similar decreases were observed for AD-SoS, UBPI and hip bone mineral density (BMD). In the multiple logistic model, DXA and QUS significantly discriminate women with and without fractures (p < 0.0001); odds ratio (OR) was higher at lumbar spine BMD (OR 4.01), FWA (OR 3.88), AD-SoS (OR 3.81) and total hip BMD (OR 3.77). Even adjusting the logistic model for age, height, weight, lumbar spine and total hip BMD, all QUS parameters remained significantly predictive of vertebral fracture. AD-SoS showed the best performances both in terms of OR and ROC analysis. QUS parameters show a different behavior in evaluating the effect on bone mass of the time since menopause; AD-SoS and BTT showed a high sensitivity to first changes in bone tissue after menopause. After correction for potential confounders, AD-SoS showed the same ability of lumbar spine BMD in discriminating women with or without vertebral fractures and in the prediction of fracture risk. (E-mail: carlina.albanese@uniroma1.it)     

Changes in Bone Mineral Density of the Proximal Femur and Spine with Aging: DIFFERENCES BETWEEN THE POSTMENOPAUSAL AND SENILE OSTEOPOROSIS SYNDROMES

We measured bone mineral density (BMD) of the proximal femur, lumbar spine, or both by dual photon absorptiometry in 205 normal volunteers (123 women and 82 men; age range 20 to 92 yr) and in 31 patients with hip fractures (26 women and 5 men; mean age, 78 yr). For normal women, the regression of BMD on age was negative and linear at each site; overall decrease during life was 58% in the femoral neck, 53% in the intertrochanteric region of the femur, and 42% in the lumbar spine. For normal men, the age regression was linear also; the rate of decrease in BMD was two-thirds of that in women for femoral neck and intertrochanteric femur but was only one-fourth of that in women for lumbar spine. This difference may explain why the female/male ratio is 2:1 for hip fractures but 8:1 for vertebral fractures. The standard deviation (Z-score) from the sex-specific age-adjusted normal mean in 26 women with hip fracture averaged −0.31 (P < 0.05) for the femoral neck, −0.53 (P < 0.01) for the intertrochanteric femur, and +0.24 (NS) for the lumbar spine; results were similar for 5 men with hip fractures. By contrast, for 27 additional women, ages 51-65 yr, with only nontraumatic vertebral fractures, the Z-score was −1.92 (P < 0.001) for the lumbar spine. Thus, contrary to the view that osteoporosis is a single age-related entity, our data suggest the existence of two distinct syndromes. One form, “postmenopausal osteoporosis,” is characterized by excessive and disproportionate trabecular bone loss, involves a small subset of women in the early postmenopausal period, and is associated mainly with vertebral fractures. The other form, “senile osteoporosis,” is characterized by proportionate loss of both cortical and trabecular bone, involves essentially the entire population of aging women and, to a lesser extent, aging men, and is associated with hip fractures or vertebral fractures or both.     

Quantitative ultrasound at the phalanxes discriminates osteoporotic women with vertebral but not with hip fracture

Caucasian postmenopausal women with vertebral fracture (38), hip fracture (38) and without fracture (124) were measured by spine and femoral neck bone mineral density (BMD) (Norland XR 36), and two quantitative ultrasound (US) or QUS parameters (Igea DBM sonic 1200): the amplitude-dependent speed of sound (Ad-Sos) and the US bone profile score (UBPS), at the proximal hand phalanxes to investigate the ability of QUS to detect previous fracture. Age, height and weight were not different among groups, but menopausal age was lower with vertebral fracture (p < 0.005). QUS parameters of hip (AdSos = 1806.2 +/- 104.6 m s(-1); UBPS = 0.22 +/- 0.13) or spine fracture (AdSos = 1774.4 +/- 90.0 m s(-1); UBPS = 0.19 +/- 0.10) were not significantly lower than controls (AdSos = 1819.1 +/- 111.9 m s(-1); UBPS = 0.25 +/- 0.17), and BMD of hip (spine: 756.0 +/- 138.9 mg cm(-2); femoral neck: 583.6 +/- 61.8 mg cm(-2)) and vertebral (spine: 727.4 +/- 120.4 mg cm(-2); femoral neck: 592.8 +/- 82.1 mg cm(-2);) fracture was lower than controls (spine: 829.2 +/- 167.6 mg cm(-2); femoral neck 665.0 +/- 108.9 mg cm(-2)) (p < 0.001). Spine and femoral neck BMD significantly separated both types of fractures from controls, but AdSos and UBPS significantly separated only vertebral fractures. Femoral neck BMD has the best receiver operating characteristic (ROC) area for both hip (0.715, SE 0.043) and vertebral (0.693, SE 0.047) fractures, being significantly better (p < 0.01) than that of AdSos (0.503, SE 0.056) and UBPS (0.501, SE 0.057) for hip fractures, but not for vertebral fractures (AdSos 0.604, SE 0.050; UBPS 0.563, SE 0.048). In conclusion, QUS at hand phalanxes predicts vertebral fracture as effectively as BMD, but does not predict hip fracture.     

