中国人骨质疏松症诊断标准回顾性研究

目的　通过对既往国内文献复习 ,提出一种更方便、更科学的中国人骨质疏松症诊断标准。方法　检索国内期刊数据库中已发表的文献 ,摘录骨密度丢失率数据进行统计、计算、分析 ,得到不同年龄段、不同作者、使用不同型号仪器、不同部位的骨密度丢失百分率及相关曲线。结果　中国男性骨质疏松诊断标准推荐使用骨密度丢失百分率 2 5 %或 2SD ;中国女性骨质疏松诊断标准推荐使用骨密度丢失百分率 2 5 %或 2SD ;测量部位推荐使用如下顺序 :股骨颈 >前臂远端 1/ 3、1/ 10、1/ 6 >RA法手指骨 2 ,3,4中节 >股骨Troch区 ;不推荐使用股骨Ward区和腰椎侧位。结论　使用骨密度丢失百分率这个指标作为中国人骨质疏松症诊断标准非常有意义 ,值得进一步推广和深入研究。     

女性骨质疏松性骨折骨密度阈值及中国人群骨质疏松诊断标准探讨

目的研究河南地区女性骨质疏松性骨折骨密度阈值并进一步探讨中国人群骨质疏松诊断标准。方法收集465例女性骨质疏松性骨折患者的病历资料,对双能X线测定的骨密度值、T值、Z值进行统计分析。结果女性患者腰椎BMD值低于0.7955 g/cm2、T值低于-2.15、Z值低于-0.52时,骨折风险较高;髋部BMD值低于0.7270 g/cm2、T值低于-2.10、Z值低于-1.01时,骨折风险较高。结论对于骨密度低于上述阈值者,需高度警惕骨质疏松性骨折的发生,应采取积极有效的预防和治疗措施。WHO的骨质疏松诊断标准与中国人群的骨密度情况存在一定差异,因此,应展开全国范围的骨质疏松流行病学调查工作,健全中国人群骨密度数据库,为制定适合中国人群骨质疏松诊断标准提供流行病学依据。     

北京地区放射吸收法测量手指骨密度6819例分析

目的 利用放射吸收(radiographic absoptiometry, RA)方法测定手指骨密度,建立北京地区RA测量手指骨密度参考值数据库.方法 选取北京地区10-90岁健康人6819例,男性3376例,女性3443例,研究对象详细填写健康调查表,排除因继发性骨病或服用影响骨代谢药物的病例.用美国CompuMed公司OsteoGram-2000骨密度仪测定所有对象非优势手的第2、3、4指中节指骨骨密度,按10岁一个年龄组男女各分8组.结果 用OsteoGram软件系统进行统计分析.按WHO提出的骨质疏松诊断标准,BMD峰值减去2.5个标准差和我国提出的骨质疏松诊断标准,BMD峰值减去2.0个标准差分别统计分析.结论 WHO标准北京女性骨质疏松患病率21%,男性4%;我国标准北京女性骨质疏松患病率33%,男性10%.     

包头地区人群骨密度影响因素研究

目的 研究影响包头地区人群骨密度的相关因素。方法 采用病例-对照研究方法。收集来自包头医学院第一附属医院进行健康体检的596例女性和230例男性流行病学资料，用双能X线吸收仪对研究对象进行骨扫描，按骨密度检测值分为正常对照组和骨质疏松及骨量流失组。采用 Logistic回归法分析影响骨密度的相关因素。结果 经Logistic回归分析，饮酒是女性发生骨质疏松的危险因素，吸烟、饮酒是男性发生骨质疏松的危险因素。补钙是人群保护因素。结论 包头地区 男、女性通过补钙均可预防骨质疏松；饮酒与女性骨量流失及骨质疏松显著相关，吸烟、饮酒与男性骨量流失及骨质疏松显著相关。     

哈尔滨地区中老年人周围骨骨密度的测量状况分析

目的应用DEX200双能X线骨密度仪分析中老年人周围骨骨密度的测量结果。方法所选对象为哈尔滨地区及附近农村、郊区的中老年人,共3432例。年龄范围为40～79岁,每10岁为一个年龄段,分为4组。诊断标准:采用世界卫生组织(WHO)批准的诊断标准:T值≤-2.5标准差(SD)诊断为骨质疏松症;T值≥-1.0SD为骨量正常,-2.5SD相似文献   

