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)     

广东湛江地区老年人骨密度及骨质疏松患病率的初步调查

目的探讨湛江地区老年人骨密度（BMD）现状,为广东粤西沿海地区老年人骨质疏松症的防治提供科学依据。方法①采用美国Hologic QDR 4500A型双能X线骨密度仪对480例老年人的腰椎及髋部进行测量及分析。②按年龄、性别输入数据,以5岁为1个年龄组,分别计算骨密度。结果①60、70、80岁男性第2～4腰椎BMD分别为0.932、0.870、0.739,女性分别为0.831、0.707、0.647。②60、70、80岁男性Neck和Ward’s区BMD分别为0.752和0.683、0.734和0.650、0.671和0.593;女性分别为0.724和0.650、0.617和0.568、0.556和0.482。③60、70、80岁骨质疏松患病率男性为15.1%、28.9%和25.0%,女性为24.0%、47.5%和62.5%,女性骨质疏松患病率高于男性,差异有统计学意义（P〈0.05）。结论湛江地区老年人随着年龄的增加,男、女性腰椎和髋骨的骨密度逐渐下降。骨质疏松患病率随年龄增加而上升,同龄女性组骨质疏松患病率高于男性组。     

骨密度定量CT测定的实验和临床研究

应用统一的同时校正技术和测量方法对24个离体椎体和64个活体椎体作了mAs、kVp和机型(Somaton CR、Cytec300、GE9800)对骨密度(BMD)测定影响的研究。结果提示:(1)低mas、低kVp扫描是可行的,既大大降低扫描剂量,又不显著影响BMD值,故具重要的临床应用价值;(2)同机、同kVp扫描能灵敏地反映BMD变化;(3)同kVp或相近kVp不同机型的扫描能增加BMD值的可比性,但不同机型间BMD测量值比较价值有限;(4)使用通用标准校正体模及同时校正技术,制定正规扫描技术和测量方法,能提高测量的准确性和可靠性,避免不必要的重复研究。     

Estimation of wrist fracture load using phalangeal speed of sound: an in vitro study

This study aimed to evaluate the ability of speed of sound (SOS) measured at the phalanges to estimate simulated wrist fracture load and stress. SOS was measured along the proximal phalanges of the second, third and fourth fingers using an ultrasound (US) system operating in axial transmission mode. The bone mineral density (BMD) of the radius and the phalanges was also measured with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA), and the combined cortical thickness (CCT) of the phalanges was measured from hand radiographs. After the measurements were completed, the radius was excised from the cadaver, embedded in polymethylmethacrylate and tested to failure on a servohydraulic testing machine. The configuration of the radius was chosen to simulate a fall onto the hand. Linear regression analysis showed a highly significant correlation between SOS (r = 0.76–0.94, p < 0.001), CCT (r = 0.86–0.90, p < 0.001) and BMD (r = 0.92–0.96, p < 0.0001) in the three proximal phalanges measured. SOS, BMD and CCT were significant predictors of fracture load (r = 0.60–0.69, p < 0.03) and stress (r = 0.65–0.77, p < 0.02). Cortical area and bone mineral content (BMC) of the radius were consistently higher predictors of fracture load (r = 0.76–0.82, p < 0.01 for area and R = 0.78–0.88, p < 0.01 for BMC) than BMD. The correlation of BMC and area was poorer with fracture stress. In a step-wise regression analysis using both phalangeal BMD and SOS, only SOS remained a significant predictor of fracture stress. In forward stepwise regression analysis, both cortical area and SOS were entered into the regression model to estimate fracture load. Only SOS remained significant in the model for estimating fracture stress. Phalangeal BMD was only entered in the combined model with the cortical area at the 4% site (r = 0.84, p = 0.002). Phalangeal SOS is a useful parameter in the assessment of bone status of the radius.     

