骨定量手段诊断骨质疏松的进展

估量骨质疏松症 (ＯＰ)必须有症状、体征、实验室检查 (骨代谢生化和激素指标等 )、Ｘ线摄片等方法的帮助 ,特异的、定量的诊断骨质疏松的手段是骨密度测量 ,没有骨密度的支持不能诊断骨质疏松 ,有创的骨组织形态计量学的手段难于在临床上推广 ,目前广泛应用的是各种无创性骨密度测量手段 ,1963年Ｃａｍｅｒｏｎ开创的光子吸收法的先河(单光子吸收法—ＳＰＡ) ,骨密度测量进入了无创性、高精度、快速、定量时期 ,骨密度测量还包括单能Ｘ线吸收法 (ＳＸＡ)、双光子吸收法(ＤＰＡ已淘汰 )、双能Ｘ线吸收法(ＤＸＡ始于 1987年 ) ,这些是二维骨…     

骨密度测定与骨质疏松

骨密度测定是评价骨质疏松的重要手段,本文就骨密度测定法、适用范围及测定结果的临床意义等进行综述。     

跟骨定量超声骨强度在骨质疏松筛查和诊断中的价值

目的 在社区人群中进行跟骨定量超声法(QUS)骨强度(STI)与双能X线吸收法(DXA)腰椎和髋部骨密度(BMD)测量的临床对比,探讨QUS在骨质疏松筛查和诊断中的临床应用价值.方法 在上海长风社区对6 105例45岁以上常住户籍居民,采用DXA测定腰椎1～4、双侧髋部BMD值,同时采用QUS测定右侧跟骨STI值,分析两者的相关性,以DXA为金标准评价QUS测定STI在骨质疏松筛查和诊断中的灵敏度、特异度和诊断一致率.结果 DXA和QUS诊断的骨量减少、骨质疏松的患病率分别为38.82％、10.29％和64.50％、4.49％.STI与腰椎、左侧和右侧髋部BMD相关系数分别为0.536、0.574和0.570(P值均＜0.001).与DXA相比,QUS筛查骨量异常(骨量减少和骨质疏松)的灵敏度为86.16％、特异度为47.57％,诊断骨质疏松的灵敏度为23.57％、特异度为97.70％.结论 QUS测定STI与DXA测定BMD有较好的相关性和一致性,QUS筛查骨量异常的高灵敏度和诊断骨质疏松的高特异度使之成为值得在基层医疗机构推广使用的骨质疏松筛查和诊断工具.     

骨矿含量的测定方法简介及其相关问题

骨矿含量的测定方法多种多样，其临床应用方面还有许多相关问题值得商榷。本文仅就临床常见的X线片测量、X线片光吸收法、单光子和单能X线吸收测量法、双能X线吸收测量法、定量Cr、显微Cr、定量磁共振和定量超声等测量方法作一简介，并就有关的诊断标准、质控、骨密度仪的选择和应用、骨密度报告的解释、骨质疏松和骨质增生病的区分和影像的鉴别诊断及其意义等问题进行了初步探讨。     

