Osteoporosis Canada 2010 guidelines for the assessment of fracture risk

Osteoporosis Canada's 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada focus on the clinical impact of fragility fractures, and on the assessment and management of women and men at high risk for fragility fracture. These guidelines now integrate a 10-year absolute fracture risk prediction into an overall management approach by using validated risk assessment tools. There currently is a large gap between optimal practices and those that are now being provided to Canadians with osteoporosis. These guidelines are part of a concerted effort to close this gap. Key changes from the 2002 guidelines of interest and relevance to radiologists are highlighted in this report.     

类风湿关节炎患者的骨质疏松及其相关影响因素

目的探讨类风湿关节炎(RA)患者骨质疏松的发生情况及其相关影响因素。方法采用双能X线骨密度仪,测定53例(男8例,女45例)RA患者和63例(男18例,女45例)正常人的前臂、L2~4以及股骨颈、Ward区和大转子的骨密度,并同时测定RA患者各临床及实验室指标。结果除股骨颈外,RA患者各测定部位的骨密度均明显低于对照组(P<0.05~0.005);18例患者(34.0%)有至少一个检测部位骨质疏松,21例患者(39.6%)表现为至少一个检测部位骨量低下,总体骨量丢失较对照组明显(P<0.05)。53例RA患者中发生骨质疏松组较非骨质疏松组年龄更大(P<0.0001),关节功能更差(P<0.001),HAQ积分更高(P<0.01),握力更低(P<0.05)。28例服用糖皮质激素的RA患者中有46.4%(13/28)发生骨质疏松,高于未服用糖皮质激素组的20.0%(5/25)(χ2=4.113,P=0.043),服用激素组仅L3的骨密度低于未服用激素组(t=2.163,P=0.035)。19例绝经的女性RA患者中有57.9%(11/19)发生骨质疏松,明显高于未绝经女性RA组的15.4%(4/26)(χ2=8.927,P=0.003),除前臂外,绝经的女性RA患者各测定部位骨密度均明显低于未绝经女性RA患者(P<0.05~0.005)。结论RA患者骨质疏松发生率较正常人更高,多部位的骨密度均显著降低。其骨质疏松的发生是多因素的,与年龄、关节炎的严重程度、绝经及服用糖皮质激素等有关。     

去势法联合皮质激素快速诱导兔骨质疏松模型

目的探讨去势法联合皮质激素快速诱导骨质疏松(OP)模型兔的可行性。材料与方法 40只8月龄雌性大白兔随机分为假手术组(A组,n=20)及去势+肌注甲强龙组(B组,n=20)。术后第2、4、8、10周行血清骨代谢标志物检测及离体L5椎体显微CT(Micro-CT)扫描。结果两组骨密度(BMD)在OVX术后第8周开始差异有统计学意义,而骨体积分数(BV/TV)、骨小梁连接密度(Conn.D)、骨小梁数目(Tb.N)、结构模型指数(SMI)、骨小梁间隙(Tb.Sp)及骨小梁厚度(Tb.Th)分别在术后4、8周开始差异有统计学意义。结论去势联合肌注甲强龙可在8周内快速建立OP兔模型,骨微结构参数变化早于BMD降低。     

Opportunistic Osteoporosis Screening: Addition of Quantitative CT Bone Mineral Density Evaluation to CT Colonography

PurposeFor patients undergoing CT colonography (CTC), the screening presents an opportunity for concurrent osteoporosis screening, without increasing radiation exposure or the time involved for the patient, using proximal femur quantitative CT-CT x-ray absorptiometry (QCT-CTXA).MethodsThis cohort included 129 women and 112 men (mean age: 60.1 ± 8.2 years; range: 50–95 years) who underwent CTC between March 2013 and September 2014. Areal bone mineral density (BMD; g/cm²), and resultant left femoral neck T-score, was prospectively measured on the supine CT series. QCT results were reported with the CTC. Chart review evaluated whether the patients were eligible for BMD screening according to guidelines from the US Preventive Services Task Force and the National Osteoporosis Foundation guidelines; whether they had undergone prior BMD testing; and whether QCT results changed patient management.ResultsOverall, 68.0% (164 of 241) of patients from this cohort had not previously undergone BMD screening. According to the National Osteoporosis Foundation guidelines, 44.0% (106 of 241) of patients were eligible for screening. T-scores within the osteopenic and osteoporotic range were detected in 32.3% (78 of 241) and 5.0% (12 of 241) of patients, respectively. Of these patients with low BMD, 66.7% (60 of 90) either had not previously undergone screening or were eligible for BMD testing. Reporting of QCT-CTXA T-scores altered management in 9 patients (3.7%) who had low BMD.ConclusionsMaximizing the pre-existing value from imaging studies is crucial in the current era of health care reform. We demonstrate that colorectal and osteoporosis screening can be combined at CT examination, adding clinical and likely economic value.     