Estimation of wrist fracture load using phalangeal speed of sound: an in vitro study

This study aimed to evaluate the ability of speed of sound (SOS) measured at the phalanges to estimate simulated wrist fracture load and stress. SOS was measured along the proximal phalanges of the second, third and fourth fingers using an ultrasound (US) system operating in axial transmission mode. The bone mineral density (BMD) of the radius and the phalanges was also measured with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA), and the combined cortical thickness (CCT) of the phalanges was measured from hand radiographs. After the measurements were completed, the radius was excised from the cadaver, embedded in polymethylmethacrylate and tested to failure on a servohydraulic testing machine. The configuration of the radius was chosen to simulate a fall onto the hand. Linear regression analysis showed a highly significant correlation between SOS (r = 0.76–0.94, p < 0.001), CCT (r = 0.86–0.90, p < 0.001) and BMD (r = 0.92–0.96, p < 0.0001) in the three proximal phalanges measured. SOS, BMD and CCT were significant predictors of fracture load (r = 0.60–0.69, p < 0.03) and stress (r = 0.65–0.77, p < 0.02). Cortical area and bone mineral content (BMC) of the radius were consistently higher predictors of fracture load (r = 0.76–0.82, p < 0.01 for area and R = 0.78–0.88, p < 0.01 for BMC) than BMD. The correlation of BMC and area was poorer with fracture stress. In a step-wise regression analysis using both phalangeal BMD and SOS, only SOS remained a significant predictor of fracture stress. In forward stepwise regression analysis, both cortical area and SOS were entered into the regression model to estimate fracture load. Only SOS remained significant in the model for estimating fracture stress. Phalangeal BMD was only entered in the combined model with the cortical area at the 4% site (r = 0.84, p = 0.002). Phalangeal SOS is a useful parameter in the assessment of bone status of the radius.     

Use of decision rules for osteoporosis prevention and treatment: implications for nurse practitioners

PURPOSE: To describe the current literature regarding the benefits of bone mineral density (BMD) screening and to discuss clinical decision rules for BMD screening. DATA SOURCES: Extensive review of the scientific literature regarding osteoporosis, BMD screening, and current clinical decision rules. CONCLUSIONS: Osteoporosis is a disease characterized by deterioration of bone and increased susceptibility to fractures, crippling, and disfigurement. BMD testing is the best predictor for osteoporosis and associated fractures; however, routine global BMD testing is cost-prohibitive. A need exists for a selective and practical clinical decision rule for referral for testing. IMPLICATIONS FOR PRACTICE: Several effective clinical decision rules are presented, and their uses and applications are described. The osteoporosis self-assessment tool is recommended by the authors because of its predictive power and ease of use.     

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.     

Representativity of regional to total bone mineral in healthy subjects and 'anticonvulsive treated' epileptic patients. Measurements by single and dual photon absorptiometry

Dual photon (153Gd) and single photon (125I) absorptiometry were used to measure the regional bone mineral content (BMC) and density (BMD), as well as the total body mineral content (TBBM) and density (TBBD), in sixty-nine healthy subjects and in twenty-three epileptics on phenobarbitone. The BMCs (and BMDs) of all regions were significantly correlated to each other and to the TBBM (and TBBD). No difference in the ability to discriminate between the different study groups was found for the various regions, excepting the BMD of the head. The relationship between the forearm BMC and TBBM was highly significant, and identical in the five groups. The relationships between spinal BMC and forearm BMC, and TBBM differed in the five groups. It is concluded that some local measurement may be used as estimates of the total body bone mineral in some groups of patients with minor metabolic bone disease and healthy subjects.     