双能X线吸收法测定大鼠骨量的评价及去卵巢骨丢失敏？…

目的　探讨双能X线吸收法 (DXA)测量大鼠骨密度 (BMD)的精密度和准确度及大鼠去卵巢后骨丢失的敏感区域。方法　用扇形束DXA(QDR45 0 0A)重复测量 16只SD大鼠不同骨胳区域BMD的变异系数 (CV)评价精密度 ;测量 40只大鼠骨矿含量 (BMC)与骨灰重比较评价准确度 ;与假手术组比较测定大鼠去卵巢后不同骨胳区域骨丢失率的变化选择骨丢失敏感区域。结果DXA测量BMD的CV为全身 (0 .71± 0 .44 ) % ,腰椎 (0 .82± 0 .5 3) % ,股骨 (0 .5 2± 0 .2 7) % ,胫骨(0 .81± 0 .11) % ,股骨和胫骨的各亚区 (1.46± 0 .2 6 ) % ;BMC与骨灰重呈高度正相关 (r =0 .984～0 .85 5 ) ,BMC显著低于骨灰重 (P <0 .0 0 1) ;生长期大鼠去卵巢 14周与假手术组BMD比较 ,腰椎(- 7.0 3% )、股骨远端 (- 9.0 3% )和近端 (- 7.49% )及胫骨近端 (- 11.7% )BMD显著减少 ,胫骨远端BMD显著增加 (8.82 % )。结论　DXA测量大鼠骨量是精密和有效的方法 ,胫骨近端干骺端和股骨远端干骺端是大鼠去卵巢后骨丢失最敏感区域。     

女性随年龄增长不同骨骼部位的骨丢失

目的 评价健康女性随增龄，不同骨骼部位的骨丢失。方法 用ＤＸＡ ＱＤＲ４５００Ａ型扇形束骨密度仪测量１６６４例１５￣９６岁健康女性不同骨骼部位（腰椎正位和侧位、髋部和前臂）的骨密度（ＢＭＤ）。结果 横断面分析显示，绝经时所有部位骨丢失显著（Ｐ〈０．０１￣０．００１），其中松质骨占优势的部位（腰椎侧位和Ｗａｒｄ’ｓ三角）丢失最多（－１３％￣－１９％，Ｐ〈０．００１）。所有部位绝经１５年内（〈６５岁）     

前臂骨骨密度测定诊断骨质疏松标准的研究

目的探讨女性前臂骨骨量的年龄分布规律,为建立周围骨骨密度的骨质疏松诊断标准积累数据。方法采用美国NORLAND-Stratec周围型双能X线骨矿测量仪(pDXA)测量了452名20～79岁女性健康志愿者非优势侧前臂远端桡骨和尺骨(distal radius+ulna)、近端桡骨和尺骨(proximal radius+ulna)以及近端桡骨(proximal radius)的BMD值,以问卷调查方法收集研究对象的一般情况,分析前臂骨不同测量部位BMD变化的年龄分布规律。结果前臂骨不同测量部位的BMD数据均符合正态分布规律。健康女性峰值骨密度出现在40～44岁年龄段,此后随年龄增加而下降,在50～59岁和70岁以上年龄段出现快速骨丢失,尤其是前臂远端骨丢失速率较快,55～59岁年龄段女性骨累积丢失率达25%,与DXA测定中轴骨的骨量丢失规律一致。前臂远端桡+尺骨的骨质疏松(OP)检出率较高,是围绝经期妇女OP检出的敏感部位。50～54岁年龄段女性低骨量发生率为57.6%,骨质疏松的发生率为25.8%(以低于PBM-2.0s为诊断标准)和12.1%(以低于PBM-2.5s为诊断标准);55～59岁年龄段女性低骨量发生率上升至80.9%,骨质疏松的发生率上升至50.0%和30.9%。60岁以后,低骨量和骨质疏松发生率的增加速度趋缓,但70岁以后低骨量和骨质疏松的发生率再次上升。结论前臂骨骼BMD测定可以作为骨质疏松高危人群筛查的有效工具。将前臂远端桡+尺骨为BMD主要检测部位,以低于PBM-2.0s为骨质疏松诊断标准,是筛查骨质疏松人群和评估干预措施较适宜的标准。     

绝经后妇女腰椎骨质疏松的定量CT研究

目的：研究绝经后妇女不同年龄组腰椎骨密度（ＢＭＤ）与骨质疏松关系及临床表现。方法采用ＣＴ机横断扫描及自制固体标准模测量９９例绝经后妇女第２－４腰椎上１／３处骨密度（ＢＭＤ）,并对其临床症状进行观察。结果９９例绝经后妇女有７６例被诊断为骨质疏松,占７７％,并显示腰椎骨密度（ＢＭＤ）随增龄逐渐减低,以大于７０岁年龄密度最低,骨质疏松最严重,平均值６０．２ｍｇ／ｃｍ＾３,方差为１８．９,而且１００％有不     

