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1.
Proximal Femur Geometry To Detect and Distinguish Femoral Neck Fractures from Trochanteric Fractures in Postmenopausal Women 总被引:19,自引:4,他引:15
S. Gnudi C. Ripamonti L. Lisi M. Fini R. Giardino G. Giavaresi 《Osteoporosis international》2002,13(1):69-73
Some proximal femur geometry (PFG) parameters, measured by dual-energy X-ray absorptiometry (DXA), have been reported to
discriminate subjects with hip fracture. Relatively few studies have tested their ability to discriminate femoral neck fractures
from those of the trochanter. To this end we performed a cross-sectional study in a population of 547 menopausal women over
69 years of age with femoral neck fractures (n= 88), trochanteric fractures (n= 93) or controls (n= 366). Hip axis length (HAL), neck–shaft angle (NSA), femoral neck diameter (FND) and femoral shaft diameter (FSD) were measured
by DXA, as well as the bone mineral density (BMD) of the nonfractured hip at the femoral neck, trochanter and Ward’s triangle.
In fractured subjects, BMD was lower at each measurement site. HAL was longer and NSA wider in those with femoral neck fractures.
With logistic regression the age-adjusted odds ratio (OR) for a 1 standard deviation (SD) decrease in BMD was significantly
associated at each measurement site with femoral neck fracture (femoral neck BMD: OR 1.9, 95% confidence interval (95% CI):
1.4–2.5; trochanter BMD: OR 1.6, 95% CI 1.2–2.0; Ward’s triangle BMD: OR 1.7, 95% CI 1.3–2.2) and trochanteric fracture (femoral
neck BMD: OR 2.6, 95% CI 1.9–3.6; trochanter BMD: OR 3.0, 95% CI 2.2–4.1; Ward’s triangle BMD: OR 1.8, 95% CI 1.4–2.3). Age-adjusted
OR for 1 SD increases in NSA (OR 2.2, 95% CI 1.7–2.8) and HAL (OR 1.3, 95% CI 1.1–1.6) was significantly associated with the
fracture risk only for femoral neck fracture. In the best predictive model the strongest predictors were site-matched BMD
for both fracture types and NSA for neck fracture. Trochanteric BMD had the greatest area (0.78, standard error (SE) 0.02)
under the receiver operating characteristic curve in trochanteric fractures, whereas for NSA (0.72, SE 0.03) this area was
greatest in femoral neck fractures. These results confirm the association of BMD with proximal femur fracture and support
the evidence that PFG plays a significant role only in neck fracture prediction, since NSA is the best predictive parameter
among those tested.
Received: 24 April 2001 / Accepted: 1 August 2001 相似文献
2.
Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women 总被引:19,自引:6,他引:13
C. Gómez Alonso M. Díaz Curiel F. Hawkins Carranza R. Pérez Cano A. Díez Pérez 《Osteoporosis international》2000,11(8):714-720
The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft
angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All
parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years)
with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women;
aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly
lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic
regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck
BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45
(95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95%
CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40
(95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except
for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.
Received: 16 September 1999 / Accepted: 22 February 2000 相似文献
3.
Primary hyperparathyroidism (PHPT) may result in greater cortical than trabecular bone loss. Ultrasound is able to predict
osteoporotic fracture risk independent of densitometric measurements, but little is known about the changes in ultrasound
variables with PHPT. The aim of our study was to examine the effect of PHPT on ultrasound variables and bone density measurements
at cortical (hand) and trabecular (lumbar spine and heel) sites, and to evaluate their reversibility following surgical treatment.
We recruited 25 postmenopausal women diagnosed with PHPT ages 51–76 years (mean 62 years) and 95 postmenopausal controls ages
57–80 years (mean 67 years). Measurements were made at baseline and 1 year. Speed of sound (SOS) and broadband ultrasound
attenuation (BUA) of the heel were measured using the Lunar Achilles (LA+) and McCue CUBA Clinical (CC). Amplitude-dependent
speed of sound (AD-SoS) and ultrasound bone profile index (UBPI) of the fingers were measured using the IGEA DBM Sonic. Bone
mineral density (BMD) of the hand and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). At baseline,
hand BMD, LS BMD and heel BUA were significantly lower and finger UBPI significantly higher in the PHPT patients compared
with controls (p<0.001). There were no differences in Stiffness Index, heel SOS or finger AD-SoS between control and PHPT subjects. At 1 year
postoperatively, there was a mean (±SD) increase in LS and hand BMD of 3 ± 1% (p<0.01). BUA at the heel increased (11 ± 5%, p<0.001), and UBPI of the fingers decreased (17 ± 7%, p<0.001) probably reflecting different modes of attenuation in trabecular (scattering) and cortical (absorption) bone. Stiffness
Index, SOS of the heel and AD-SoS of the fingers did not change. BUA, UBPI and BMD returned towards normal postmenopausal
values following surgery. There were no changes in BMD or QUS variables at 1 year in the control group. Quantitative ultrasound
(QUS) measurements provide different information about bone structure than densitometric measurements and cannot be regarded
as simply reflecting bone density. With further research the combined use of BMD and QUS could improve the assessment of skeletal
status in patients with PHPT before and after surgery.
