绝经后妇女椎体骨折与骨密度的对照研究

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度的关系。方法随机选择椎体骨折的绝经后妇女120例为骨折组，无椎体骨折的120例绝经后妇女为对照组。两组的年龄、身高、体重等差异无显著性，均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量腰椎（L2-4）前后位及髋部骨密度（BMD）和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组（P≤0．05）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关，髋部骨密度值的降低在一定程度上也能提示骨折的危险性。绝经后骨质疏松妇女应重视BMD变化，预防椎体骨折的发生。     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

腰椎松质骨CT值与年龄、双能X线骨密度值相关性研究

目的研究女性腰椎松质骨CT值与年龄、双能X线骨密度值的相关性。方法 103例女性住院患者纳入研究对象,所有患者行腰椎骨密度与腰椎螺旋CT检查,双能X线骨密度仪(DXA)测量腰1~4椎体骨密度(BMD)和T值。CT扫描分析腰1~4椎体松质骨CT值。将所有研究对象的年龄、腰1~4椎体CT值、DXA测得BMD值及T值进行收集、整理及统计学处理。结果 1不同年龄段腰1~4椎体松质骨CT值差异具有统计学意义(F=102.5,P0.001);每两个年龄段间的CT值比较差异亦具有统计学意义(P0.001)。组内比较腰1~4椎体之间的CT值没有统计学意义(P0.05)。2按T值将所有研究对象分为3组(骨量正常、骨量减少及骨质疏松症组),各组间腰1~4椎体松质骨CT值差异具有统计学意义(F=248.6,P0.001)。组间两两比较,骨质疏松症组CT值骨量减少组CT值骨量正常组CT值,差异具有统计学意义(P0.001)。组内比较腰1~4椎体的CT值没有统计学意义(P0.05)。3腰1~4椎体BMD值与椎体松质骨CT值呈显著正相关(P0.001)。结论女性腰椎椎体的松质骨CT值随着年龄增长逐渐减低。DXA测得BMD值与腰椎椎体松质骨CT值存在显著正相关。     

立位脊柱三维重建技术在椎体轴向旋转角测量中的应用研究

目的利用基于双平面X线的立位脊柱三维重建技术定量测量椎体轴向旋转角(Vertebral Axial Rotation,VAR)。并初步判断立位三维重建下测量VAR的精度。方法对一位主诉为腰痛的病人,加用标定装置拍摄腰椎正侧位X线片,标定装置上有数个小钢珠做成的已知三维坐标的标定点。依据Nash-Moe法,在平片上寻找出存在轴向旋转的椎体,运用相关软件,提取旋转椎体的VAR测量相关点在正侧位平片上投影点的二维坐标和平片上正侧位成像各自标定点的二维坐标。根据立位三维重建的基本原理,重建出VAR测量相关点的三维坐标。定量测量VAR,并和Nash-Moe法的测量结果进行对比,初步判断测量精度。结果发现1个存在轴向旋转的椎体,位于第3腰椎(Lumber vertebrae,L),Nash-Moe分度为1度,测量VAR为+2.3°。方向与双侧椎弓根形状变化一致,但数值不在Nash-Moe法(L_2-L_4,1度)相对应的旋转范围5-15°之内。结论本实验在国内率先利用基于双平面X线的立位脊柱三维重建技术定量测量出VAR,但测量精度需要进一步提高。     

腰椎定量CT骨密度测定与双能X线骨密度测量在老年男性骨质疏松症中的应用效果对比

目的对比分析腰椎定量CT(QCT)骨密度(BMD)测定与双能X线(DXA) BMD测量在老年骨质疏松症中的应用效果。方法对84例老年男性患者行腰椎QCT BMD测定和腰椎正位及髋关节DXA BMD测量,两项检查的时间间隔≤20 d。对比分析QCT测定BMD与DXA测量BMD对老年骨质疏松的检出率。结果DXA诊断84例老年男性腰椎、髋关节及腰椎或髋关节骨质疏松的检出率分别为5. 95%、9. 52%、13. 10%;腰椎QCT测定椎体松质骨骨质疏松的检出率为35. 71%,差异有统计学意义(P 0. 05)。结论腰椎QCT和DXA均可检测BMD,但腰椎QCT测定BMD的敏感性较腰椎正位及髋关节DXA测量BMD更好,更能准确反映出骨质代谢的变化。     