~1H-MRS与DWI在骨质疏松症中的初步应用

目的 探讨绝经后女性腰椎骨髓脂肪分数(fat fraction,FF)、表观扩散系数(apparent diffusion coefficient,ADC)值与骨密度(bone mineral densities,BMD)的关系.资料与方法 将行腰椎双能量X线吸收测定(dual X-rayabsorptionmetry,DXA)的60例绝经后女性根据T值分为3组:骨质正常组(T>-1.0)20例,骨质减少组(T=-1.0～-2.5)20例,骨质疏松组(T<-2.5)20例.所有研究对象均行氢质子磁共振波谱分析(~1H MR spectroscopy,~1H-MRS)、MR扩散加权成像(diffusion weighted imaging,DWI),分别测定L_3椎体FF和ADC值.采用组间t检验对不同骨质组间FF、ADC值差异进行统计学分析.采用Pearson相关分析3组间FF、ADC值与BMD的相关性. 结果骨质疏松组脂肪含量[(59.1±8.8)%,P=0.003]与骨质减少组脂肪含量[(54±7.6)%,P=0.039]均比骨质正常组[(49±9.1)%]高.骨质疏松组比骨质减少组椎体脂肪含量高(P=0.045).椎体骨髓ADC值与T值无相关性.所有绝经后女性患者FF值与T值呈负相关(r=-0.46,P<0.01),与ADC值间呈轻度负相关(r=-0.25,P<0.05),但骨质疏松组中FF值与ADC值间呈较明显负相关(r=-0.72,P<0.01).ADC值与T值无相关性(r=0.315,P>0.05).结论 绝经女性椎体骨髓脂肪含量随着BMD的减小而增大.MRS可作为BMD检查的辅助手段.MRS与DWI可以无创性了解骨质疏松症患者骨髓的生理、病理变化,单纯DWI并不能反映BMD的改变.     

1H-MRS评价激素性骨质疏松模型兔:与病理对照

目的 采用3.0T磁共振波谱(1H-MRS)动态评估糖皮质激素诱导的兔骨质疏松模型骨髓脂质变化规律.方法 将20只(5个月)雌性新西兰大白兔随机分为对照组及肌肉注射甲泼尼龙琥珀酸钠组(MPS组),每组10只.分别于0、4、8、12周行L3～L4及股骨近端MRS扫描及骨密度测定,获取骨髓脂质分数(LF).第8周及12周各处死实验兔10只行病理组织学检查.结果 第4、12周时,MPS组LF较基线时分别增高35.9％和75.2％(P值均＜0.001).第4周始,组间LF有显著性差异,而组间骨密度至第8周时差异有统计学意义(P＜0.05).第8、12周MPS组骨髓脂肪细胞密度较对照组分别增高57.1％和35.4％,而骨髓脂肪细胞直径分别降低13.3％、增高22.7％,骨髓脂肪细胞面积分别增高30.8％和53.8％.结论 MRS可以动态评估骨髓脂质变化规律.糖皮质激素诱导的骨质疏松初期骨髓脂肪以小尺寸脂肪细胞为主,后期以大尺寸脂肪细胞为主.     

动态增强MRI评价去势兔骨质疏松腰椎骨髓灌注:与BMD和MVD对照研究

目的用MR动态增强观察去势兔骨质疏松腰椎的骨髓灌注变化,并与骨密度(BMD)、免疫组织化学对照。材料与方法新西兰大白兔22只,随机分为2组(实验组12只,对照组10只)。双侧卵巢切除术后3、5、7个月分别行动态增强MRI和双能X线吸收测量法(DEXA)检测腰椎骨髓灌注的最大增强百分比(Emax)、增强斜率(ES)和BMD,并与组织的微血管密度(MVD)对照。结果双侧卵巢切除去势法(OVX)组兔在术后7个月时腰椎BMD与对照组相比明显降低(P<0.05)。术后3个月和5个月两组间腰椎的Emax和ES值均无明显差异(P>0.05);术后第7个月OVX组腰椎的灌注较对照组明显下降,Emax和ES值均明显降低(P<0.05);对照组腰椎骨髓MVD计数平均为67.58±11.6;而OVX组的MVD计数为39.32±9.54,明显少于对照组(P<0.05)。OVX组兔术后7个月腰椎动态增强MRI的Emax、ES和组织的MVD呈正相关(r分别为0.866和0.771,P<0.05);Emax、ES和腰椎BMD之间亦有明显的正相关性(r分别为0.714和0.820,P<0.05)。结论去势兔骨质疏松后腰椎骨髓的血液灌注明显下...     

