Comparison of ultrasound transmission velocity with computed metacarpal radiogrammetry and dual-photon absorptiometry

The aim of our study was to evaluate the validity of a quantitative US technique for measuring the bone density of the proximal phalanges of the nondominant hand compared with computed metacarpal radiogrammetry and dual-photon absorptiometry (DPA) of the lumbar spine. Mean US bone velocity (UBV) correlated with mean metacarpal cortical index (MCI), with mean metacarpal bone density (MBD) and with bone mineral density (BMD) of the lumbar spine, whereas it was correlated negatively with age and menopause duration. The average UBV was significantly higher in premenopausal women than in postmenopausal women, and higher in normal lumbar DPA patients than in reduced lumbar DPA patients. We conclude that the US evaluation of the nondominant hand proximal phalanges may be a new alternative way for measuring bone mass in screening of osteoporosis. Correspondence to: A. Sili Scavalli     

老年骨质疏松症与腰椎间盘突出症的相关性研究

目的:采用CT及定量CT骨密度(QCT-BMD)检测骨质疏松症患者与骨密度正常人腰椎间盘突出症发病率的差异,探讨骨质疏松症与腰椎间盘突出症的相关性。方法:应用QCT检测技术对本地450例50～78岁受检者进行L2～L4椎体松质骨骨密度测定,并根据T值和BMD值分为骨质疏松症组和骨密度正常组,对两组腰椎间盘突出症发病率进行比较分析。结果:450例中符合骨质疏松症诊断标准为88例,其中男22例,女66例。符合骨质密度正常诊断标准为257例,其中男165例,女92例。88例骨质疏松症组中有38例CT诊断为腰椎间盘突出症,发病率为43.2%,257例骨密度正常组中有70例CT诊断为腰椎间盘突出症,发病率为27.2%,两组发病率差异具有统计学意义(P<0.05)。结论:骨质疏松症患者的腰椎间盘突出症发病率明显高于骨密度正常组,骨质疏松症可视为腰椎间盘突出症的高危因素。     

Comparisons of bone mass measurements on various skeletal sites including quantitative ultrasonography of the calcaneus for assessing age-related losses, their correlations, and diagnostic agreement using the Japanese and WHO criteria for osteoporosis

Purpose The aim of this study was to compare age-related bone losses and correlations among several bone mass measurements and to evaluate diagnostic agreement among them using the Japanese and WHO criteria for osteoporosis. Materials and methods A total of 846 women (mean ± SD: age 54 ± 9 years) were evaluated. Bone mineral densities of the lumbar spine, femoral neck, and calcaneus were measured by dual X-ray absorptiometry and distal radius by peripheral computed tomography. Quantitative ultrasonography (QUS) parameters of the calcaneus were also measured. The age-related bone losses after 50 years of age and correlations among bone mass results were evaluated using linear regression analysis. Diagnostic agreement was evaluated by kappa statistics. Results The annual losses ranged from 1.0% to 1.6%. The correlation coefficients ranged from 0.54 to 0.78. The kappa scores ranged from 0.52 to 0.30 for all subjects using the Japanese criteria and from 0.38 to 0.15 using the WHO criteria. Conclusion Bone mass measurements including QUS on various skeletal sites documented age-related changes similarly, and their bone masses correlated moderately. The diagnostic agreements among them were fair to poor. To screen out women with a risk of osteoporosis, it is important to choose which technique to use and which skeletal site to measure.     

A comparison between quantitative computed tomography and dual-energy densitometry in the study of patients at risk for postmenopausal osteoporosis]

A comparison was made of the densitometric values of the lumbar vertebrae obtained using quantitative Computed Tomography, and those measured with dual energy X-ray absorptiometry. A selected group of patients at increased risk of developing postmenopausal osteoporosis was chosen: women who had undergone bilateral oophorectomy in child-bearing years. The densitometric data recorded revealed a considerable decrease in bone mass, in particular in the cancellous portion of the vertebrae (a 17% change in the quantitative Computed Tomography value and a 13% decrease in that of dual energy X-ray absorptiometry a one year after oophorectomy). Although quantitative Computed Tomography and dual energy X-ray absorptiometry demonstrated a similar trend in bone mass reduction, given the marked and unexplained variability of both absolute values and percent variations, it was impossible to establish a clinically useful mathematical correlation between the two sets of data. Quantitative Computed Tomography is the densitometric procedure of choice to study metabolic bone disorders that involve mainly tha cancellous portion, such as postmenopausal osteoporosis. Nevertheless, given its accuracy, short execution time, lower radiation dose required, as well as good sensitivity in the measurement of bone mass variations, it would seem that dual energy X-ray absorptiometry could also find a place in clinical studies on postmenopausal osteoporosis.     