青岛与长沙地区成年女性多部位骨密度的比较

目的 通过建立不同厂家双能X线吸收法骨密度仪(DXA)之间的数据换算关系,比较青岛与长沙地区成年女性骨密度(BMD)差异及影响因素.方法 选择25～35岁健康成年女性30人分别在Challenger及Holigic QDR4500型DXA上测得BMD值.通过直线相关与回归分析分别计算出腰椎(L2-L4)正位和左侧髋部(股骨颈、大转子、Ward三角区)6个骨骼区域的BMD换算公式,并进行两地区骨密度数据库的比较.结果 ①Challenger与Holigie QDR4500型DXA之间的骨密度测定数据显著相关,存在线性关系.②校正之前,青岛地区女性髋骨BMD几乎无一例外地高于长沙地区;校正之后两地区骨密度无显著性差别.结论 BMD测定受很多因素影响,除地域、性别、生活习惯和BMI外,DXA仪器本身也是很重要的影响因素.     

女性人群腰椎骨密度与其腰椎曲度的相关性分析

目的综合分析女性人群腰椎骨密度与其腰椎曲度的相关性。方法自2014-08-2016-11,选取268例女性患者,通过双能X线吸收法(DXA法)来测定其腰椎骨密度值——BMD值、T值以及Z值等,通过X线片测量腰椎矢状面Cobb角和腰椎侧凸Cobb角。采用SPSS20.0统计学软件进行统计学分析腰椎骨密度与其腰椎曲度的相关性。结果女性人群腰椎骨密度与其腰椎曲度的相关系数比较,无统计学意义(P0.05)。结论女性人群腰椎骨密度与其腰椎矢状面Cobb角和腰椎侧凸Cobb角之间没有相关性。     

绝经后女性腰椎T值评分与椎体骨折的关系

目的探讨绝经后女性腰椎骨密度的T值评分与发生椎体骨折的关系。方法选择原发性骨质疏松症女性患者共74例,其中发生椎体骨折患者37例,无椎体骨折患者37例,所有受检者均行正侧位胸腰椎X线摄片证实。两组女性的出生年月、身高、体重、绝经年限等无显著性差异。用双能X线吸收仪(DXA)分别检测正位腰椎(L1-L4)及一侧股骨近段股骨颈的骨密度(BMD)值及T值,统计腰椎部位的T值评分(T-Score),以腰椎T值评分达≤-2.5可入选,并对两组腰椎的T值评分进行统计分析。结果骨折组腰椎T值评分明显低于非骨折组腰椎T值评分(P0.05)。结论绝经后女性发生椎体压缩性骨折与腰椎骨密度的T值评分降低相关。     

腰椎椎弓根对应横断面椎体松质骨CT值与BMD值、T值的相关性

目的 对中国女性患者腰椎椎弓根对应横断面椎体松质骨CT值与年龄、双能X线骨密度值以及T值的相关性进行研究,以期为脊柱外科椎弓根螺钉置入术术前评估钉道骨质量提供参考。方法 将465例因腰腿痛住院的女性患者纳入本研究 ,所有患者均行腰椎CT及骨密度检查。研究人员测量了腰1~4椎弓根中部对应横截面上椎体松质骨的CT值,同时用双能X线骨密度仪（DXA）测量了腰1~4椎体的骨密度（BMD）,并计算了404名绝经后女性研究对象的T值。将腰 1~4椎弓根对应横断面椎体松质骨CT值、年龄、BMD 以及 T 值进行统计学分析。结果 ①椎弓根对应横断面椎体松质骨CT值随着年龄增长而不断下降,各年龄组间差异有统计学意义（P<0.001）; ②腰 1~4椎弓根对应横断面椎体CT值与BMD、T值均呈显著正相关（P<0.001）,腰4椎体相关性较其他三个椎体差。③根据T 值大小,将其中404名女性患者分为骨量正常、骨量减少及骨质疏松3组。组间两两进行比较,椎弓根对应横断面椎体CT值：骨质疏松症组＜骨量减少组＜骨量正常组,差异具有统计学意义（P<0.001）。结论 女性腰椎椎弓根对应横断面椎体松质骨 CT 值随着年龄增大而逐渐减小,与BMD 值、T值呈现显著正相关。其中腰4椎体由于更容易发生退变导致其CT值与BMD值、T值相关性较差。     