The clinical role of dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA) measurements of hip and spine bone mineral density (BMD) have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of anti-fracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organisation (WHO) T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.     

石斛对去卵巢大鼠骨质疏松的影响

目的 观察中药石斛对去卵巢大鼠骨质疏松的影响.方法 用去卵巢的方法建立绝经后骨质疏松症大鼠模型,给以低、高两种剂量的中药石斛8周,观察石斛对骨质疏松大鼠骨密度,股骨头的组织病理学以及血清中磷、钙、总碱性磷酸酶、总蛋白等骨代谢生化指标的影响.结果 中药石斛可以提高卵巢切除大鼠的骨密度,改善骨质疏松程度,但对生化指标影响不...     

骨疏松性骨折的定量CT预测

笔者分析了６３例女性骨疏松病例的脊椎平片及ＱＣＴ检查。６３例中伴骨折者２９例。骨折组的椎骨骨矿密度（ＢＭＤ）明显低于无骨折组者（Ｐ＝０．０００６）。笔者认为，以椎骨ＢＭＤ测值９５ｍｇ／ｃｍ￣３作为骨折阈值更适用于中国老龄妇女。６３例中有异位钙化者１８例。有及无异位钙化组的椎骨ＢＭＤ值有显著性差异（Ｐ＜０．０５），ＢＭＤ值越低，发生异位钙化的机会越大。笔者提议把异位钙化作为判断骨疏松的提示性征象。     

某部986名青年指战员骨矿含量变化的研究

为探讨部队指战员训练与骨矿含量关系，对９８６名青年指战员骨矿含量进行了测定。结果显示：训练强度大的连队战士骨矿含量高于训练强度小的连队战士，随着入伍年限的延长，骨矿含量也逐年增高。因此建议，骨矿含量可作为衡量部队综合训练的指标之一。     

尿脱氧吡啶酚与大鼠实验性骨质疏松相关性研究

 目的研究尿脱氧吡啶酚(DPD)含量变化与大鼠发生实验性骨质疏松的相关性,探讨尿脱氧吡啶酚在骨质疏松防治研究中的意义.方法采用维甲酸诱导的大鼠急性骨质疏松模型,以淫羊藿总黄酮进行对抗治疗.分别测定模型组、淫羊藿总黄酮治疗组和对照组的尿DPD、Ca/Cr、P/Cr,血清骨钙素、甲状旁腺素和骨Ca、骨P及骨密度值,并进行统计学分析.结果DPD值在模型组显著上升,在淫羊藿总黄酮治疗组则趋于正常水平.DPD值所反映骨吸收情况与血清骨钙素、甲状旁腺素及骨指标一致,并比Ca/Cr和P/Cr灵敏.结论尿脱氧吡啶酚是一项灵敏快速的特异性骨质疏松诊断与疗效评价指标.     

骨密度测定技术的研究现状及进展

骨矿物密度(bone mineral density,BMD)测量作为一种无创伤、生理性测定手段,有助于定量分析骨矿物含量(bone mineral contant,BMC),从而对骨质疏松症进行早期诊断、预防和疗效评价,并能预测骨折危险性。目前,已有多种技术进行骨密度测量,本文对骨密度测量的各种方法及应用进展进行阐述。     

2型糖尿病并发骨质疏松的相关危险因素

 目的 探讨2型糖尿病(T₂DM)患者并发骨质疏松的危险因素。方法 将334例T₂DM患者根据骨密度(BMD)值分为骨量正常组、骨量减少组和骨质疏松组,对比各组患者年龄、DM病程、体重指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、C肽分泌指数(HOMA-β)、C肽曲线下面积(C-PAUC)、C肽抵抗指数(HOMA-CR)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿微量白蛋白(mALb)、肾小球滤过率(GFR)及慢性并发症发生的差异,并进行Logistic回归分析。结果 334例T₂DM患者中骨量正常者116例,男75例(64.66%),女41例(35.34%);骨量减少者110例,男50例(45.45%),女60例(54.55%);骨质疏松者108例,男46例(42.59%),女62例(57.41%)。与骨量正常组比较,骨质疏松组和骨量减少组年龄大,DM病程长,HbA1c高,HOMA-β、C-PAUC低、下肢动脉硬化发生率高(P<0.05)。骨质疏松组BMI、HOMA-CR低于骨量正常组(P＜0.05),mALb、中重度下肢动脉硬化、视网膜病变及周围神经病变发生率高于骨量正常组(P＜0.05)。高龄(OR=1.123,P=0.019)、长病程(OR=1.052,P=0.028)、低HOMA-β(OR=0.706,P=0.016)及高mALb(OR=1.289,P=0.006)是骨质疏松的独立危险因素。结论 高龄、长病程、胰岛功能差、糖尿病肾病是T₂DM并发骨质疏松的危险因素,糖尿病慢性并发症与骨质疏松密切相关。     