Received: 10 September 2001 / Accepted: 31 January 2002 相似文献
4.
T. S. Wei C. H. Hu S. H. Wang K. L. Hwang
Departments of 《Osteoporosis international》2001,12(12):1050-1055
Hip fracture is the most serious consequence of osteoporosis, frequently occurring in the elderly; however, no research has
been performed to identify the fall characteristics, functional mobility and bone mineral density (BMD) concurrently as risk
factors. We investigated the risk factors of hip fractures using a multifactorial approach for a further preventive strategy.
This age- and sex-matched case-control study was conducted in a community-based general hospital. A total of 252 consecutive
community-dwelling ambulatory elderly, aged between 65 and 85 years, were studied: 127 patients (faller with hip fracture)
and 125 controls (faller without hip fracture). Body mass index (BMI), predisposing medical conditions, fall characteristics,
functional mobility and BMD of the hip were evaluated by direct interview and clinical examination. In the final model of
multivariate regression analysis, risk factors for hip fracture were direct hip impact (adjusted odds ratio (OR), 4.9; 95%
confidence interval (CI), 2.7–8.8), previous stroke (adjusted OR, 2.9; 95% CI, 1.3–6.3), sideways fall (adjusted OR, 2.5;
95% CI, 1.6–3.9), functional mobility (a decrease of 1 SD; adjusted OR, 2.0; 95% CI, 1.1–3.5), BMI (a decrease of 1 SD; adjusted
OR, 1.8; 95% CI, 1.1–2.8) and femoral neck BMD (a decrease of 1 SD; adjusted OR, 1.7; 95% CI, 1.0–2.8). The effect of risk
factors remained the same in different analysis sets, and adding or removing femoral neck BMD did not change other risk factors,
though BMD was significantly correlated with functional mobility and BMI. Importantly, both sideways fall and direct hip impact
are independent predictors of hip fracture. From these results, we suggest a preventive strategy of hip fracture in the elderly:
besides the maintenance of BMD, keeping an appropriate body weight and maintaining a physically active lifestyle might be
crucial.
Received: 11 January 2001 / Accepted: 6 July 2001 相似文献
5.
P. Garnero P. Dargent-Molina D. Hans A. M. Schott G. Bréart P. J. Meunier P. D. Delmas 《Osteoporosis international》1998,8(6):563-569
We have previously shown that hip bone mineral density (BMD), heel broadband ultrasound attenuation (BUA) and bone resorption
markers are independent predictors of hip fracture in elderly women. We investigated whether a combination of these three
parameters could improve the predictive value of a single test in a nested case–control analysis (75 hip fractures and 228
age-matched controls) of the EPIDOS prospective study comprising 7598 healthy women 75 years of age and older followed prospectively
for a mean 22 months. At baseline, prior fracture, femoral neck BMD by dual-energy X-ray absorptiometry (DXA), heel BUA and
urinary type I collagen C-telopeptide breakdown products (CTX) were assessed. The area under the receiver operating characteristic
curve was significant for the three diagnostic tests, heel BUA being the best single predictor. The added value of urinary
CTX to either BMD or BUA depends on the cutoff point chosen to define patients at risk and on the therapeutic strategy that
is considered. Defining patients at risk as those with low BMD (or low BUA) or high CTX resulted in a significant increase
in the sensitivity compared with BMD or BUA alone – a strategy that could be applied when a broad treatment is considered.
However, this increased sensitivity was also obtained simply by increasing the BMD and BUA cutoffs, suggesting that a combination
of CTX with BMD/BUA is not useful for that type of treatment strategy. Conversely, defining patients at risk as those with
both low BMD and high CTX increases the specificity (88% vs 78%) with a similar number of hip fracture patients being identified
(30% vs 32%) – a combination that could be useful when the strategy is to target treatment to a subset of high-risk patients.