Correlation of quantitative heel ultrasonography with central dual-energy X-ray absorptiometric bone mineral density in postmenopausal women.

OBJECTIVES: In this study, we sought the proper cutoff level for quantitative ultrasonography (QUS) of the heel in identifying bone mineral density (BMD) categories as determined by dual-energy x-ray absorptiometry (DXA) in postmenopausal women. METHODS: With the use of DXA, BMD categories of the lumbar spine and different areas of the left femur of 420 healthy women according to World Health Organization definitions were determined. Quantitative ultrasonography of the heel was also performed in each subject. Receiver operating characteristic curves were plotted, and sensitivity and specificity of QUS to diagnose osteoporosis were examined at different points to identify the best cutoff level. The diagnostic agreement between the two techniques in identifying osteoporosis was assessed with kappa scores. RESULTS: The kappa scores were 0.31 for the lumbar region and 0.5 for the femoral neck region. On the receiver operating characteristic study, a score of -1 was found to be the appropriate cutoff point for QUS studies, in which the sensitivity of QUS to diagnose BMD osteoporosis varied between 78% and 87.5% depending on the site of the DXA study. With the proposed cutoff point (-1), sensitivity and specificity of QUS in detecting osteoporosis at the lumbar spine were 83.9% and 51%, respectively, and at the femoral neck were 84% and 50%, respectively. CONCLUSIONS: Insufficient agreement between QUS and DXA led to uncertainty on expected BMD in people tested by QUS. The proposed cutoff value could achieve higher sensitivity but only by accepting higher rates of false-positive results.     

DXA, QUS, and radiogram

In this article, an outline of dual energy X-ray absorptiometry (DXA), quantitative ultrasound (QUS), and radiogram, and their characteristics, problems, and assessment of osteoporosis in the elderly were reviewed. It is well known that both DXA and QUS are available to risk assessment of fractures. However, because lumbar bone mineral density (BMD) is overestimated in the elderly complicated with fracture, deformity, and osteosclerotic change in the lumbar vertebra (e), some cases are unsuitable to measurement of BMD with lumbar DXA. To define vertebral fracture, visual semiquantitative and morphometric methods are used. In addition, differential diagnosis of osteoporotic vertebral fractures is necessary. Thus, to establish an exact diagnosis of osteoporosis in the elderly, it is important to understand some problems associated with the elderly.     