双能X线骨密度仪测定成都市城区771例健康人骨密度结果分析

目的观察成都市城区健康人群骨密度变化规律,建立该型骨密度仪成都地区骨密度正常值,为骨质疏松诊断、防治提供参考依据。方法①采用EXPERT-XL双能X线骨密度仪(美国 LUNAR公司生产)测定成都市城区健康体检者771例,其中男性300例,女性471例,测量部位包括腰椎1～4和髋部;②按年龄、性别分别输入数据,以10岁为一年龄组,分别计算各组骨密度值,结果以x-±s表示。结果男性腰椎及股骨近端骨密度峰值出现在30～39岁,女性腰椎及股骨近端骨密度峰值出现在20～29岁,随着年龄增加,骨密度逐渐降低,男性在70岁后腰椎骨密度有反弹,而女性在50～59岁间骨密度下降迅速。结论本组健康人群骨密度数据将为成都地区骨质疏松诊断、防治提供参考依据;分析男性腰椎骨密度时应结合股骨近端骨密度;女性50岁后应注意预防、治疗骨质疏松,男性骨质疏松不容忽视。     

中日女性超声骨密度测定对比研究

目的 比较中日女性间的骨密度差异,探讨中国女性骨质疏松诊断标准。方法 采用定量超声衰减技术（BUA）测定114例健康女性,采取骨强度值与同类群日本女性相对比分析。结果 与同类群日本女性相比,中国女性骨密度值总体较低,但在统计学上无明显差异。结论 中国女性的骨质疏松诊断标准可参照日本女性标准建立。     

1166例正常人髋部骨密度测量结果分析

目的 了解正常人髋部骨密度变化，为建立北京地区骨密度正常参考值提供依据。方法 应用美国Norland XR36型双能X线骨密度仪（DEXA），对北京地区20－92岁正常人进行髋部骨密度测量，男性449人，女性717人，按5岁一个年龄组进行统计分析。结果 女性股骨颈，大粗隆，Ward's三角的峰值骨密度在30－34岁，男性峰值骨密度在20－24岁；股骨颈，大粗隆，Ward's三角的骨密度男性峰值骨量比女性高；随年龄增长男性女性骨密度值逐渐降低，女性55岁以及骨量丢失速度明显加快。结论 骨密度随年龄增长而下降，骨质疏松发病率随之增加，女性骨质疏松患病率高于男性，因此女性骨质公的预防治疗应及早入手。     

中美日女性骨质健康水平的比较与研究

目的 在建立了中美日女性最佳诊断参考图的基础上,对中美日女性骨量峰值及骨质流失率进行分析,比较中美日女性骨塑建及骨重建的能力差异,以此透视中美日骨质健康水平的差异.方法 采用定量超声法测量北京市海淀区155名高校女教师跟骨骨密度,制定最佳诊断参考图;同时采用描点法制定的中日美骨密度诊断曲线并进行对比和分析.结果 1)高校女教师和中国女性骨密度变化的趋势基本一致;2)中国女性骨密度峰值高于日本和美国女性,但骨质流失较日本和美国女性迅速.结论 1)中国老年学学会-骨质疏松委员会公布的我国女性骨密度判定参考曲线适合于我国高校女教师骨密度的诊断.2)中国女性骨的构建能力较日本和美国女性强,骨峰值较高;但骨的重建能力较日本和美国弱,骨流失速度快.产生这一现象的机制有待于进一步的研究.     

天津地区1695例骨密度调查研究

目的 调查天津地区部分人群骨密度，建立天津地区骨密度参考值数据库，为骨质疏松预防、诊断、治疗提供科学依据。方法 应用双能X线骨密度仪对天津地区1695例人群进行骨密度检测、分析。结果 天津地区男女骨密度峰值均在25～30岁年龄组，女性50岁、男性60岁以后骨密度丢失率、患病率升高，女性65～70岁年龄组骨密度均值城乡差异有显著性。结论 天津地区人群骨密度参考值，为骨质疏松的临床研究及流行病学比较奠定基础。     

Reference Data and Predictive Diagnostic Models for Calcaneus Bone Mineral Density Measured with Single-Energy X-ray Absorptiometry in 7428 Chinese