This strategy appears to be more cost-effective than bone mass measurement alone as indicated by the 37% fewer patients who
need to be treated to avoid one fracture per year. If DXA or ultrasound is not available, the combination of a bone resorption
marker with a history of any type of fracture after the age of 50 years gave a predictive value similar to that obtained with
femoral neck BMD or heel BUA alone, for both types of treatment strategy. We conclude that the combination of urinary CTX
with hip BMD could be useful for the identification of elderly women at high risk for hip fracture, resulting in higher specificity
for a given sensitivity threshold than BMD measurement alone. If DXA is not available, the combination of history of fracture
and urinary CTX performs as well as hip BMD to assess hip fracture risk in elderly women.
Received: 24 November 1997 / Revised: 3 March 1998 相似文献
6.
Comparison of Six Calcaneal Quantitative Ultrasound Devices: Precision and Hip Fracture Discrimination 总被引:1,自引:0,他引:1
C. F. Njeh D. Hans J. Li B. Fan T. Fuerst Y. Q. He E. Tsuda-Futami Y. Lu C. Y. Wu H. K. Genant 《Osteoporosis international》2000,11(12):1051-1062
Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of
QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation
algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between
normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). The short-term
and mid-term precisions of these devices were also determined. Thirty-five women (mean age 74.5 ± 7.9 years) who had sustained
a hip fracture within the past 3 years, and 35 age-matched controls (75.8 ± 5.6 years) were recruited. Ultrasound measurements
were acquired using six ultrasound devices: three gel-coupled and three water-coupled devices. Bone mineral density was measured
at the hip using DXA. Discrimination of fracture patients versus controls was assessed using logistic regression analysis
(expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver
operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The
sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA).
The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson
correlation coefficients between different devices was highly significant (SOS, r= 0.79–0.93; BUA, r= 0.71–0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r= 0.30–0.55; BUA, r= 0.35–0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than
water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r= 0.48–0.57 for BMD and r= 0.18–0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip
fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1–2.8) and BUA (2.4–3.4) were comparable
to those for femoral BMD (2.6–3.5), as were the area under the curve (SOS, 0.65–0.71; BUA, 0.62–0.71; BMD, 0.65–0.74) from
ROC analysis. Within the limitation of the sample size all devices show similar diagnostic sensitivity.
Received: 2 February 2000 / Accepted: 1 May 2000 相似文献
7.
Y. Q. He B. Fan D. Hans J. Li C. Y. Wu C. F. Njeh S. Zhao Y. Lu E. Tsuda-Futami T. Fuerst H. K. Genant 《Osteoporosis international》2000,11(4):354-360
The incidence of osteoporotic hip fracture increases in postmenopausal women with low hip bone mineral density (BMD). Dual
X-ray absorptiometry (DXA) is the most commonly used technique for the assessment of bone status and provides good measurement
precision. However, DXA affords little information about bone architecture. Quantitative ultrasound (QUS) systems have been
developed to evaluate bone status for assessment of fracture risk. Our study was designed to assess a new QUS system from
Hologic, the Sahara; to compare it with a previous model, the Walker-Sonix UBA 575+; and to investigate whether it is able
to discriminate between women with and without fracture. Using both ultrasound devices, the measurements were performed at
the heels of 33 postmenopausal women who had recently sustained hip fracture. A control group of 35 age-matched postmenopausal
women was recruited for comparison. The total, neck and trochanter femoral BMD values were assessed using DXA for both groups.
QUS and DXA measurements were significantly lower in fractured patients (p<0.005) than in the control group. The short-term, mid-term and standardized short-term precisions were used to evaluate the
reproducibility of the two QUS systems. The Sahara showed a better standardized coefficient of variation for broadband ultrasound
attenuation (BUA) than did the UBA 575+ (p<0.001). The correlation of BUA and speed of sound (SOS) between the two QUS devices was highly significant, with an r value of 0.92 for BUA and 0.91 for SOS. However, the correlation between DXA and ultrasound parameters ranged from 0.28 to
0.44. We found that ultrasound measurements at the heel were significant discriminators of hip fractures with odds ratios
(OR) ranging from 2.7 to 3.2. Even after adjusting the logistic regressions for total, neck or trochanter femoral BMD, QUS
variables were still significant independent discriminators of hip fracture. The areas under the ROC curves of each ultrasound
parameter ranged from 0.75 to 0.78, and compared very well with femoral neck BMD (p>0.05). In conclusion, our study indicated that the calcaneal QUS variables, as measured by the Sahara system can discriminate
hip fracture patients equally as well as hip DXA.