Preventing osteoporotic fractures in older people

While fractures at the spine, wrist and hip are regarded as classical osteoporotic fractures, all fragility fractures in the elderly should be considered as osteoporotic once pathological fracture (e.g. metastatic disease) has been excluded. The assessment of fracture risk should take account of specific risk factors in addition to bone mineral density (BMD). The WHO has produced FRAX, a well validated tool that estimates the probability of a major osteoporotic fracture in the next 10 years. The algorithm is specifically designed for primary care. After age and prior fragility fracture, BMD is the next major determinant of fracture risk. Rather than scanning all individuals with a risk factor, measurements should be targeted to those whose probability of fracture lies close to the intervention threshold where knowledge of BMD will influence management. Individuals with a low trauma vertebral fracture or low BMD for age should be investigated for underlying causes of osteoporosis. Secondary causes account for up to 40% of cases of osteoporosis in women and 60% in men. The goal of osteoporosis management is to reduce the future risk of fracture. Lifestyle modification includes measures to reduce falls risk and bone loss such as exercise, adequate dietary calcium and avoidance of smoking and excessive alcohol consumption. All patients with an osteoporotic fracture and those at high risk should be assessed for falls risk. Combined therapy, with calcium and vitamin D, has been shown to reduce hip fracture risk in the frail elderly and should be considered in all older patients who are housebound or in residential care. Alendronate and risedronate are available as once-weekly preparations with evidence for significant reductions in vertebral and non-vertebral fractures. Denosumab is approved for osteoporosis in postmenopausal women at increased risk of fractures. Strontium ranelate has been shown to reduce fracture risk significantly in postmenopausal women.     

Relationship of extremity muscle torque and bone mineral density in postmenopausal women

The purpose of this study was to examine the correlations between the torque of four extremity muscle groups and the bone mineral density (BMD) of the lumbar spine and hip in postmenopausal women. Fifty-six postmenopausal women (means age = 55.4 years, s = 7.1; means height = 162.6 cm, s = 6.4; means weight = 65.9 kg, s = 9.3) served as subjects. Bone mineral density was measured from the L2-L4 vertebral bodies, greater trochanter, femoral neck, and Ward's triangle using dual-photon absorptiometry. Hip abduction, knee extension, hip flexion, and grip force were assessed using the Spark Muscle Examination and Exercise Dosimeter (MEED) 3000 system. The Pearson product-moment correlations between muscle torque and BMD ranged from .07 to .42. The significant (p less than .05) correlations between torque and BMD (r = .27-.42) occurred in functionally and anatomically related areas. Results of this study demonstrate a statistically significant relationship between torque and BMD in anatomically related areas in postmenopausal women. This relationship, however, is not sufficiently strong to allow for prediction of BMD from the four muscle groups tested in this study. The relationship does suggest that strength may be a factor in the determination of BMD. Maintenance of strength in those muscle groups with anatomical or functional relationships to the hip and lumbar spine may play a role in the prevention and cessation of the osteoporotic changes that occur.     

Evaluation of a gel-coupled quantitative ultrasound device for bone status assessment.

OBJECTIVE: To evaluate a new gel-coupled calcaneal quantitative ultrasound system, Osteospace (Medilink, Montpellier, France), which was designed to assess the status of bone in the calcaneus. METHODS: The study group consisted of 215 healthy white women aged 20 to 85 years and 51 white women aged 60 to 86 years with osteoporotic fractures. Fifty-two healthy women aged 50 to 85 years were randomly selected from the healthy cohort as the control group. All the women had calcaneal quantitative ultrasonic measurements. The women with osteoporotic fractures and the control group also had proximal femur and lumbar anteroposterior spine bone mineral density measurements using dual X-ray absorptiometry. Bone mineral density was also measured in a subgroup of 54 women at the calcaneus. RESULTS: There was a significant inverse correlation of broadband ultrasound attenuation and speed of sound with age (P < .001). Short-term measurement precision values expressed as coefficients of variation were 1.72% for broadband ultrasound attenuation and 0.64% for speed of sound, and standardized short-term precision values were 6.09% for broadband ultrasound attenuation and 3.87% for speed of sound. The correlations between the quantitative ultrasonic parameters and calcaneal bone mineral density were 0.69 (P = .0001) for broadband ultrasound attenuation and 0.45 (P = .0008) for speed of sound. Both quantitative ultrasonic parameters and all bone mineral density measurements of the hip and spine differed significantly between the control and osteoporotic fracture groups (P < .01). Age-, weight-, and height-adjusted odds ratios per SD decrease were as follows: broadband ultrasound attenuation, 1.79; speed of sound, 1.83; spine bone mineral density, 2.34; femoral neck bone mineral density, 1.69; and total hip bone mineral density, 1.85. The areas under the receiver operating characteristic curve for quantitative ultrasound parameters and bone mineral density measurements were close, ranging from 0.75 to 0.80. CONCLUSIONS: This new quantitative ultrasound system can detect age- and menopause-related influences on skeletal status and can discriminate healthy women from those with osteoporotic fractures in a manner comparable with that of bone mineral density measurement by dual X-ray absorptiometry.     