Calcaneus bone mineral density (BMD) of 7428 Chinese (4126 women, 3302 men; aged 22–94 years) was measured using single-energy X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Chinese men and women was established and the usefulness of this method for screening and diagnosis in osteoporosis was evaluated. The peak BMD occurred at 20–24 years old and peak BMD in women was significantly lower than in men. BMD loss in the calcaneus started at the age of 35 years for women, and at 63 years in men. BMD loss rate was 1.2%/year for women and 0.56 %/year for men after 50 years. The young normal reference for calcaneus BMD was 442.1±69.6 mg/cm² for men and 388.3±61.7 mg/cm² for women calculated from the mean BMD value of subjects whose age ranged from 20 to 49 years. The accumulated BMD loss in the calcaneus is similar to that of Ward’s triangle. Multiple linear regression showed that both age and weight were important factors. The incidence of osteoporosis in older men and women (≥60 years) is 6.6% and 32.1% respectively. We conclude that calcaneus BMD measurement is useful and sensitive for the screening and diagnosis of osteoporosis. A predictive diagnostic model for osteoporosis based on the calcaneus was constructed using multiple linear regression and the WHO criteria for diagnosing osteoporosis can be applied to calcaneus BMD. Received: 16 August 2000 / Accepted: 20 March 2001     

骨质疏松症诊断标准的探讨

本文目的是再次讨论骨质疏松的诊断标准问题。骨质疏松症的诊断以骨密度DXA检测为金标准。1994年世界卫生组织(WHO)推荐的骨质疏松诊断标准为:患者骨密度低于同性别人群峰值骨量均值2.5个标准差以上,或减少30%以上。这个标准的T值是根据年轻白人妇女计算的,但是对于不同地区是不能固守这一标准的。有研究调查我国部分地区骨质疏松症总患病率为32.3%(2.0SD)和14.9%(2.5SD),2种骨密度诊断标准计算骨质疏松症患病率差异有显著性,若以2.5SD为标准很可能造成漏诊。该研究者还发现骨质疏松症的患病率在老年远高于年轻人。而WHO采用的是白人年轻女性的数据库,它是否适用就更值得推敲。另有研究者以骨密度低于-2.0SD标准,推算杭州市妇女骨质疏松的发病率为29.5%。认为以-2.0SD为标准可以相对早期发现骨质疏松。还有研究对于高原的藏族人群进行检测,也得出同样结论。有研究者推算我国各个DXA仪器之间的换算公式,发现上述换算公式基本上与日本推出的相同,但是与美国推出的换算公式有差异。这都证明WHO骨密度诊断标准是否适用于黄种人是有疑问的。国内有研究者以BMD-2.0SD为诊断标准,结合以骨代谢生化指标,认为能全面合理评价骨转换。还有研究者对目前国内使用骨密度检测方法进行统计分析,发现60岁骨量丢失率有18%左右,70岁阶段达到22%左右。这个患病百分率比较符合中国人的实际情况。按照世界上基本通用的换算方法,1.0SD约等于10%～12%的骨量丢失百分率,因此建议男性骨质疏松诊断标准为骨量丢失率达到25%或2.0SD,实际诊断年龄在70岁以上。如果采用2.5SD,中国人患病诊断时间会推迟到70岁以后,尤其是男性要推迟到90岁以后。骨质疏松症的研究关键是正确合理的诊断,不同种族、不同国家或地区有不同的诊断标准。1994年以前全世界都执行WHO1985年提出的峰值骨量丢失2.0个标准差诊断为骨质疏松症。1994年WHO提出了白人妇女小于-2.5SD为骨质疏松,但也明确指出该标准仅适用于欧美白人妇女。以Orimo为首的日本骨代谢学会制定了日本人群的骨质疏松诊断标准:骨密度在同性别青年人平均值30%以下为骨质疏松,丢失20%～30%为骨量减少。1999年中国老年学学会骨质疏松委员会诊断学组建议骨质疏松的诊断标准为骨量丢失百分率达到25%,或者说2.0SD。对于国外也有学者倾向于采用-2.0SD的标准来评价骨质疏松症。有研究发现不同国家间,和每国内部不同人群和人种的骨密度是明显不同的。非洲和拉丁美洲人种的骨密度高于白种人,而白种人的骨密度则高于黄种人。总结:1、国内外人群间骨密度的差异是公认的,我国人群骨密度是低于制定国际标准的白种人的,有倾向以T值低于-2.0SD为骨密度诊断标准。但是大规模的流行病学调查比较研究还很少,有必要进一步提供更确切的骨质疏松诊断更改的流行病学依据。2、以2.0SD为标准可以减少骨质疏松的漏诊,对于流行病学人群调查筛选病例,进行危险因素分析和对骨质疏松高危人群进行干预实验尤为有必要。3、如果加强国内和国际间多单位的联合研究,可以提高标准制定的科学性和权威性。     