Received: 29 October 1999 / Accepted: 7 September 1999 相似文献
8.
Hip Fracture Risk and Proximal Femur Geometry from DXA Scans 总被引:10,自引:5,他引:5
C. Bergot V. Bousson A. Meunier M. Laval-Jeantet J. D. Laredo 《Osteoporosis international》2002,13(7):542-550
In this retrospective study of hip fracture risk evaluation from hip dual-energy X-ray absorptiometry (DXA) scans, our objectives
were to determine which part of the femoral neck length contributes most to the fracture risk and to define a geometric parameter
better than hip axis length (HAL) for discriminating hip fracture patients. Forty-nine Caucasian women with a nontraumatic
femoral neck fracture were matched on age to 49 normal women and on both age and femoral neck bone mineral density (BMD) to
49 unfractured women. In addition to BMD, geometric parameters including neck–shaft angle, neck width and several HAL segments
were evaluated by discriminant analysis to determine which was the best hip fracture discriminator. Neck–shaft angle had a
limited influence on the hip fracture risk. Age-related bone loss was associated with a neck width increase in unfractured
and fractured patients. HAL was significantly longer in fractured patients and was a significant discriminator between fractured
patients and normal controls. HAL was not significant as a discriminator between fractured and low-BMD unfractured patients.
The intertrochanter–head center distance (from the intertrochanteric line to the femoral head center) coincides with the femoral
lever arm and includes no segments that adapt to BMD changes, such as the greater trochanter–intertrochanter distance. Among
all tested lengths, this segment was the part of HAL that discriminated best between fractured and low-BMD unfractured patients.
A longer intertrochanter–head center distance increased the risk of femoral neck fracture among low-BMD patients. Including
automatic measurement of this segment in standard DXA protocols may prove useful in identifying patients at high risk for
hip fracture. At present, HAL remains the easier neck length to measure, but automatic evaluation of the intertrochanter–head
center distance must be a goal for future image analysis development.
Received: 11 April 2001 / Accepted: 3 January 2002 相似文献
9.
The ability of quantitative ultrasound (QUS) to estimate the risk of osteoporotic fractures was evaluated in a prospective
study over a mean time of 5.47 years in 254 postmenopausal women (mean age 58.06 ± 7.67 years). Baseline measurements of ultrasound
transmission velocity (UTV) and bone mineral density (BMD) were taken at the distal radius (DR). UTV was also measured at
the patella (P). Fifty nonspine fractures due to minor trauma were detected during annual check-ups with an incidence of 3.59/year.
Fractures occurred in older women with a lower BMD and QUS. Using Cox regression analysis the relative risk (RR) per 1 standard
deviation (SD) decrease in the unadjusted QUS and BMD measurements was: BMD-DR = 3.56, 95% confidence interval (CI) 1.57–8.09;
UTV-DR = 5.35, 95% CI 2.07–13.83; UTV-P = 4.49, 95% CI 2.08–9.68. The relationship between BMD and QUS variables and fracture
risk persisted after adjusting for potential confounders apart from previous fractures, giving the following RR: BMD-DR =
2.99, 95% CI 1.06–8.41; UTV-DR = 3.69, 95% CI 1.18–11.49; UTV-P = 3.89, 95% CI 1.53–9.90. Correcting also for previous fractures,
only UTV-P remained an effective predictor of fracture risk even after QUS measurement correction for BMD. Wrist fractures
were best related to BMD-DR (RR 7.33, 95% CI 1.43–37.50) and UTV-DR (RR 10.94, 95% CI 1.10–108.45), while hip and ankle fractures
were significantly associated only with UTV-P (hip: RR 32.14, 95% CI 1.83–562.80; ankle: RR 17.60, 95% CI 1.78–173.79). The
combined use of BMD and QUS is a better predictor of fracture risk than either technique used separately. Comparison of the
areas under the receiver operating characteristic (ROC) curves did not show differences in the ability of BMD and QUS to correctly
distinguish fractures. In conclusion, QUS predicts fracture risk in osteoporotic women at least as well as BMD. UTV-DR and
BMD-DR are good predictors of wrist fractures, while UTV-P is strongly related to hip and ankle fractures. QUS and BMD combined
improve the diagnostic ability of each technique individually.
Received: 27 April 1999 / Accepted: 3 December 1999 相似文献
10.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献
11.