老年性骨质疏松症多层螺旋CT腰椎骨结构分析和测量研究

目的:探讨多层螺旋CT(MSCT)评判腰椎形态和骨组织细微结构改变、测量腰椎指数及松质骨CT值这3种方法在老年性骨质疏松症中的诊断价值.方法:对100例经双能X线骨密度仪检测诊断为老年性骨质疏松症病例行腰椎MSCT扫描,分别行形态和骨组织细微结构改变评判、腰椎指数测量、松质骨CT值测量等方法评判,将评判和测量结果采用x...     

Appearance of trabecular bone in the femoral neck (Singh index). Relation to vertebral bone mass post mortem.

In 89 consecutive cases trabecular bone mass of the second or third lumbar vertabra was subjectively estimated in post mortem specimens, using frontal section 1 cm in thickness. The trabecular appearance of the femoral neck (Singh index) at radiography and the thickness of the femoral cortical bone were also determined. Agreement between vertebral bone mass and either of the two radiologic indices was present in only two thirds of the cases, and most often these indices underestimated the presence of vertebral osteoporosis. The results indicate that neither of these radiologic indices can be used for clinical guidance of the diagnosis of vertebral osteoporosis in the individual case.     

Effects of projective bone area size of the spine on bone density and the diagnosis of osteoporosis in healthy pre-menopausal women in China

The aim of this study was to understand the effects of projective bone area (BA) size of the spine on bone density and the diagnosis of osteoporosis. Measurements of BA, bone mineral content (BMC), areal bone density (aBMD) and volumetric bone density (vBMD) at the posteroanterior (PA) lumbar spine (vertebrae L2-L4) followed by a paired PA/lateral spine (L2-L4) were made using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) in 1436 healthy pre-menopausal women aged from 20 to 56-years-old. At the PA and lateral lumbar spine, there was a significant positive correlation between BA and BMC (r=0.762 and 0.762, p=0.000) and aBMD (r=0.370 and 0.352, p=0.000), but not vBMD (r=0.000 and 0.102, p=0.813 and 0.063). When BA at the PA spine changed by one standard deviation (SD), BMC and aBMD correspondingly changed by 12.6% and 4.3% on the basis of their respective means while vBMD indicated no change. When a variation of 1 SD was observed in BA at the lateral spine, BMC, aBMD and vBMD correspondingly changed by 13.8%, 4.4% and 1.73% on the basis of their respective means. Through an intercomparison among large, intermediate and small BA groups, significant differences were found in the means of subject's height, weight, BMC and aBMD at the PA and lateral spine as well as the detection rate of osteoporosis by aBMD (p=0.000). Detection rates of osteoporosis by aBMD at the PA, lateral spine and vBMD in healthy pre-menopausal women aged from 40 years to 56 years were 4.5%, 16.4% and 9.7%, respectively, in the small BA group; 1.3%, 6.4% and 7.3%, respectively, in the intermediate BA group; and 0, 0 and 5.5%, respectively, in the large BA group. No significant differences were found in the detection rates of osteoporosis by vBMD among the groups. The results of multiple linear regression revealed that the major factors influencing BA of the lumbar spine was height. In healthy pre-menopausal women of the same race and age, the BA size of the lumbar spine would have significant influence upon aBMD and the diagnosis of osteoporosis, i.e. the larger the BA, the greater the aBMD and the lower the osteoporosis detection rate while conversely, the smaller the BA, the smaller the aBMD and the higher the osteoporosis detection rate. Though vBMD does not change with BA sizes of the lumbar spine, it is a sensitive marker for diagnosing osteoporosis.     

The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements.

In 34 female patients suffering from osteoporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.     

前臂骨密度检测在骨质疏松症中的应用

骨密度是诊断骨质疏松症的最佳定量指标,双能X射线吸收测定法测定的腰椎及髋部骨密度是临床诊断骨质疏松症的"金标准"。对于因年龄和疾病等因素导致腰椎及髋部骨密度检测结果不准确的患者,前臂骨密度检测可作为常规骨密度检测的有力补充。笔者对前臂骨密度检测在骨质疏松症中的应用价值、优势及存在的问题作一综述。     