骨质疏松的定量和影像学诊断

骨质疏松的定量和影像学诊断马寄晓上海市第六人民医院核医学科骨质疏松防治中心（２００２３３）马寄晓主任医师骨质疏松的诊断与治疗效果的评价，主要应用非创伤性的定量和影像学方法。这些方法几乎均以射线测量法为基础。以往曾采用人体中子活化分析法，即将人体的某一...     

骨密度定量超声与双能X线检测比较

<正>骨质疏松(OP)是一种以骨量降低和骨组织微结构破坏为特征,导致骨脆性增加和易于骨折的代谢性骨病〔1〕。临床上以性激素减少和年龄增加所致的生理退行性病变的原发性OP多见。本文就定量超声与双能X线骨密度(BMD)检测方法进行综述。1 OP流行及危害OP现已跃居世界常见病的第7位,而我国至少有6 944万OP患者。50岁以上人群患病率高达30.8%〔2〕。OP是一种难     

Bone remodelling in osteoporosis

Bone remodelling, a highly regulated succession of events, is the temporal sequence of osteoclastic bone resorption and osteoblastic bone formation. Bone loss with age and in osteoporotic patients is due to a desequilibrium between both processus. Bone histomorphometry was the method used to measure these events. Its shows clearly that, with age, the quantity of bone formed in one remodelling unit (so called mean wall thickness) decreases. In osteoporotic women, compared to control women of the same age the amount of bone formed is also decreased. Concordant data on this point have been obtained in different laboratories. By contrast, the cellular mechanism underlying this decreased amount of bone formed is largely controversial: a decreased osteoblast recruitment or life span or capacity to synthetise collagen have been suggested. Bone loss with age is associated with an increase in the amount of bone resorbed. This observation is the result of an indirect measurement founded on the distance between trabeculae. As the decreased bone formation, this processus is exaggerated in postmenopausal osteoporosis. The respective importance of decreased bone formation and increased bone resorption is however difficult to assess. Some osteoporotic patients have increased bone resorption surfaces compared to control women on their bone biopsy; however, it does not seem that these patients form a definite subgroup of osteoporotic patients as the extent of resorption surfaces changes with time in an untreated osteoporotic. In conclusion, the observed changes in bone remodelling in osteoporotic postmenopausal women are an exaggeration of those observed during ageing. These changes should be a basis for a coherent therapy of bone loss in osteoporotic patients.     

Bone remodelling in osteoporosis

Clinical Rheumatology - Bone remodelling, a highly regulated succession of events, is the temporal sequence of osteoclastic bone resorption and osteoblastic bone formation. Bone loss with age and...     

New diagnostic criteria of primary osteoporosis

New diagnostic criteria of primary osteoporosis (2000 version) was presented. The basic concepts are as follows. Firstly, estimation of low bone mass should be made by lumbar BMD by DXA. However, when measurement of lumbar BMD is not appropriate due to fracture or deformities of the spine, hip, radial, calcaneal, or metacarpal BMD should be used. X ray picture of the spine should be used when DXA is not available. Secondary, in cases with fragility fractures, or in cases with BMD below 70% of young adult mean, differential diagnosis should be made in order to rule out other diseases with low BMD than primary osteoporosis.     

Bone quality in glucocorticoid induced osteoporosis

The administration of oral glucocorticoids is associated with a significant decrease in bone formation (low turnover) and with generalized thinning of bone trabecula. These condition will be worse of bone quality and bone strength than high turnover state that indicate partial breakage of bone trabecula. Because the cut-off value of bone mineral density induced fracture is higher in glucocorticoid-induced osteoporosis than in postmenopausal osteoporosis.