Implications in the use of T-scores for the diagnosis of osteoporosis in men.

Osteoporosis is recognized as a disorder of both men and women. However, the World Health Organization's (WHO) definition of osteoporosis (a bone mineral density [BMD] T-score of -2.5 or less) was formulated for use with postmenopausal women only. In the absence of a BMD-based definition for male osteoporosis, the WHO definition is often applied to men as well. Several important questions exist when considering the use of T-scores in men. First, is the WHO definition appropriate for men? What is the impact of using a -2.5 criteria, in terms of the number of men that would be identified as osteoporotic? When calculating T-scores in men, should male or female young normal values be used? Can the same T-score criteria be used for all skeletal sites and technologies? To address these questions, osteoporosis prevalence estimates for men aged 50 yr and over were generated using WHO methods and manufacturer normative data from dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and ultrasound. Estimates were determined for several skeletal sites and technologies using both male and female young normal values. Prevalence estimates were compared to published fracture risk estimates. Mean T-scores declined with age at all measurement sites. Discrepancies were found between the different skeletal sites and techniques, similar to the previously reported differences in women. A -2.5 criterion (based on young normal males or females) appeared to underestimate the prevalence of osteoporosis, except for QCT, which seemed to overestimate risk. Depending on the technique used, 0 to 12.5 million US men 50 yr of age and older would be classified as osteoporotic using the WHO definition. T-Scores based on male norms were less discordant across skeletal sites than female-based T-scores. Male-based T-scores between -1.8 and -2.3 using DXA and ultrasound and -3.1 for QCT provided osteoporosis prevalence estimates that approximated the likelihood of common fractures in men 50 and over. We conclude that the use of single T-score-based criterion for the diagnosis of osteoporosis in men has many potential difficulties. BMD measurement techniques provide discrepant estimates of prevalence and may underestimate the size of the male population at risk for fracture. Based on available normative data, a -2.5 criterion underestimates osteoporosis prevalence in men, whether based on male or female norms. Prospective studies are needed to further refinement to the BMD definition of osteoporosis in men.     

Utility of diagnostic criteria for involutional osteoporosis established by the Japanese ministry of health and welfare

We conducted a study to determine whether the draft criterion for the diagnosis of involutional osteoporosis proposed by the Silver Science Research Group of the Ministry of Health and Welfare have achieved a widespread consensus. Over the past year, we conducted a study of the appropriateness of this draft diagnostic criterion in 209 women diagnosed with primary osteoporosis at our hospital. In overall evaluation scores, 96.2% of the subjects had scores of 4 or above, and none of the subjects had scores of 2 or below. Comparing spinal BMD values according to over all score, spine BMD showed a decrease as the scores increased, with the scores reflecting the degree of osteoporosis. The draft diagnostic criterion for involutional osteoporosis is capable of covering most patients. However, the fact that this criterion cannot evaluate women shortly after menopause and the fact that spine BMD is low in cases in which the score is reduced because of slightly elevated alkaline phosphatase are thought to be somewhat problemmatic.     

Assessment of low quantitative ultrasound values of calcaneus in Chinese mainland women.