Anna Ekman Karl Micha?lsson Marianne Petrén-Mallmin Sverker Ljunghall Hans Mallmin 《Journal of clinical densitometry》2002,5(1):79-85
Few studies have examined different bone densitometry techniques to determine male hip fracture risk. We conducted a case-control study of 31 noninstitutionalized men, mean age 77 yr, with a first hip fracture and compared the results with 68 randomly selected age-matched control subjects. The methods used were dual X-ray absorptiometry (DXA) of the proximal femur, quantitative ultrasound (QUS) of the heel and fingers, and radiographic absorptiometry of the fingers. Case patients had significantly lower values (4-17%; p < 0.01) for all methods. The odds ratios for every SD reduction in bone values were 4.8 (95% confidence interval [CI]: 2.3-9.9) for DXA of the femoral neck, 2.2 (95% CI: 1.2-3.9) for QUS of the heel, 2.0 (95% CI: 1.2-3.3) for QUS of the phalanges, and 3.1 (95% CI: 1.5-6.6) for radiographic absorptiometry of the phalanges. The results indicate a strong capability of DXA of the femoral neck to distinguish between men with a first hip fracture and control subjects. Furthermore, ultrasound of the heel and fingers as well as radiographic absorptiometry proved capable of discriminating men with hip fractures from control subjects. 相似文献
12.
Quantitative ultrasound (QUS) has been proposed as a tool which can measure both the quantitative and qualitative aspects
of bone tissue and can predict the future risk of osteoporotic fractures. However, the usefulness of QUS in long-term monitoring
has yet to be defined. We studied a group of early postmenopausal women over a 4-year period. Thirty subjects were allocated
to hormone replacement therapy and 30 selected as controls matched for age, years past the menopause (YPM) and bone mineral
density (BMD) at the anteroposterior spine (AP spine). The mean age of the subjects was 52.4 years (SD 3.9 years), mean YPM
4.0 years (SD 3.2) and all subjects had a BMD T-score above −2.5 SD (number of standard units related to the young normal mean population). BMD was measured at baseline
and annually by dual-energy X-ray absorptiometry (DXA) at the AP spine and total hip, and QUS carried out at the calcaneus,
measuring broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness. Mean percentage changes from baseline
were assessed at 2 and 4 years. The overall treatment effect (defined as the difference in percentage change between the two
groups) was: AP spine BMD, 11.4%; total hip BMD, 7.4%; BUA, 6.4%; SOS, 1.1%; and Stiffness, 10.4% (p<0.01). To compare the long-term precision of the two techniques we calculated the Standardized Precision, which for QUS was
approximately 2–3 times that of DXA, for a given rate of change. The ability of each site to monitor response to treatment
was assessed by calculating the Treatment Response Index (Treatment Effect/Standardized Precision), which was: AP spine BMD,
10.4; total hip BMD, 3.9; BUA, 3.1; SOS, 0.3; and Stiffness, 4.2. This was then normalized for AP spine BMD (to compare the
role of QUS against the current standard, AP Spine BMD), which was: total hip BMD, 0.38; BUA, 0.30; Stiffness, 0.40 (p<0.01); and SOS, 0.03 (NS). In summary, QUS parameters in the early menopause showed a similar rate of decline as AP spine
BMD and total hip BMD measured by DXA. Hormone replacement therapy results in bone gain at the AP spine and total hip, and
prevents loss in BUA and SOS measured by QUS at the calcaneus. QUS has a potential role in long-term monitoring, although
presently the time period to follow individual subjects remains 2–3 times that for DXA, for a given rate of change. Anteroposterior
spine remains the current optimal DXA monitoring site due to its greater rate of change and better long-term precision.
Received: 20 January 1999 / Accepted: 14 June 1999 相似文献
13.
How Hip and Whole-Body Bone Mineral Density Predict Hip Fracture in Elderly Women: The EPIDOS Prospective Study 总被引:1,自引:0,他引:1
A. M. Schott C. Cormier D. Hans F. Favier E. Hausherr P. Dargent-Molina P. D. Delmas C. Ribot J. L. Sebert G. Breart P. J. Meunier 《Osteoporosis international》1998,8(3):247-254
We conducted a population-based cohort study in 7598 white healthy women, aged 75 years and over, recruited from the voting
lists. We measured at baseline bone mineral density (BMD g/cm2) of the proximal femur (neck, trochanter and Ward's triangle) and the whole body, as well as fat and lean body mass, by dual-energy
X-ray absorptiometry (DXA). One hundred and fifty-four women underwent a hip fracture during an average 2 years follow-up.