正常儿童跟骨超声骨密度测定及其影响因素

目的 在建立定量超声骨密度测量精密度的基础上,分析正常儿童超声骨密度的变化规律及其影响因素.方法 采用定量超声(QUS)技术测定长居广州市的475名6～12岁正常儿章的跟骨QUS参数[超声传导速度(SOS)、超声衰减系数(BUA)和骨强度指数(STI)],同时测量受检者身高和体重.结果 同年龄男、女章的SOS、BUA和STI差异均无统计学意义.6～12岁正常儿童SOS值随年龄增加而降低,BUA值随年龄增加而增加.STI值男童在9岁、女童在8岁降至最低,之后随年龄增加而增加,在11岁出现一个高峰后又下降.年龄和身高是超声骨密度参数的主要决定因素.结论 6～12岁正常儿童的跟骨超声骨密度因年龄不同而呈现不同规律;年龄和身高是影响儿童骨密度的重要因素.     

老年男性吸烟与骨转换标志物、骨密度和骨质疏松性骨折风险的关系

目的 调查老年男性吸烟与骨转换标志物、骨密度和骨质疏松性骨折风险的关系.方法 调查576例60～97岁老年男性吸烟等情况,按照是否吸烟分成吸烟组31例和非吸烟组545例.检测两组骨转换标志物[包括I型胶原羧基末端肽交联(CTX)、I型前胶原氨基端前肽(P1NP)和骨钙素(OC)]、骨密度[包括股骨颈骨密度(FNBMD)...     

The assessment of development of bone mass in children by quantitative ultrasound through the proximal phalanxes of the hand

The purpose of this study was to determine the relationship between quantitative ultrasound and age and body size, and to establish reference ranges for speed of sound (Ad-SoS) in the phalanxes of children. Healthy children (433), aged from 9 to 15 y were studied (226 girls and 207 boys). Ultrasound device (DBM Sonic 1200, IGEA, Italy) measuring the Ad-SoS through the phalanxes was used. Up to 11 y, the mean values for boys and girls were not significantly different. The increase of values was observed in the girls at 11 y, in the boys 2 y later. Stepwise multiple linear-regression analysis has shown that, in girls, the main factor influencing Ad-SoS was age and, in boys, height and weight. In the study, the ability of measurements of proximal phalanxes to reveal skeletal changes in healthy Polish children was shown. The study enabled us to establish the reference curves for healthy Polish children.     

血清骨钙素水平与绝经后女性2型糖尿病患者骨密度的关系

目的:探讨血清骨钙素水平与绝经后女性2型糖尿病(type 2 diabetes,T2DM)患者骨密度(bone minaral density,BMD)间的关系。方法:本研究为回顾性分析,共纳入505例绝经后女性,其中T2DM住院患者305例,非糖尿病对照者200例,采用双能X线骨密度仪(DXA)检测腰椎(第2至第4腰椎)、股骨颈和全髋的BMD,同时检测血清骨钙素(osteocalcin,OC)水平。结果:与正常对照组相比,T2DM组患者的血清OC水平显著降低(P<0.05),腰椎、股骨颈、全髋的BMD及体质量指数显著增高(P<0.01)均呈显著负相关;校正年龄、体质量指数和糖尿病病程后,血清OC水平与腰椎及全髋的BMD间仍存在明显的负相关。结论:血清OC水平与绝经后女性T2DM患者腰椎及全髋的BMD密切相关,随着OC水平的升高,BMD呈下降趋势,提示血清OC水平可作为早期筛查绝经后女性T2DM患者骨质疏松的生化指标,结合血清OC水平和BMD能更好地预测绝经后女性T2DM患者的骨质疏松和骨折的风险。     

Prevalence of low bone mineral density in inpatients with traumatic brain injury receiving neurobehavioural rehabilitation: a postoperative,observational study

Background

Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors.

Objectives

To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice.

Design

Prospective, observational.

Setting

Specialist, residential unit providing care for individuals with brain injury, many with a history of severe challenging behaviour.

Participants

Current inpatients (n = 51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years).

Methods

Participants’ BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected.

Results

Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia.

Conclusions

Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.     