放射吸收法测量手指骨密度对于骨质疏松的诊断价值

目的 评价放射吸收法(radiographic absorptiometry, RA)测量指骨骨密度(bone mineral density, BMD)的准确性和对骨质疏松的诊断价值.方法 选取志愿者80例(男性30例,女性50例),分别用RA和双能X线骨密度仪(dual energy X-ray absorptiometry, DXA)测量非优势手的2、3、4指中节指骨BMD值和T值 (n=80),用DXA测量正位腰椎(n=77)、左侧近段股骨(股骨颈、股骨粗隆及全股骨)(n=78)的BMD值和T值.分别以DXA测量正位腰椎T值、左侧近段股骨T值、RA测量指骨T值进行骨质疏松诊断(T值≥-1.0SD为骨量正常,-2.5SD相似文献   

Bone mineral density in patients with ossification of the posterior longitudinal ligament in the cervical spine

Bone mineral density (BMD) has not been clearly determined in patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. BMD in patients with OPLL was measured in the third vertebral body in the lateral projection and in the distal part of the radius in the anteroposterior projection using dual-energy X-ray absorptiometry (DXA). Patients with OPLL had significantly higher BMD than healthy controls in both the lumbar spine and radius. Observing BMD by gender and age group, high BMD was recognized especially in female patients over 60 years of age. Significantly increased BMD was observed in patients with ankylosing spinal hyperostosis (ASH) in addition to OPLL. These findings suggest that patients with OPLL may tend to develop systemic hyperostosis, leading to the pathological ectopic ossification observed in OPLL. Received: July 7, 1998 / Accepted: March 17, 1999     

Measurement of bone mineral density at the spine and proximal femur by volumetric quantitative computed tomography and dual-energy X-ray absorptiometry in elderly women with and without vertebral fractures.

The goal of this study was to determine the effect of vertebral fracture status on trabecular bone mineral density (BMD) measurements obtained in the proximal femur and spine by helical volumetric quantitative computed tomography (vQCT). The study population consisted of 71 Italian women (average age 73 +/- 6) years. This group included 26 subjects with radiographically confirmed atraumatic vertebral fractures and 45 controls. The subjects received helical CT scans of the L1 and L2 vertebral bodies and the hip. The three-dimensional CT images were processed using specialized image analysis algorithms to extract measurements of trabecular, cortical, and integral BMD in the spine and hip. To compare the vQCT results with the most widely used clinical BMD measurement, dual X-ray absorptiometry (DXA) scans of the anteroposterior (AP) spine and proximal femur were also obtained. The difference between the subjects with vertebral fractures and the age-matched controls was computed for each BMD measure. All BMD measurements showed statistically significant differences, which ranged from 7% to 22% between subjects with fractures and controls. Although, given our small sample size, we could not detect statistically significant differences in discriminatory power between BMD techniques, integral BMD of the spine measured by vQCT and DXA tended to show stronger associations with fracture status (0.001 < p < 0.004). Measurements by QCT and DXA at the hip were also associated with vertebral fracture status, although the association of DXA BMD with fracture status was explained largely by differences in body weight between subjects with vertebral fractures and controls.     

Evaluation of lumbar spine bone mineral density in the anteroposterior and lateral projections by dual-energy X-ray absorptiometry.