Each standard deviation decrease in BMD increased the risk of hip fracture adjusted for age, weight and centre by 1.9 (95%
CL 1.5, 2.3) for the femoral neck, 2.6 times (2.0, 3.3) for the trochanter, 1.8 times (1.4, 2.2) for Ward's triangle, 1.6
times (1.2, 2.0) for the whole body, and 1.3 times (1.0, 1.5) for the fat mass. The areas under the receiver operating characteristic
(ROC) curves were not significantly different between trochanter and femoral neck BMD, whereas ROC curves of femoral neck
and trochanter BMD were significantly better than those for Ward's triangle and whole-body BMD.
emsp;Women who sustained an intertrochanteric fracture were older (84 ± 4.5 years) than women who had a cervical fracture
(81 ± 4.5 years) and trochanter BMD seemed to be a stronger predictor of intertrochanteric ([RR = 4.5 (3.1, 6.5)] than cervical
fractures ([RR = 1.8 (1.5, 2.3]).
emsp;In very elderly women aged 80 years and more, hip BMD was still a significant predictor of hip fracture but the relative
risk was significantly lower than in women younger than 80 years.
emsp;In the 48% of women who had a femoral neck BMD T-score less than –2.5, the relative risk of hip fracture was increased by 3, and the unadjusted incidence of hip fracture
was 16.4 per 1000 woman-years compared with 1.1 in the population with a femoral neck BMD T-score 5–1.
Received: 19 May 1997 / Accepted: 16 October 1997 相似文献
14.
The aim of this study was to assess a dry calcaneal quantitative ultrasound (QUS) device by examining: (i) short- and long-term
precision; (ii) the ability of the ultrasound parameters to identify women with vertebral fractures; (iii) age- and menopause-related
bone loss; (iv) applicability of the WHO criteria in scan interpretation. The study group consisted of 422 healthy women with
no risk factors associated with osteoporosis (227 premenopausal and 195 postmenopausal) and 93 women with one or more vertebral
fractures. All women had calcaneal QUS and bone mineral density (BMD) measurements of the lumbar spine and hip performed.
Broadband ultrasound attenuation (BUA) and speed of sound (SOS) measurements in the heel were combined and expressed as estimated
heel BMD. Short-term precision studies yielded coefficient of variations of 0.3% for SOS, 4% for BUA and 3.3% for estimated
heel BMD. Standardized short-term precision values were approximately 0.2 SD. Long-term standardized precision errors ranged
from 0.17 to 0.38 SD. All the QUS and BMD measurement parameters showed significant negative relationships with age in the
postmenopausal group. Annual losses were 0.35 dB/MHz per year for BUA, 0.56 m/s per year for SOS and 0.002 g/cm2 per year for estimated heel BMD. All the QUS and BMD parameters were able to discriminate between healthy postmenopausal
women and women with vertebral fracture. Age-adjusted odds ratios for each SD decline in QUS measurements were 3.63, 5.25
and 4.79 for BUA, SOS and estimated heel BMD respectively. Corresponding odds ratios for BMD at the lumbar spine, femoral
neck and total hip were 2.39, 2.51 and 2.95 respectively. When the QUS and BMD parameters were expressed as T-scores, estimated heel BMD showed the least age-related decline, while femoral neck BMD displayed the greatest decrease with
age. The mean T-score and prevalence of osteoporosis (T<−2.5) for a Caucasian woman aged 60–65 years were −1.35 and 21% respectively for the lumbar spine compared with −0.59 and
2% for estimated heel BMD. In conclusion, this study revealed that contact ultrasound can detect age- and menopause-related
influences on bone status and was able to discriminate between healthy individuals and women with vertebral fracture. However,
the widely accepted threshold of a T-score of less than −2.5 for the definition of osteoporosis may need modifying for the interpretation of QUS scans.
Received: 8 February 1999 / Accepted: 5 May 1999 相似文献
15.
Versluis RG Petri H Vismans FJ van de Ven CM Springer MP Papapoulos SE 《Calcified tissue international》2000,66(1):1-4
Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density
(BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques
require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities
in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip
by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55–84 (mean age 67.2 years, SD 8.7) were randomly selected
from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry
were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral
neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe
vertebral deformities of 1.5 (95% CI: 1.1–2.1) for RA and 1.3 (95% CI: 0.9–1.9) for DXA, together with similar receiver operating
characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities
at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA
equipment is available.
Received: 21 July 1998 / Accepted: 1 July 1999 相似文献
16.