绝经期女性胸腰椎后凸与椎体压缩骨折相关性分析

目的探讨绝经期女性骨质疏松骨折的临床特点,以及胸腰段脊柱力线对骨折发生的风险分析。方法本研究为病例对照研究,收集自2013年1月至2015年6月因骨质疏松性压缩骨折在北京积水潭医院住院,并行椎体成形术的绝经期女性患者396例(研究组),平均年龄64岁(55~72岁);对照组选取因下腰椎退行性疾病住院手术的患者271例,平均年龄62岁(55~84岁)。记录所有患者入院时的年龄、体质量指数(BMI)、骨密度定量CT(QCT)、骨折椎体。利用站立位X线影像测量胸腰段(T11~L2)矢状位和冠状位的Cobb角。利用患者胸腰段椎体的平均Cobb角,修订并推算骨折前患者T11~L2的矢状位和冠状位Cobb角。分析胸腰段骨质疏松性骨折的临床点和危险因素。结果研究组患者中,T11椎体骨折患者69例(19.6%),T12椎体骨折153例(43.5%),L1椎体骨折174例(49.4%),L2椎体骨折70例(19.9%)。研究组和对照组患者的年龄和BMI差异无统计学意义(P>0.05)。研究组患者修订后的胸腰段矢状位Cobb角为(13.6°±7.6°),对照组为(5.9°±6.0°),两组间差异有统计学意义(P<0.01)。研究组患者修订后胸腰段冠状位Cobb角为(0.4°±4.0°),对照组为(0.1°±4.1°),两组间差异无统计学意义(P>0.05)。使用ROC曲线和尤登指数计算胸腰段矢状位Cobb角,对于胸腰椎骨质疏松性骨折的最佳分界值为7.5°,OR值为7.6(95%可信区间为2.5~22.8)。结论胸腰段矢状位后凸会增加骨质疏松性骨折的风险,后凸Cobb角度>7.5°时,骨折风险增加7倍,但冠状位的侧弯不增加骨折的风险。     

Rate of spinal trabecular bone loss in normal perimenopausal women: CT measurement

Age-related bone loss in women may begin at any time following attainment of peak skeletal maturity bone mass. The rate of bone loss may accelerate near the time of menopause and continue for several years thereafter. Women with low baseline bone mass and women who are fast bone losers are potentially at risk for early spinal osteoporosis. In a prospective longitudinal study, spinal trabecular bone mineral content (BMC) of 83 healthy women, 47-53 years old, was measured with use of computed tomography (CT) at 0, 12, 24, and 36 months. Fifty-four of these same women had a fifth measurement at 48 months. In 51 women the rate of bone loss was less than or equal to 2% per year (average 1.96%; normal bone losers); in 32, it was more than 2% per year (average 5.61%; fast bone losers). CT studies can identify women with low spinal trabecular BMC and/or fast bone loss--women likely to be at increased risk for early spinal osteoporosis. This information may be useful in selection of candidates for vigorous preventive measures, including estrogen replacement.     

Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis

OBJECTIVE: Measurements of mandibular inferior cortical shape and width detected on dental panoramic radiographs may be a useful screening tool for spinal osteoporosis in postmenopausal women. The purposes of this study were to clarify whether these measures are validated compared with simple screening tools based on questionnaires, such as the osteoporosis self-assessment tool (OST) and whether these measures can be used in postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. SUBJECTS AND METHODS: We calculated the diagnostic performances of panoramic measurements and the OST for identifying women with spinal osteoporosis in both 159 healthy postmenopausal and 157 postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. Spinal osteoporosis was defined as a bone mineral density T score of -2.5 or less at the lumbar spine. Cortical shape and width were evaluated on dental panoramic radiographs. Receiver operating characteristic curve analyses were used to determine the optimal cutoff thresholds for cortical width and the OST in healthy postmenopausal women. RESULTS: The sensitivity and specificity, respectively, for identifying women with spinal osteoporosis were 89.5% and 33.9% for cortical width, 86.8% and 57.8% for the OST, and 86.8% and 63.6% for cortical shape in healthy postmenopausal women. Sensitivity and specificity, respectively, were 92.5% and 35.0% for cortical width, 72.5% and 58.1% for the OST, and 80.0% and 64.1% for cortical shape in postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. CONCLUSION: Dentists may be able to refer postmenopausal women with suspected spinal osteoporosis for bone densitometry on the basis of dental panoramic radiographs with diagnostic performance similar to that of osteoporosis screening tools based on questionnaires.     