Dual-energy x-ray absorptiometry (DXA) is an established method for estimating bone mineral density (BMD) of the lumbar spine. In a prospective study, the sensitivity of BMD measurements between anteroposterior and lateral projections were evaluated in 204 postmenopausal women based on their DXA analysis. Patients were divided into two groups according to the absence or presence of lumbar scoliosis. Lateral projection DXA measurements were more sensitive than AP projection measurements for early detection of bone loss in postmenopausal women. Lateral projection DXA analysis is not recommended in spines with lumbar scoliosis.     

New or worsening lumbar spine vertebral fractures increase lumbar spine bone mineral density and falsely suggest improved skeletal status.

Changes in lumbar spine bone mineral density (BMD) are determined by follow-up dual-energy x-ray absorptiometry (DXA) assessments. Inclusion of new or worsening vertebral fractures in follow-up measurements may increase BMD. To test this hypothesis, we examined pooled data from the placebo groups of two clinical trials that involved postmenopausal women with osteoporosis. DXA measurements of lumbar spine BMD, bone mineral content (BMC), and area were obtained at baseline and at two years in the Multiple Outcomes of Raloxifene Evaluation (MORE) Trial and at baseline and study endpoint in the Fracture Prevention Trial. In these trials, fractured vertebrae identified by expert radiologists during posterioranterior (PA) spine DXA assessment were excluded from the BMD assessment. Lateral spine radiographs were graded using a semi-quantitative (SQ) scale. Most new or worsening vertebral fractures (84%) diagnosed from lateral spine radiographs were not identified by PA spine DXA. While the follow-up BMD of vertebrae without new or worsening fractures did not change significantly, each unit increase in SQ grade was associated with an approximate 7.0% increase in the BMD of affected vertebrae (p < 0.001). Increases in BMD were highly correlated with increases in BMC (r = 0.87, p < 0.001). Inclusion of new or worsening vertebral fractures increased PA spine BMD measurements at follow-up, with the impact being related to the magnitude of change in SQ score. It is difficult to reliably identify vertebral fractures from PA spine DXA assessments. Inclusion of new or worsening vertebral fractures in follow-up DXA measurements may falsely suggest an improvement in spine BMD. Our suggestion is to perform lateral spine imaging concurrently with any assessment of PA spine BMD in patients who, in the opinion of the health care provider, may have vertebral fractures.     

Bone Densitometry and Vertebral Fracture Assessment

Measurement of bone mineral density (BMD) is used to diagnose osteoporosis, assess fracture risk, and monitor response to therapy. Of the different methods for measuring BMD, dual-energy X-ray absorptiometry (DXA) is the only technology for classifying BMD according to criteria established by the World Health Organization (WHO) and the only technology that is validated for BMD input with the WHO fracture risk assessment algorithm, FRAX. Vertebral fracture assessment (VFA) by DXA provides an image of the thoracic and lumbar spine for the purpose of detecting vertebral fracture deformities. Identification of a previously unrecognized vertebral fracture may change diagnostic classification, assessment of fracture risk, and treatment decisions. In comparison with standard radiographs of the spine, the correlation for detecting moderate and severe vertebral fractures is good, with a smaller dose of ionizing irradiation, greater patient convenience, and lower cost. Optimal performance of DXA and VFA requires training and adherence to quality standards.     

Correlations between periodontitis and loss of mandibular bone in relation to systemic bone changes in postmenopausal Japanese women

A new method of measuring mandibular alveolar bone mineral density (BMD) was applied to 40 postmenopausal Japanese women aged 50–69 years exhibiting minimal to mild periodontal diseases. Lumbar spine BMD was measured by dual X-ray absorptiometry (DXA) and calcaneus speed of sound (SOS) by quantitative ultrasound (QUS). There were age-related decreases of alveolar BMD, calcaneus SOS and vertebral BMD. There were significant correlations between two of the respective bone mass values. Correlations between clinical dental findings and bone mass data including alveolar BMD, SOS and lumbar spine BMD were investigated. Significant correlations were demonstrated between alveolar BMD and calcaneus SOS or vertebral BMD. Alveolar BMD showed significant correlation with clinical dental findings including periodontal pocket depth and mobility as well as calcaneus SOS and lumbar spine BMD. Using multivariate analysis combinations of univariate predictors, including deoxypyridinoline (DPD), significantly predicted attachment levels. The SOS value was useful combined with other predictors for predicting attachment level. It was concluded that the new method of evaluating alveolar BMD is useful to predict systemic bone mass and strength as well as dental clinical findings.     