Quantitative Ultrasound Measurements of the Tibia and Calcaneus in Comparison with DXA Measurements at Various Skeletal Sites 总被引:2,自引:0,他引:2
The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people
(age range 65–87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and
SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation
(CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral
density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry
(DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations
with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r= 0.48–0.64, r= 0.30–0.47, r= 0.35–0.47, respectively; p<0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body
weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values.
After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests
that correction for body weight is important and could add to the predictive value of QUS measurements.
Received: 16 July 1997 / Accepted: 8 July 1998 相似文献
17.
D. Mulleman I. Legroux-Gerot B. Duquesnoy X. Marchandise B. Delcambre B. Cortet 《Osteoporosis international》2002,13(5):388-393
Quantitative ultrasound (QUS) measurement, a different approach to bone fragility assessment, has already been attempted
in women with osteoporosis but rarely in men. In order to test its value and ability to identify osteoporotic men, a case–control
prospective study was conducted using the Lunar Achilles, a device that measures attenuation and velocity parameters. Broadband
ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI), a composite parameter, were assessed through
the heel of 66 osteoporotic patients, and compared with the results in 35 controls. Patients had sustained a low-trauma fracture
and/or had a lumbar and/or femoral bone mineral density (BMD) more than 2.5 SD below the young male reference value. As expected,
all QUS parameters were statistically lower in patients, as were the dual-energy X-ray absorptiometry (DXA) measurements at
the hip and lumbar spine. The two methods were compared for their ability to predict the risk of osteoporotic fractures. The
odds ratios (ORs), with their 95% confidence limits, for fractures per 1 SD decrease were significant, especially for SOS
and SI (OR = 2.3 [1.4–3.6] and 2.1 [1.3-3.3] respectively) and to a lesser extent for BUA (1.6 [1.0–2.4]). Our study suggests
that QUS is associated with a history of low-trauma fracture in men; sensitivity is, however, less than when results are compared
with BMD measurements (OR = 2.8 [1.6–5.0] and 3.4 [1.6–7.0] for lumbar spine and hip, respectively). Prospective studies are
required before QUS can be recommended for clinical use in male osteoporosis.
Received: 11 June 2001 / Accepted: 16 November 2001 相似文献
18.
Risk Factors for Perimenopausal Fractures: A Prospective Study 总被引:11,自引:6,他引:5
J. Huopio H. Kröger R. Honkanen S. Saarikoski E. Alhava 《Osteoporosis international》2000,11(3):219-227
This prospective study was aimed at determining the risk factors for the development of fractures in perimenopausal women.
The study group (n= 3068) was comprised of a stratified population sample of women aged between 47 and 56 years. During the follow-up period
of 3.6 years, 257 (8.4%) of the women sustained a total of 295 fractures. After adjustment for covariates, the relative risk
(RR) of sustaining a fracture was found to be 1.4 [95% confidence interval (CI) 1.2–1.6] for a 1 standard deviation (SD) decrease
in the spinal and femoral neck bone mineral density (BMD). Women with a previous fracture history were found to have an increased
risk of fracture [RR 1.7 (95% CI 1.3–2.2)] and those reporting three or more chronic illnesses exhibited a RR of 1.4 (95%
CI 1.0–1.9). Women not using hormone replacement therapy (HRT) had a RR of 1.5 (95% CI 1.1–2.2) for all fracture types. When
osteoporotic fractures (vertebral, hip, proximal humerus and wrist fractures; n= 98) were used as an endpoint, the independent risk factors were found to be a low BMD (RR for a 1 SD decrease in both spinal
and femoral neck BMD was 1.6, 95% CI 1.3–2.0), a previous fracture history (RR 1.9, 95% CI 1.3–2.9) and nonuse of HRT (RR
2.2, 95% CI 1.3–4.0). The independent risk factors for all other fractures (n = 158) were a low BMD (RR for a 1 SD decrease in the spinal BMD was 1.4, 95% CI 1.2–1.6 and in the femoral neck BMD was 1.3,
95% CI 1.1–1.5), a previous fracture history (RR 1.6, 95% CI 1.1–2.2), smoking (RR 1.8, 95% CI 1.1–2.7) and having had three
or more chronic illnesses (RR 1.6, 95% CI 1.1–2.2). Weight, height, age, menopausal status, maternal hip fracture, use of
alcohol, coffee consumption or dietary calcium intake were not independently associated with the development of any particular
type of fracture. We conclude that the independent risk factors for perimenopausal fractures are a low bone density, previous
fracture history, nonuse of HRT, having had three or more chronic illnesses and smoking, the gradient of risk being similar
for spinal and femoral neck BMD measurements in the perimenopausal population. The risk factors are slightly different for
perimenopausal osteoporotic than for other types of fractures.