Bone mineral content in early-postmenopausal and postmenopausal osteoporotic women: comparison of measurement methods

To investigate associations among methods for noninvasive measurement of skeletal bone mass, we studied 40 healthy early postmenopausal women and 68 older postmenopausal women with osteoporosis. Methods included single- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiography was performed, and a spinal fracture index was calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and modest correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were modest in healthy women and poor in osteoporotic women. Measurements resulting from one method are not predictive of those by another method for the individual patient. The strongest correlation with severity of vertebral fracture is provided by QCT; the weakest, by SPA. There was a high correlation between single- and dual-energy QCT results, indicating that errors due to vertebral fat are not substantial in these postmenopausal women. Single-energy QCT may be adequate and perhaps preferable for assessing postmenopausal women. The measurement of spinal trabecular bone density by QCT discriminates between osteoporotic women and younger healthy women with more sensitivity than measurements of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT.     

Factors affecting bone loss in female endurance athletes: a two-year follow-up study

BACKGROUND: Low bone mass leading to stress fractures is a well-known and yet unsolved problem among female athletes. PURPOSE: To quantify the rate of bone loss in healthy female athletes and investigate the effects of estrogen and vitamin K supplementation on bone loss. STUDY DESIGN: Prospective cohort study. METHODS: We classified 115 female endurance athletes into amenorrheic, eumenorrheic, or estrogen-supplemented groups and randomized them to receive either placebo or vitamin K(1). The bone mineral densities of the subjects' femoral neck and lumbar spine were measured at baseline and after 2 years. RESULTS: Bone mineral density in the lumbar spine remained constant, but bone density in the femoral neck had decreased significantly after 2 years in all three subgroups. The decrease was higher in amenorrheic (-6.5% +/- 4.0%) than in eumenorrheic (-3.2% +/- 4.1%) and estrogen-supplemented athletes (-3.9% +/- 3.1%). Supplementation with vitamin K did not affect the rate of bone loss. CONCLUSIONS: The rate of bone loss in all three subgroups of female athletes was unexpectedly high; neither estrogen nor vitamin K supplementation prevented bone loss. Clinical Relevance: High-intensity training maintained over several years must be regarded in women as a risk factor for osteoporosis, and protocols for optimal treatment should be developed.     

DXA椎体骨折评估联合腰椎侧位骨密度诊断老年性骨质疏松的临床研究

目的研究双能X线吸收检测法（DXA）椎体骨折评估（VFA）联合腰椎侧位骨密度诊断老年性骨质疏松的效能。方法选取我院DXA同时检测髋部、腰椎前后位、腰椎侧位骨密度及VFA的老年受检者86例,根据DXA骨密度低下或VFA有脆性骨折诊断骨质疏松。比较腰椎侧位骨密度联合VFA与常规DXA检测髋部及腰椎前后位骨密度诊断骨质疏松的检出率。检出率的比较采用χ2检验。结果所有受检者中,常规DXA检测髋部及腰椎前后位诊断出骨质疏松患者58例（58/76,76.3%）,侧位骨密度联合VFA诊断出骨质疏松患者76例（76/76,100%）,二者检出率差异有统计学意义（χ2=10.617,P < 0.001）。其中,股骨颈骨密度诊断骨质疏松疏检出率（55.3%）高于髋部整体（34.2%）,二者差异有统计学意义（χ2=6.812,P < 0.05）;髋部骨密度、腰椎前后位骨密度、腰椎侧位骨密度和VFA诊断骨质疏松症检出率分别为60.5%、47.4%、84.2%和78.9%,腰椎侧位骨密度与VFA的骨质疏松检出率比较,差异无统计学意义（χ2=0.700,P>0.05）,但二者均高于髋部骨密度的骨质疏松检出率（χ2=10.66、6.110,均P < 0.05）。结论DXA检测腰椎侧位骨密度联合VFA对老年性骨质疏松的诊断具有重要价值,能够避免骨质疏松的漏诊。     

肾移植术后患者骨密度水平的调查研究

 目的 探讨肾移植术后患者与正常体检人群骨密度(bone mineral density, BMD)水平,以及骨量丢失(骨量减少和骨质疏松)发病率的差异。方法 选择在武警总医院随访的肾移植患者177例(男104例,女73例),根据女性是否绝经和男性年龄将入选者分为＜50岁男性、≥50岁男性、绝经前女性和绝经后女性移植组。选择同期在我院体检的正常人群250例(男131例、女119例)作为对照组。采用双能X线骨密度仪测定所有人的腰椎、右股骨颈和右全髋BMD,比较各移植组与对照组BMD以及骨量丢失发病率的差异。结果 各肾移植组患者股骨颈和全髋骨密度均低于对照组(P<0.01);＜50岁男性肾移植患者腰椎骨密度低于对照组(P<0.01)。男性和绝经后女性移植患者骨量丢失(包括骨量减少和骨质疏松)发病率显著高于对照组(P<0.01)。结论 肾移植患者骨密度水平明显低于正常体检人群,且骨量丢失的发病率高于正常人群。建议肾移植患者术后在维生素D和钙剂的基础上,选用双膦酸盐防治骨质疏松和骨折。     