Clinical utility of spine bone density in elderly women.

It is common clinical practice to obtain a bone density measurement at both the hip and spine to evaluate osteoporosis. With aging, degenerative changes in the lumbar spine may elevate the bone mineral density (BMD) results giving false assurances that the fracture risk at the spine is low. We examined the association of spine osteoarthritis and bone mineral density in 1082 community-dwelling ambulatory older women aged 50-96 years who participated in a 1992-1996 osteoporosis research clinic visit. The BMD was measured at the hip and posteroanterior (PA) and lateral lumbar spine using dual energy X-ray absorptiometry (DXA). Spine osteoarthritis was identified on the PA lumbar spine DXA images by a musculoskeletal radiologist. Forty percent of women had evidence of spine osteoarthritis (OA). Women with spine OA had a mean age of 77.4 yr (95% confidence interval [CI]: 76.5-78.2), were significantly older than women without spine OA (mean age, 66.8 yr; 95% CI: 65.9-67.7), and were more likely to have prevalent radiographic fractures (14.2% vs. 9.5%; p<0.05). Age-adjusted BMD at the femoral neck, total hip, PA spine, and lateral spine was significantly higher in women with spine OA. Women with spine OA were more likely to have osteoporosis by the World Health Organization classification at the femoral neck and total hip than those without spine OA, but less likely based on the PA spine (14.4% vs. 24.5%). Despite higher BMD levels, women with OA of the lumbar spine had higher prevalence of osteoporosis at the hip and more radiographic vertebral fractures. In elderly women 65 yr and older who are likely to have spine OA, the DXA measurement of the spine may not be useful in assessing fracture risk, and DXA of the hip is recommended for identification of osteoporosis.     

Failure strength of human vertebrae: prediction using bone mineral density measured by DXA and bone volume by micro-CT

Significant relationships exist between areal bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) and bone strength. However, the predictive validity of BMD for osteoporotic vertebral fractures remains suboptimal. The diagnostic sensitivity of DXA in the lumbar spine may be improved by assessing BMD from lateral-projection scans, as these might better approximate the objective of measuring the trabecular-rich bone in the vertebral body, compared to the commonly-used posterior-anterior (PA) projections. Nowadays, X-ray micro-computed tomography (μCT) allows non-destructive three-dimensional structural characterization of entire bone segments at high resolution. In this study, human lumbar cadaver spines were examined ex situ by DXA in lateral and PA projections, as well as by μCT, with the aims (1) to investigate the ability of bone quantity measurements obtained by DXA in the lateral projection and in the PA projection, to predict variations in bone quantity measurements obtained by μCT, and (2) to assess their respective capabilities to predict whole vertebral body strength, determined experimentally. Human cadaver spines were scanned by DXA in PA projections and lateral projections. Bone mineral content (BMC) and BMD for L2 and L3 vertebrae were determined. The L2 and L3 vertebrae were then dissected and entirely scanned by μCT. Total bone volume (BV(tot)=cortical+trabecular), trabecular bone volume (BV), and trabecular bone volume fraction (BV/TV) were calculated over the entire vertebrae. The vertebral bodies were then mechanically tested to failure in compression, to determine ultimate load. The variables BV(tot), BV, and BV/TV measured by μCT were better predicted by BMC and BMD measured by lateral-projection DXA, with higher R(2) values and smaller standard errors of the estimate (R(2)=0.65-0.90, SEE=11%-18%), compared to PA-projection DXA (R(2)=0.33-0.53, SEE=22%-34%). The best predictors of ultimate load were BV(tot) and BV assessed by μCT (R(2)=0.88 and R(2)=0.81, respectively), and BMC and BMD from lateral-projection DXA (R(2)=0.82 and R(2)=0.70, respectively). Conversely, BMC and BMD from PA-projection DXA were lower predictors of ultimate load (R(2)=0.49 and R(2)=0.37, respectively). This ex vivo study highlights greater capabilities of lateral-projection DXA to predict variations in vertebral body bone quantity as measured by μCT, and to predict vertebral strength as assessed experimentally, compared to PA-projection DXA. This provides basis for further exploring the clinical application of lateral-projection DXA analysis.     