航天职工2型糖尿病并发骨质疏松的相关危险因素

 目的 探讨航天职工2型糖尿病患者合并骨质疏松的危险因素。方法 选择航天职工中2型糖尿病患者211例,根据骨密度分为骨质疏松组和非骨质疏松组,对比各组患者年龄、糖尿病病程、体重指数、骨钙素、CTX、25-羟维生素D、甲状旁腺素、空腹血糖、糖化血红蛋白、C肽曲线下面积、HOMA-β、HOMA-CR、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的差异,并进行Logistic回归分析。结果 单因素分析:骨质疏松组和非骨质疏松组比较,糖尿病病程、BMI、25(OH)D、HbA₁c、HOMA-β、HOMA-CR差异有统计学意义(P<0.05)。多因素Logistic回归分析:糖尿病病程(OR=0.007,95%CI:0.000～0.182)、体重指数(OR=8.888,95%CI:1.646～47.998)、糖化血红蛋白(OR=0.497,95%CI:0.332～0.744)、HOMA-β(OR=27.433,95%CI:8.105～92.844)、25-羟维生素D(OR=1.169,95%CI:1.047～1.306)是独立影响因素。结论 长糖尿病病程、低体重、高血糖、胰岛功能差、25-羟维生素D缺乏是航天系统职工2型糖尿病合并骨质疏松的危险因素。     

正常绝经后女性椎体骨密度测量——2000QCT与QCT3000的对照研究

目的通过比较两种定量CT（QCT）体模对本地区正常绝经后女性椎体骨矿密度（BMD）的测量,探讨QCT体模对BMD测量的影响。资料与方法分别采用2000QCT与QCT3000两种体模及相同的扫描参数,对绝经后1-27年（平均15年）的正常受检者116人行T12-L2椎体QCT骨密度测定。（1）通过配对t检验比较两种QCT体模测量的椎体BMD值、T值、Z值的统计学差异,并分别计算出95%的可信区间作为正常值的参考;（2）对两种QCT体模椎体的BMD值、T值、Z值按年龄进行分组,通过单因素方差分析分别比较两体模各组椎体的BMD值、T值、Z值,并通过SNK法进行组间两两比较。结果2000QCT体模BMD值、Z值的均值明显高于QCT3000,而T值的均值则0.05）。结论QCT体模及其软件系统对QCT测量结果有较大的影响,同时其他许多因素对QCT测量也存在影响,当使用其结果对骨质疏松症（OP）进行诊断和治疗时,要结合当地该人群及该体模的正常值标准进行综合分析。     

Impact of a Deep Learning Model for Predicting Mammographic Breast Density in Routine Clinical Practice

ObjectiveLegislation in 38 states requires patient notification of dense mammographic breast tissue because increased density is a marker of breast cancer risk and can limit mammographic sensitivity. Because radiologist density assessments vary widely, our objective was to implement and measure the impact of a deep learning (DL) model on mammographic breast density assessments in clinical practice.MethodsThis institutional review board–approved prospective study identified consecutive screening mammograms performed across three clinical sites over two periods: 2017 period (January 1, 2017, through September 30, 2017) and 2019 period (January 1, 2019, through September 30, 2019). The DL model was implemented at sites A (academic practice) and B (community practice) in 2018 for all screening mammograms. Site C (community practice) was never exposed to the DL model. Prospective densities were evaluated, and multivariable logistic regression models evaluated the odds of a dense mammogram classification as a function of time and site.ResultsWe identified 85,124 consecutive screening mammograms across the three sites. Across time intervals, odds of a dense classification decreased at sites exposed to the DL model, site A (adjusted odds ratio [aOR], 0.93; 95% confidence interval [CI], 0.86-0.99; P = .024) and site B (aOR, 0.81 [95% CI, 0.70-0.93]; P = .003), and odds increased at the site unexposed to the model (site C) (aOR, 1.13 [95% CI, 1.01-1.27]; P = .033).DiscussionA DL model reduces the odds of screening mammograms categorized as dense. Accurate density assessments could help health care systems more appropriately use limited supplemental screening resources and help better inform traditional clinical risk models.