Identifying elderly women with osteoporosis by spinal dual X-ray absorptiometry, calcaneal quantitative ultrasound and spinal quantitative computed tomography: a comparative study

The ability of spinal dual x-ray absorptiometry (DXA), calcaneal quantitative ultrasound (QUS) and spinal quantitative computed tomography (QCT) to identify women with osteoporosis within the GISELA study was evaluated in 43 women, aged 62-87 years. Osteoporosis was defined as a T-score below or equal to -2.5 using DXA (femoral neck). To determine the performance of each method, the sensitivity, specificity and area under the curve (by means of a receiver operating characteristic [ROC] analysis) were calculated. The median T-scores from the measurements differed significantly (p < 0.0001). DXA (spine) identified 75% of women with osteoporosis; QUS and QCT identified 100%. The specificity was 89% for DXA (spine), 66% for QUS and 29% for QCT. ROC analysis showed that all three methods are qualified to identify women with osteoporosis; however, the different sensitivities and specificities of the methods, as well as the thresholds used for diagnosing osteoporosis have to be considered. (E-mail: monika.neuhaeuser-berthold@ernaehrung.uni-giessen.de)     

Influence of type 2 diabetes mellitus on bone mineral density response to bisphosphonates in late postmenopausal osteoporosis

Bisphosphonates are effective agents for postmenopausal osteoporosis, but their efficacy in patients with type 2 diabetes mellitus (DM) is not known. The investigators evaluated bone mineral density (BMD) response to alendronate in women with concurrent late postmenopausal osteoporosis and type 2 DM. In a retrospective, matched case-control study, 26 late postmenopausal osteoporotic women with type 2 DM (age, 67.6±7.3 y; type 2 DM duration, 12.8±6.8 y; duration of menopause, 10.9±7.4 y; time on alendronate: 4.8±2.3 y; body mass index [BMI], 31.4±6.3 kg/m²) were matched with 26 controls according to age, BMI, duration of menopause, and alendronate treatment received. All subjects were given alendronate 10 mg/d or 70 mg/wk, along with sufficient vitamin D (≥400 IU) and calcium (≥1 g/d) intake, for 4.8 y. Response to alendronate therapy was determined by assessment of mean percent change in BMD of total hip, femoral neck, forearm, and lateral spine. The presence of type 2 DM resulted in no difference in spinal BMD response to alendronate therapy. In contrast, BMD in the total hip (mean percent change in BMD, −5.6% vs +1.4%;P=.096), femoral neck (−8.1 % vs +1.1 %;P=.015), and forearm (−3.6% vs +12.7%;P=.013) fell progressively from baseline in subjects with type 2 DM who were taking alendronate for 4.8 y, compared with controls. Elderly, postmenopausal, osteoporotic obese women with type 2 DM are resistant to long-term bisphosphonates, especially in regions of the hip, femoral neck, and forearm compared with the spine. The efficacy of bone resorption inhibitors in patients with type 2 DM, especially in comparison with anabolic agents, should be considered in additional studies.     

Broadband ultrasound attenuation in the os calcis: relationship to bone mineral at other skeletal sites

1. We have examined the relationship between broadband ultrasound attenuation in the os calcis and measurements of bone mineral in the distal forearm and lumbar spine of normal and postmenopausal osteoporotic women. 2. Values of broadband ultrasound attenuation in postmenopausal women with vertebral osteoporotic fractures were significantly lower (35%) than in normal pre- and peri-menopausal women (55.4 +/- 3.8 and 79.6 +/- 0.8 dB/MHz, respectively). 3. Broadband ultrasound attenuation correlated significantly with bone mineral content measured in the distal forearm by single-photon absorptiometry (r = 0.77, P less than 0.0001) and with bone mineral content (r = 0.66, P less than 0.0001) and bone mineral density (r = 0.72, P less than 0.0001) measured in the lumbar spine by dual-photon absorptiometry. 4. Although significant, these correlations are not sufficiently close to be predictive. However, the accuracy of broadband ultrasound attenuation in discriminating between normal subjects and patients with vertebral fracture compared very favourably with direct measurements in the spine by dual-photon absorptiometry. 5. Broadband ultrasound attenuation, but not the other measurements, correlated significantly with age in the osteoporotic patients (r = 0.50, P less than 0.05). 6. These findings may reflect the partial dependence of broadband ultrasound attenuation on the intrinsic trabecular architecture of cancellous bone, the disruption of which contributes to an increase in fracture risk.     