Received: 6 April 1999 / Accepted: 18 August 1999 相似文献
19.
Predicting Fractures Using Bone Mineral Density: A Prospective Study of Long-Term Care Residents 总被引:9,自引:0,他引:9
K. E. Broe M. T. Hannan D. K. Kiely C. M. Cali L. A. Cupples D. P. Kiel 《Osteoporosis international》2000,11(9):765-771
Bone mineral density (BMD) has been shown to predict fracture risk in community-dwelling older persons; however, no comparable
prospective study has been performed in the long-term care setting where the role of BMD testing is uncertain. To determine
the ability of a single BMD measurement to predict the risk of subsequent fracture in long-term care residents, we designed
a prospective study in a 725-bed long-term care facility. A total of 252 Caucasian nursing home residents (mean age 88 years,
74% women) were recruited between 1992 and 1998. BMD of the hip, radius or both sites was measured using dual-energy X-ray
absorptiometry. Participants were followed through September 1999 for the occurrence of fracture. Cox proportional hazards
regression models were constructed to determine the relationship between BMD and the risk of fracture controlling for potentially
confounding variables. Sixty-three incident osteoporotic fractures occurred during a median follow-up time of 2.3 years. The
multivariate-adjusted risk of fracture for each standard deviation decrease in BMD was 2.82 (95% CI 1.81–4.42) at the total
hip, 2.79 (95% CI 1.69–4.61) at the femoral neck, 2.26 (95% CI 1.51–3.38) at the trochanter, 1.83 (95% CI 1.14–2.94) at the
radial shaft and 1.84 (95% CI 1.21–2.80) at the ultradistal radius. Subjects in the lowest age-specific quartile of femoral
neck BMD had over 4 times the incidence of fracture compared with those in the highest quartile. BMD at either hip or radius
was a predictor of osteoporotic fracture, although in women, radial BMD did not predict fracture. Knowledge of BMD in long-term
care residents provides important information on subsequent fracture risk.
Received: 3 December 1999 / Accepted: 17 March 2000 相似文献
20.
Multisite Quantitative Ultrasound: Colles’ Fracture Discrimination in Postmenopausal Women 总被引:2,自引:0,他引:2
K. M. Knapp K. M. Knapp G. M. Blake I. Fogelman D. V. Doyle T. D. Spector 《Osteoporosis international》2002,13(6):474-479
Distal forearm fractures are the most common perimenopausal fracture and are generally associated with osteoporosis. The
aim of this study was to evaluate the capability of speed of sound (SOS) measurements in cortical bone at the phalanx, radius,
tibia and metatarsal to discriminate Colles’ fracture cases from controls in postmenopausal women and to compare this with
bone mineral density (BMD) measurements obtained by dual-energy X-ray absorptiometry (DXA). Sixty-three postmenpausal Colles’
fracture cases and 191 postmenopausal controls had SOS measurements of the radius, tibia, phalanx and metatarsal using a semi-reflection
ultrasound technique and BMD measurements of the lumbar spine and proximal femur using DXA. The age-adjusted odds ratios (ORs)
for fracture for the SOS measurement sites were 1.50 [95% CI 1.07–2.10] for the radius, 1.23 [0.86-1.76] for the tibia, 1.85
[1.06–3.23] for the phalanx and 1.74 [1.12–2.71] for the metatarsal site. For the BMD measurements the ORs were 1.95 [1.34–2.85]
for the lumbar spine, 2.21 [1.43–3.40] for the femoral neck and 2.62 [1.69–4.08] for the total hip. The benefits of combining
sites either by taking their average Z-score or by using the manufacturer’s ORI algorithm were evaluated. The two methods yielded similar results and the ORs for
the combination of the radius and phalanx were 2.00 [1.21–3.33], for the radius and metatarsal 1.67 [1.05–2.67], for the phalanx
and metatarsal 1.86 [1.11–3.08] and for the radius, phalanx and metatarsal 1.81 [1.07–3.06]. Combinations of DXA sites gave
2.22 [1.44–3.41] for the lumbar spine and femoral neck and 2.41 [1.57–3.70] for the lumbar spine and total hip. In conclusion,
semi-reflection ultrasound measurements at the radius, phalanx or metatarsal demonstrated an ability to discriminate fracture
cases from controls in postmenopausal Colles’ fracture patients, although the odds ratios were lower than with spine and femur
BMD.
Received: 6 July 2001 / Accepted: 11 December 2001 相似文献