Calcaneus quantitative ultrasound (QUS) assessment is a safe and reliable method for evaluating skeletal status. Until now, considerable data have been accumulated on the distribution of QUS in Caucasian populations, whereas such data are still insufficient in Asian populations, especially in Chinese mainland. The present study aimed to obtain the distribution characteristic of calcaneus QUS in healthy Chinese women, and to further investigate the distribution of low bone mass by QUS stiffness index (SI). This study included 2,498 healthy Chinese females aged 10-87 yr. The QUS exhibited a characteristic mild rise and then fall pattern with increasing age. Age, body height, and weight were significant influencing factors on SI, especially age and weight. The prevalence of osteoporosis detected using instrument-derived T-score or internal T-score was different from that calculated according to calcaneus bone mass density (BMD) previously reported. Furthermore, between instrument-derived T-scores and internal T-scores, there were also significant differences. We concluded that the World Health Organization criteria from BMD may not be appropriate for QUS, and the instrument-derived T-score may also not be appropriate for the studied population. The results will be useful for predicting fracture risk of Chinese women and determining diagnostic criteria of osteoporosis by QUS.     

Classification of osteoporosis based on bone mineral densities.

In this article we examine the role of bone mineral density (BMD) in the diagnosis of osteoporosis. Using information from 7671 women in the Study of Osteoporotic Fractures (SOF) with BMD measurements at the proximal femur, lumbar spine, forearm, and calcaneus, we examine three models with differing criteria for the diagnosis of osteoporosis. Model 1 is based on the World Health Organization (WHO) criteria using a T score of -2.5 relative to the manufacturers' young normative data aged 20-29 years, with modifications using information from the Third National Health and Nutrition Examination Survey (NHANES). Model 2 uses a T score of -1 relative to women aged 65 years at the baseline of the SOF population. Model 3 classifies women as osteoporotic if their estimated osteoporotic fracture risk (spine and/or hip) based on age and BMD is above 14.6%. We compare the agreement in osteoporosis classification according to the different BMD measurements for the three models. We also consider whether reporting additional BMD parameters at the femur or forearm improves risk assessment for osteoporotic fractures. We observe that using the WHO criteria with the manufacturers' normative data results in very inconsistent diagnoses. Only 25% of subjects are consistently diagnosed by all of the eight BMD variables. Such inconsistency is reduced by using a common elderly normative population as in model 2, in which case 50% of the subjects are consistently diagnosed as osteoporotic by all of the eight diagnostic methods. Risk-based diagnostic criteria as in model 3 improve consistency substantially to 68%. Combining the results of BMD assessments at more than one region of interest (ROI) from a single scan significantly increases prediction of hip and/or spine fracture risk and elevates the relative risk with increasing number of low BMD subregions. We conclude that standardization of normative data, perhaps referenced to an older population, may be necessary when applying T scores as diagnostic criteria in patient management. A risk-based osteoporosis classification does not depend on the manufacturers' reference data and may be more consistent and efficient for patient diagnosis.     

中国健康男性腰椎和股骨近端的骨密度(英文)

目的:建立中国健康汉族男性的骨密度(BMD)参考数据库,以评价群体中骨质疏松的患病率。方法:对上海市1385例20-89岁健康汉族男性使用双能 X 线吸收仪测定腰椎1-4(L1-4)和股骨近端的 BMD。结果:年龄与股骨近端各部位 BMD 值呈显著负相关,但与腰椎 BMD 值之间无相关性。以20-39岁年龄段的男性腰椎和股骨近端各部位 BMD 均值作为峰值,根据 WHO 制定的骨质疏松诊断标准,中国男性 L1-4、全髋部、股骨颈、大转子和转子间部位 BMD 的骨质疏松诊断值分别为0.719、0.638、0.575、0.437、0.725 g/cm~2;使用本参考数据库,在1084例50岁以上男性中 L1-4、全髋部、股骨颈、大转子和转子间部位骨质疏松检出率分别为5.4%、3.8%、6.3%、1.8%和2.8%,而使用美国非西班牙裔白种男性参考数据库(NHANES Ⅲ),髋部各部位骨质疏松和骨量减少的检出率均显著高于使用本研究中的中国参考数据库。结论:中国健康汉族男性 BMD 参考数据库的建立,将有利于中国男性骨质疏松的正确诊断。     