Does Quantitative Ultrasound at the Calcaneus Predict an Osteoporosis Diagnosis in Postmenopausal Women from the Silesia Osteo Active Study?

The aims of the study were to assess the clinical conformity between quantitative ultrasound (QUS) and densitometry with use of the standard World Health Organization T-score thresholds to determine optimal diagnostic cutoff values for QUS T-scores in different age groups. Three hundred sixty-five postmenopausal Caucasian women were enrolled into the study and divided into two age groups (<65 y and ≥65 y). Skeletal status was assessed using QUS measurements at the calcaneus and bone densitometry at the spine and proximal femur (Hologic Explorer, Bedford, MA, USA). QUS measurement results expressed as the stiffness index (SI) correlated significantly with both femoral neck bone mineral density (r = 0.51, p < 0.0001) and lumbar spine bone mineral density (r = 0.52, p < 0.0001). On the basis of receiver operating characteristic curve analyses, the thresholds for correspondence between QUS T-score values and T-score –2.5SD in dual X-ray absorptiometry (DXA) were established. They ranged between –1.63SD and –1.70SD in relation to femoral neck DXA and between –1.22SD and –1.51SD in relation to lumbar spine DXA, depending on age category. In conclusion, the study described here confirmed that QUS measurements at the calcaneus may provide information comparable to DXA examinations at the femoral neck and lumbar spine in postmenopausal women.     

Comparison of phalangeal ultrasound and dual energy X-ray absorptiometry in healthy male and female adolescents

The aims of this study were to determine if there is a correlation between dual energy X-ray absorptiometry (DXA) and phalangeal quantitative ultrasound (QUS) in identifying children and adolescents with low bone density, and to assess if body size influences the results of the two techniques to the same degree. Measurements were performed in 67 girls and 83 boys aged 14 to 19 y using DBM Sonic 1200 (IGEA, Carpi, Italy) and the DXA equipment (LUNAR Radiation Corp., Madison, WI, USA). Twelve adolescents (eight males and four females) reported a past history of nonosteoporotic fractures. Lumbar spine bone mineral density (LS BMD), total body bone mineral density (TB BMD) and total body bone mineral content (TB BMC) correlated positively with age, height, BMI and weight, in both genders. Amplitude-dependent speed of sound (Ad-SOS) was positively correlated with age, height and Tanner stages in both genders and negatively correlated with BMI in females. TB BMD, TB BMC and LS BMD positively correlated with Ad-SOS only in males. In females, there were no significant correlations between Ad-SOS, TB BMD, TB BMC and LS BMD measurements. Twelve teenagers with previous fractures (high impact fractures) were found to have lower DXA and QUS values than age-matched teenagers without fractures but the statistical significance was found only in relation to TB BMD values (p = 0.02). In conclusion, we obtained results similar to those that have been reported by other authors using different QUS techniques. Furthermore, the Ad-SOS measurements taken at the distal metaphysis of the proximal phalanges correlate poorly with LS BMD and TB BMD measured by DXA in growing subjects. (E-mail: zhalaba@poczta.onet.pl)     

How does quantitative ultrasound compare to dual X‐ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories?