绝经后妇女椎体骨骼大小对骨密度和诊断骨质疏松的影响

目的：探讨绝经后妇女椎体骨骼大小对骨密度（BMD）和诊断骨质疏松（OP）的影响。方法：采用QDR－4500A型扇形束双能X线吸收法骨密度仪，测量1081例年龄42－96岁健康绝经妇女腰椎妇女腰椎正位投射骨面积（BA）、骨矿含量（BMC）、面积骨密度（ABMD）及腰椎侧位面积骨密度和体积骨密度（VBMD）。结果：BA与骨矿含量（r=0.606)和面积骨密度（r=0.270,P=0.000)呈正相关，与体积骨密度相关无显著性意义（r=-0.055,P=0.101).BA每增加1cm^2，骨矿含量和面积骨密度分别相应增加6．29％和1．28％。大BA组与中等BA组及中等BA组与小BA组比较，妇女的身高、体重、骨矿含量、面积骨密度和OP检出率的差异均具有显著性的意义（P＝0．000）。腰椎正位和侧位的OP检出率，大BA组分别为24．9％和39．9％，中等BA组分别为36．4％和54．5％，小BA组分别为55．2％和70．9％。各组之间体积骨密度的OP检出率的差异无显著性的意义。多元线性回归分析结果显示，影响骨骼大小和骨密度的主要因素为身高和体重。结论：绝经后妇女腰椎较大者面积骨密度较高和OP检出率较低，椎体较小者面积骨密度较低和OP检出率较高。腰椎体积骨密度不随骨骼大小而改变。腰椎侧位骨密度检测是诊断OP的敏感部位。     

基于双能X线吸收测量法的三种胫骨软骨下骨骨密度测量方法的信度与效度分析

目的 观察基于双能X线吸收测量法(DXA)的三种胫骨近端软骨下骨骨密度检测方法的信度与效度。方法 招募28名健康女性,利用双能X线骨密度仪扫描膝关节;由2名研究者分别应用三种不同测量方法选取ROI进行测量分析,通过计算组内相关系数值(ICC),评价各方法的复测信度与测量者间信度,利用t检验评价区分效度。结果 三种方法均具有较好的复测信度(ICC 0.833~0.998)与测量者间信度(ICC 0.905~0.997),且对低年龄者和高年龄者具有较好的区分效度(P<0.05)。结论 利用双能X线骨密度仪研究膝关节软骨下骨具有可行性;本研究分析的三种测量方法可有选择地用于临床研究。     

两种骨质疏松自我评价工具应用于围绝经期和绝经后妇女的筛检效果比较

目的 评价亚洲骨质疏松自我评价工具(OSTA)和我国妇女骨质疏松筛选工具(OSTC)与四川地区围绝经期和绝经后汉族妇女骨密度的关系,比较两种工具对骨质疏松症的筛检能力,探讨其临床应用价值.方法 2010年7-10月筛选获得356名45岁以上妇女的双能X线骨密度仪腰椎、股骨颈和全髋骨密度数据,利用体重和年龄分别计算OST...     

Quantitative bone ultrasound at phalanges and calcaneus in osteoporotic postmenopausal women: influence of age and measurement site

Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmenopausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than -2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group (p < 0.05). When patients aged <70 y (n = 43) and patients aged > or = 70 y (n = 84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group (p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one (p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life.     