A referent bone mineral density database for Chinese American women

Introduction While osteoporosis is common among women of Chinese descent, a readily available bone mineral density (BMD) referent database for Chinese American women does not exist. Fracture risk among this population is currently assessed using a Caucasian reference as well as diagnostic criteria for osteoporosis developed for postmenopausal Caucasian women. Many studies indicate that there are important racial differences in skeletal health and fracture risk, an observation that makes the application of Caucasian data to all groups problematical. This study was undertaken to establish a BMD referent database in Chinese American women and to compare it with a Caucasian female database. It is expected that a race-specific database will be useful in the assessment of bone health for Chinese American women. Methods Healthy Chinese American women (n=359), ages 20–90, were recruited. Along with dual-energy X-ray absorptiometry (DXA) of the total hip and lumbar spine, demographic, medical, familial, nutritional, and behavioral data were obtained. The mean and standard deviation for BMD at each site was calculated for each 10-year age group and compared to mean BMD values for Caucasian women supplied as found in the Hologic DXA instrument. Osteoporosis diagnosis rates for this cohort, calculated with the Caucasian and newly established Chinese American BMD referent values, were compared with each other. Results Compared with Caucasian women, Chinese American women have significantly lower BMD at the lumbar spine, total hip, and femoral neck across a wide spectrum of age groups. As a consequence, more than one-half of Chinese American women ≥50 years of age, who would be characterized as osteoporotic using a Caucasian referent, would not be diagnosed as such if a Chinese American referent were utilized. Conclusion Chinese American reference BMD values are significantly lower than those for Caucasian women. Future studies relating Chinese American BMD values to fracture risk are necessary in order to determine if ethnic database-derived T-scores would be more predictive of fracture risk and to develop meaningful diagnostic criteria for this population.     

The Assessment of Bone Mass in Men

Bone mineral density (BMD) is widely used in postmenopausal women to identify who should be given therapy for prevention and treatment of osteoporosis and to monitor the efficacy of treatment. There is still uncertainty about how to interpret BMD in men, and few prospective studies exist on the relationship between BMD and fracture risk. Men should be considered for measurement of BMD if they have suffered low trauma fractures, have prevalent vertebral deformities, have radiographic osteopenia, are over age 75, or have conditions that increase their risk for bone loss, such as hypogonadism, glucocorticoid use, or generally poor health. There is insufficient information to recommend a more widespread BMD screening. The World Health Organization has developed criteria for interpreting BMD which are widely used. Patients with BMD at least 2.5 SD below the young adult mean (T-score < -2.5) have osteoporosis, and those with BMD between 1 and -2.5 SD below the young adult mean (-2.5 < T-score < -1.0) have osteopenia. However, the BMD criteria that should be used to identify men in need of therapeutic intervention are still debated. Using male-specific hip BMD cutoffs, approximately 3-6% of U.S. men 50 years and older were estimated to have osteoporosis and 28-47% to have osteopenia. The corresponding figures in women were 13-18% with osteoporosis and 37-50% with osteopenia. Greater accumulation of skeletal mass during growth, slower rate of bone loss, and shorter life expectancy in men contribute to the lower prevalence of osteoporosis relative to women.     

The Prevalence of Osteoporosis: Gender and Racial Comparison

Osteoporosis is common among the growing population of older men: almost 20% of men > or = 50 years old have osteoporosis of the hip, spine, or wrist. However, the exact estimate depends on the approach taken to normalize for bone size, the specific skeletal site assessed, and the diagnostic criteria used. Bone mineral density (BMD, g/cm2) by DXA is 12-25% greater in men than women, but bone mineral apparent density (g/cm3) is similar in the two sexes. This correction for skeletal size largely eliminates apparent differences in areal BMD between the races and also reduces the apparent effects on BMD of age. The particular skeletal site that is assessed has an important influence on the prevalence of osteoporosis (sex-specific BMD T-score less than -2.5) in men which varies from 0 to 36%, depending on the site, and from 2% to 45% in postmenopausal women. The discrepancies relate mainly to different patterns of bone loss at the various sites, but estimates are also affected by the specific young normal means and standard deviations (SD) used to calculate the T-scores. A greater mean and smaller SD among normal young men in Rochester, MN produced a higher prevalence of osteoporosis at the femoral neck (22% vs 7%) compared with estimates for white men from the Third National Health and Nutritional Examination Survey; use of female normal values further reduced osteoporosis prevalence at the hip in white, Hispanic, and African-American men to 4%, 2%, and 3%, respectively, compared with 20% for white women in the United States. By contrast, fracture risk is similar for men and women at any given level of BMD. These observations reinforce current efforts to move away from osteoporosis prevalence and toward absolute fracture risk as the main basis for clinical treatment decisions.