The World Health Organisation (WHO) has proposed a set of guidelines for the diagnosis of osteoporosis in adult women based on a measurement of bone mineral density (BMD) expressed as the number of SD below young adult mean (t‐score). In this study, we investigated the number of subjects classified as either osteopenic or osteoporotic according to these guidelines using dual X‐ray absorptiometry (DXA), at the hip, at the spine and at the lower forearm and quantitative ultrasound (QUS), at the heel. A total of 247 men, 209 postmenopausal women and 195 premenopausal women were included in the study. Furthermore, the study provides the first normative data showing the influence of sex, age and menopause on broadband ultrasound attenuation (BUA) and speed of sound (SOS), as measured by the DTU‐one imaging ultrasound scanner. The difference between the number of patients classified into either diagnosis group by the investigated parameters is large ranging from 25·9% of the women being diagnosed as osteopenic by BUA at the heel to 43·0% by BMD at the femoral neck. For men, the same range is from 20·5% by BUA to 44·1% by BMD at the femoral neck. For the classification into the osteoporotic group, the range is from 2·5% by intertrochanteric BMD to 24·4% by BMD at Ward’s triangle for women and from 0% by SOS to 29·0% by BMD at Ward’s triangle for men. Using total hip BMD as the reference parameter to categorize the subjects as normal, osteopenic or osteoporotic, the agreement of the other parameters with this classification is assessed in terms of sensitivity and specificity. We conclude that there are significant differences in the classification of osteoporosis/osteopenia depending on the site measured and the technique used for the bone mass assessment. Furthermore, we suggest that development of technique and site specific cut‐off values may increase the accuracy of the classification of osteoporosis/osteopenia in both men and women.     

护骨素基因T245G多态性与老年人骨密度关系的部位及性别差异

背景:作为骨折发生的重要临床预测因子,骨密度在一定程度上由遗传因素决定.护骨素基因是骨质疏松症发病中的重要候选基因.目的:探讨护骨素基因T245G多态性与骨密度的相关性.方法:选取2008-09/2010-04在北京大学人民医院进行常规查体的老年人281名,其中男182名,女99名.应用PCR-RFLP结合DNA测序检测护骨素基因T245G多态性,使用双能X射线骨密度测量仪测定受试者腰椎、髋部标准位置及前臂的骨密度.同时收集受试者的生化指标及临床观察项目.应用ANOVA方法分析护骨素基因T245G多态性与各检测指标的关系.结果与结论:在老年男性及绝经后女性中,T245G基因T,G等位基因频率分布差异无显著性意义(P > 0.05).在老年男性中,GG和TG基因型具有较高的腰椎骨密度,而TT基因型的腰椎骨密度较低(P < 0.05),Ward's三角区及前臂骨密度在各基因型间差异无显著性意义(P > 0.05).在绝经后女性中,T245G多态性与骨密度无关,说明护骨素基因与老年男性腰椎骨密度有关.     

骨质疏松性椎体压缩骨折的临床及影像学分析

目的：探讨老年性骨质疏松性椎体压缩骨折的临床及影像学特点。材料与方法：分析158例经临床和影像学诊断为骨质疏松症合并椎体压缩骨折的临床和影像学资料,并对其DR平片、CT图像、MRI图像对比分析。结果：①老年性骨质疏松性椎体压缩骨折多发生于脊柱胸腰段,以椎体进行性塌陷变形或后突畸形为主要影像表现。②本组脊柱压缩骨折中,胸椎骨折35例,腰椎骨折54例,胸腰段骨折69例,其中以胸12腰1压缩骨折最常见,占44％。结论：老年性骨质疏松性椎体压缩骨折以女性多见,其临床和影像学表现具有一定特征性。     

Relation of polymorphism in the promotor region for the human osteocalcin gene to bone mineral density and occurrence of osteoporosis in postmenopausal Chinese women in Taiwan

Osteoporosis is a common disorder with a strong genetic component. Our aim was to evaluate the correlation of the HindIII osteocalcin gene polymorphism to bone mineral density (BMD) and their relationship to osteoporosis. We determined the HindIII osteocalcin gene polymorphism using polymerase chain reaction (PCR)-based restriction analysis in postmenopausal Chinese women in Taiwan. The osteocalcin gene polymorphism was detected by the restriction enzyme HindIII, where the H allele indicated the absence of the cuttable site and the h allele indicated its presence. We then related the genotypes to BMD and occurrence of osteoporosis in these women. The allelic frequencies for postmenopausal Chinese women in Taiwan were 64% for h and 36% for H in HindIII restriction fragment length polymorphisms. The prevalence of each genotype in the study population was 37.7% hh, 52.6% Hh, and 9.7% HH. The subjects with genotype hh had the greatest BMD at the lumbar spine and the femoral neck, and those with HH had the smallest BMD at the femoral neck, but these differences did not reach statistical significance. The HindIII osteocalcin genotype showed a significant effect on the prevalence of osteoporosis in the subjects at the femoral neck, that is, women with genotype HH had a 6.4 times greater risk for osteoporosis (P < 0.05), and those with genotype Hh had a 1.2 times greater risk than women with genotype hh. In conclusion, the HindIII osteocalcin gene polymorphism is associated with reduced BMD and predisposes women to osteoporosis at the femoral neck.     