Osteoporosis

Osteoporosis, a condition of decreased bone tissue that increases the likelihood of fracture, places a significant burden on our society in terms of health cost and morbidity. The most common type of osteoporosis is involutional, and two subtypes are recognized: type 1 and type 2. Type 1, or postmenopausal, osteoporosis is most commonly seen in perimenopausal and postmenopausal women from ages 51 to 75. Estrogen deficiency is the most dominant factor in the pathogenesis of this disorder. Type 2, or aging related, osteoporosis is seen in elderly women and men aged 70 or more. Bone loss in this group is related to aging, estrogen deficiency, negative calcium balance, and a variety of environmental and genetic factors. The best approach to the management of osteoporosis is to develop a lifelong strategy that maximizes peak bone mass and minimizes aging-related and postmenopausal bone loss. Estrogen is the only medication approved for the prevention of bone loss that is in general use. Other strategies to prevent bone loss (and maximize peak bone mass) include adequate calcium intake, adequate exercise, and avoidance of excess alcohol, tobacco, and caffeine use.     

Effect of exercise on bone: permissive influence of estrogen and calcium

Estrogen deficiency in postmenopausal women is associated with low lumbar bone mineral density and an increased incidence of fractures of the vertebrae and proximal femur. Estrogen deficiency in premenopausal women with secondary amenorrhea related to athletic training or anorexia nervosa is also associated with decreased lumbar bone mineral density. The purpose of this review is to present four concepts related to the adaptations of bone to physical exercise, as a basis to explain the loss of bone mass in women with athletic amenorrhea. These concepts are based on Lanyon's theory of a Minimum Effective Strain-Related Stimulus. The bone remodeling response to estrogen deficiency is an increase in the rate of bone remodeling activity and in the rate of bone resorption relative to formation, resulting in a net loss of bone mass. In the presence of estrogen deficiency, the stimulus of physical activity is thought first to decrease the rate of turnover and secondly to increase bone formation. Endurance exercise training appears to be an insufficient stimulus to accomplish both tasks, which may explain why these athletes often have low lumbar bone mineral density.     

Relationship between bone mineral density and tooth loss in elderly Japanese women.

OBJECTIVE: To evaluate the relationship between vertebral bone mass and tooth loss and jaw bone mass in elderly Japanese women. METHODS: Mandibular cortical bone mass, alveolar bone height and number of teeth present (total, anterior, and posterior) were compared with the 3rd lumbar vertebral bone mineral density (L3BMD), measured by dual energy computed tomography (DEQCT), in 90 Japanese women by means of multiple regression analysis, controlling for body mass index, menopausal status, years since menopause and self-reported periodontal condition. RESULTS: Mandibular cortical bone mass and number of posterior teeth were associated with both alveolar bone height and L3BMD, but there was no association between alveolar bone height, number of anterior teeth present and L3BMD. CONCLUSION: Our results suggest that the loss of posterior teeth may be associated with a decrease not only in alveolar bone height, but also alveolar bone mineral density (BMD). The latter may be related to a decrease of lumbar vertebral BMD.     

模拟失重对大鼠下颌骨、腰椎和股骨组织结构的影响

目的了解模拟失重对大鼠不同部位骨骼组织结构的影响。方法25只大鼠,随机分为2组:对照组(n=10)和头低位30°尾吊组(n=15)。实验第28天时,取2组动物的下颌骨、腰椎和股骨。观察指标为下颌骨髁状突、下颌骨体磨牙区和前磨牙区、第一腰椎、股骨头、股骨中段和股骨髁部的组织学结构。结果对照组和尾吊组髁状突骨形态学结构无明显差别,只是尾吊组骨小梁之间的交织程度增加。2组下颌骨体部骨质均较致密,骨质结构、牙周膜厚度无明显差别。与对照组比,尾吊组前磨牙区骨板排列规则,成熟程度比磨牙区高;尾吊组磨牙区骨增生线排列紊乱不规则,示骨质改建较多。与对照组比,尾吊组股骨、腰椎骨小梁成分减少,粗细不均匀,小梁之间交织连接程度差。结论4周模拟失重可以引起脊椎骨股骨的骨质疏松,但是对下颌骨没有明显的影响。