维持性血液透析患者发生骨折与骨矿物质代谢紊乱的关系

目的 观察维持性血液透析（MHD）患者发生骨折与患者预后的关系以及骨代谢指标监测对临床的指导意义。方法 采用前瞻队列研究,从2010～2012年对中国中医科学院广安门医院血液净化中心行MＨD的158例患者进行随访,记录患者干体质量变化,陈旧及新发生骨折例数,新发骨折对患者生存以及心血管事件发生情况的影响,定期监测患者血钙、磷、碱性磷酸酶、全段甲状旁腺素（iPTH）、总维生素D（总VitD）、Ⅰ型胶原交联Ｃ末端肽,骨钙素,降钙素,比较新发生骨折者与未发生骨折者上述指标以及预后的差异。结果 研究开始时已存在陈旧骨折者27例,随访期内新发骨折21例,平均骨折发生率为：4．43／100个患者年,均为脆性骨折。与未发现骨折者比较,新发生骨折患者年龄更大,ALP水平较高,女性所占比例较高,体质指数较低,干体质量呈下降者更多（P〈０．05）,规律使用骨化三醇或阿发骨化醇者比例较低（42．86％比72．26％,P〈０．05）,随访期内死亡及心血管事件发生率较高,分别为：66．67％比18．98％和52．38％比10．95％（P〈0．05）,2组患者其余矿物质及骨代谢相关指标均未见明显差异。发生骨折后未接受骨科固定治疗者1年内死亡率明显高于接受治疗者（70．59％比25．00％）,寿命表生存分析显示新发骨折使MHD患者累计生存率较未骨折组明显降低（中位生存月15．75比36．00）。Logistic回归表明干体质量下降、女性是MHD患者发生骨折的独立危险因素,OR值分别为42．94（95％CI：9．31,196．34）和3．47（95％CI：1．11,10．84）。结论 老龄、女性、干体重下降、血ALP水平增高、未规律补充维生素D治疗可能与MHD者骨折风险增高有关;除ALP外,其余骨代谢指标对预测骨折风险意义有限。骨折与MHD患者死亡及心血管事件风险明显增高有?     

老年骨质疏松性骨折骨量与骨质量关系的探讨

目的:探讨老年股骨颈骨折患者的骨量与骨质量两者的关系与规律。方法:取老年股骨颈骨折患者股骨头和正常青年股骨头,行骨密度测量后,进行扫描电镜观察和形态计量学检测。结果:86.5%病例符合WHO骨质疏松症诊断标准,43.2%病例股骨颈骨密度在骨折阈值之上。扫描电镜下观察发现:骨折患者骨小梁发生明显变化。形态计量学显示:老年组骨小梁游离末端数(FET)、平均骨小梁间距(MTPS)较青年组明显升高(P<0.01),小梁间连接点数(Tb.n)、松质骨体积(TBV)、平均骨小梁密度(MTPD)、平均骨小梁厚度(MTPT)明显减少(P<0.01)。结论:术后股骨头标本行扫描电镜观察和形态计量学分析是一种简便而准确的诊断骨量与骨质量下降的方法。     

老年妇女体重指数与骨密度和骨超声传导速度的相关性研究

目的　研究体重指数 (BMI)对老年妇女骨密度 (BMD)和骨强度的影响 ,为骨质疏松症 (OP)的预防提供科学依据。方法　采用双能X线骨密度仪和定量骨超声仪 ,测量 319例老年妇女不同骨骼部位的BMD和胫骨超声传导速度 (SOS) ,并按BMI不同分为低体重组 (BMI <2 0 )、正常体重组 (BMI =2 0～ 2 4)和肥胖组 (BMI >2 4)进行分析和比较。结果　除腰椎侧位外 ,老年妇女各部位BMD和胫骨SOS均与BMI呈正相关 (r=0 .2 6 7～ 0 .446和r =0 .16 2 ,P <0 .0 0 1和P =0 .0 0 4) ;正常体重组各部位BMD和胫骨SOS均高于低体重组对应部位 (P <0 .0 5～P <0 .0 0 1) ,而肥胖组均高于低体重组和正常体重组对应部位 (P <0 .0 0 1和P <0 .0 5～P<0 .0 0 1) ;除腰椎侧位 3组间差异无显著性外 ,老年妇女各部位OP的患病率 :低体重组 >正常体重组 >肥胖组。结论　BMI高者可能通过雌激素和负重等作用 ,延缓老年妇女BMD和骨强度下降 ,但对腰椎侧位影响小。