Vertebral Anomalies in Retired Rugby Players and the Impact on Bone Density Calculation of the Lumbar Spine

Dual energy X-ray absorptiometry (DXA) lumbar spine bone mineral density (BMD) measurements are subject to artificial elevation in the presence of structural abnormalities that are more common with age and injury, including osteoarthritis, fracture and osteophytes. The aims of this study were to investigate the presence of vertebral abnormalities on DXA scans in retired rugby players and a nonrugby control group, and to explore the effect of vertebral exclusion on the BMD diagnostic outcome. Eigty-seven male retired rugby players and 51 non-rugby controls from the UK Rugby Health Project participated in the study. Lumbar spine, total hip and femoral neck BMD were measured by DXA and scans were analyzed pre and post exclusion of anomalous vertebrae. Data were analyzed by age group to enable application of T-scores (≥50 y) and Z-scores (<50 y). From 138 lumbar spine scans, 66 required adjustment. One hundred twenty-two vertebral exclusions were made, and 12 lumbar spine scans (10 in retired rugby athletes) were un-reportable (<2 evaluable vertebrae). Vertebral exclusion significantly lowered lumbar spine BMD across all groups (p<0.01) and lowered the overall lowest T/Z-score. This effect was more pronounced in rugby groups (age <50 y, p < 0.001; age ≥50 y, p = 0.031) than in the control groups (age <50y, p = 0.125; age ≥50 y, p = 0.250). Vertebral abnormalities detected on lumbar spine scans, were highly prevalent and impacted final the T/Z-score in this cohort of retired rugby players. Current guidelines recommend exclusion of abnormalities from lumbar spine scans in adults aged ≥50 years. Our findings suggest that vertebral exclusions should also be applied to lumbar spine scans performed in those aged <50 years, particularly in former contact sports athletes, given their high risk for vertebral deformity.     

Failure load of thoracic vertebrae correlates with lumbar bone mineral density measured by DXA

Fractures of the thoracic spine account for a large portion of vertebral fractures in the elderly, yet noninvasive measurements of bone mineral properties are limited to the L2–L4 vertebral bodies. The purpose of this investigation was to determine whether bone mineral properties of the umbar spine correlate with the failure properties of thoracic ertebrae. Cadaveric lumbar segments were scanned using dual-energy x-ray absorptiometry (DXA) from both the latcrol and anteroposterior projections. Three-body segments L1–L3 and T10–T12 were then compressed to create crush tractures in the L2 and T11 vertebral bodies, and linear corelation analyses were performed to compare each DXA measure with the failure properties of L2 and T11. Lumbar BMD from the lateral view correlated significantly with T11 altimate load (r=0.94, P<0.001), as did lumbar BMD from the anteroposterior projection (r=0.83, P=0.001). Significant correlations were also found between both lumbar BMD and BMC and the stiffness and energy to failure of I'll. Furthermore, BMD and BMC measured at L2 correlated significantly with L2 ultimate load, stiffness, and energy to failure. We conclude that bone mineral properties measured at the lumbar spine provide a valid assessment of the compressive strength of both thoracic and lumbar vertebrae. Lumbar BMD may therefore be used to derive an index for the prediction of thoracolumbar fractures to aid in the early intervention of vertebral fractures.Portions of this work were presented at the 40th Annual Meeting of the Orthopaedic Research Society and appeared in abstract form in the conference proceedings.