甲状旁腺激素预防和治疗绝经后骨质疏松症疗效的系统评价

目的系统评价甲状旁腺激素（PTH）预防和治疗绝经后骨质疏松症的疗效和安全性。方法计算机检索MEDLINE（1966～2008．3）、EMBASE（1974—2008．3）、Cochrane图书馆临床试验资料库（2008年第1期）、Current Controlled Trials、The National Reseach Register、中国生物医学文献数据库（1983—2008．3）、中国期刊全文数据库（1994～2008．3），并手工检索相关领域其它杂志。检索不受语种限制，时间截至2008年3月。纳入以患原发性质疏松症或骨量减少的绝经后女性为研究对象、比较甲状旁腺激素与其它疗法疗效的随机对照试验，评价纳入研究的质量，并用RevMan4．2．10软件进行Meta分析。结果共纳入12个随机对照试验，包括5550例患者。Meta分析结果显示：PTH单用或与其它药物联用与对照组比较，减少椎体骨折风险达66％[RR=0．34，95％CI（0．26，0．45），P〈0．00001]；增加腰椎[SMD=0．41，95％CI（0．19，O．63），P=0．0003]和股骨颈[SMD=0．19，95％CI（0．10，0．28），P〈0．0001]的骨密度优于对照组。PTH发生副作用导致的退出和失访多于对照组[Peto—OR=1．69，95% CI（1．39，2．05），P〈0．00001]。结论PTH预防和治疗绝经后骨质疏松症疗效肯定，能提高腰椎及股骨颈的骨密度，降低椎体骨折的风险。PFH对绝经后骨质疏松症的疗效优于阿伦磷酸盐，但不宜和阿伦磷酸盐联合使用，骨量严重低下和有骨质疏松性骨折的绝经后女性是PTH较适合的人群。     

Etidronate and alendronate in the treatment of postmenopausal osteoporosis.

OBJECTIVE: To review the clinical trials evaluating the efficacy of etidronate and alendronate in the treatment of established postmenopausal osteoporosis. DATA SOURCE: A MEDLINE search was performed (from 1966 through September 1998) using the search terms bisphosphonates, etidronate, alendronate, and postmenopausal osteoporosis. English-language articles were considered for review. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, double-blind, placebo-controlled clinical trials using fracture as an end point were selected to review the efficacy of etidronate and alendronate in the treatment of postmenopausal osteoporosis. Results for the outcomes of bone mineral density (BMD) and fracture are summarized. DATA SYNTHESIS: Etidronate and alendronate increase spinal BMD in postmenopausal women with osteoporosis. In one study, etidronate decreased the number of women sustaining new radiographic vertebral fractures over two years, but this effect was lost after three years of treatment. Alendronate reduces the number of radiographic vertebral fractures in postmenopausal women with a low bone mass. In women with preexisting fractures, alendronate decreases the number of patients with radiographic vertebral fractures, clinical (i.e., symptomatic vertebral and nonvertebral) fractures, and hip fractures. A significant reduction in the overall number of nonvertebral fractures has not been demonstrated in clinical trials evaluating either alendronate or etidronate. CONCLUSIONS: No studies have directly compared the efficacy of alendronate and etidronate and the results of long-term clinical trials (i.e., >5 y) have not been published. Based on the results obtained in clinical trials using fracture as an end point, alendronate appears to be the bisphosphonate of choice. Safety profiles and cost should also be considered in the choice of etidronate or alendronate for the treatment of postmenopausal osteoporosis.