强直性脊柱炎患者骨密度变化及应用FRAX 评估其骨折危险性的研究

目的观察强直性脊柱炎患者骨密度（BMD)的变化以及FRAX评估AS患者10年内发生骨 折的概率的情况。方法AS组:2010年6月~ 2011年6月,住院的AS患者42例,其中男29例、女 13例,男：女=2. 2:1,年龄34. 57 ±13.67岁;健康对照组:40例,其中男27例、女13例,男：女=2. 1： 1,年龄32. 96 ±12. 58岁。分别检测双股骨颈、腰椎,_4 BMD与T值;AS组患者均检测血清CRP、 Ca2*、P3_、ALP含量与ESR;AS组患者双侧骶髂关节做CT扫描并分级;根据FRAX测定两组10年内 发生髋部骨折和主要骨质疏松性骨折的概率。统计学方法采用t检验、相关分析、方差检验及y检 验。结果①AS组男性、女性双股骨颈的BMD值（0.938 ±0.176, 0.942 ±0.150)明显低于健康对 照组（1. 180 ±0. 139,1. 172 ±0. 123) ; AS 组男性、女性的腰椎,_4 BMD 值（1. 040 ±0. 183, 1.071 ± 0. 19S)明显低于健康对照组（1. 170 ±0. 117,1. 181 ±0. 113);②AS组骨质疏松及骨量减少分别是 45. 24%和66. 67% ;?AS组双股骨颈、腰椎,4BMD与血清Ca2+含量呈正相关性（r =0. 435,0. 566); ④AS组CT第IV级的双股骨颈BMD值（0.731 ±0.087)明显低于第I、II级的值（0.991 ±0. 137, 1.002 ±0. 140);而各级腰椎,_4BMD值差异无统计学意义（P均>0. 05);⑤应用FRAX评估AS组10 年内的髋部骨折概率明显高于健康对照组（^<0.05)。结论AS患者存在不同程度的BMD的降 低,导致继发性OP或骨量减少,FRAX测评结果显示AS患者10年内发生髋部骨折的危险性明显增 加,应引起医生与患者的足够重视,积极采取防治措施。     

应用FRAX工具评估骨折风险的回顾性研究

目的 通过对国内已发表使用FRAX工具进行骨折风险评估的相关文献进行分析评价，寻找更适合国人的FRAX评估骨折风险的国内阈值。方法 检索2021年4月以前的中国知网与万方数据库，主题词为“FRAX”，检索筛选出有具体FRAX计算结果、样本量≥30例和以国人为研究对象的文献，由2名评价者单独进行资料提取，做出文献质量评价后，摘录文中相关数据，采用SPSS 17.0软件进行统计分析。结果 共检索到216篇相关文献，其中19篇文献符合标准，包括20508例次数据，其中男性11632例，女性8876例。将男女的结果分开统计计算，使用FRAX工具评估10年全身多部位骨折发生概率（PMOF），其中女性为(4.01±1.57)%，男性为(2.94±1.91)%，使用FRAX工具评估10年内髋部骨折风险概率（PHF），其中女性为(1.25±0.68)%，男性为(1.09±0.75)%，男女在10年内PMOF及PHF的差异均具有统计学意义（P＜0.05）。结论 国内FRAX工具估算10年PMOF和PHF与国外指南存在差异，PMOF推荐男性参考3%、女性参考4%；PHF推荐男性参考1%，女性参考1.25%。     

FRAX模型评估中国老年2型糖尿病患者骨折风险的价值

目的 应用FRAX模型评估老年2型糖尿病和非糖尿病患者的骨折风险,明确FRAX模型评估中国大陆老年2型糖尿病亚群的骨折风险的有效性.方法 随机选取2型糖尿病老年患者267例,对照组(非糖尿病患者)359例,进行调查问卷、骨密度测量、FRAX分值计算.应用二分类变量回归方法分析FRAX高骨折风险的相关因素.结果 2型糖尿...     

FRAX评估类风湿关节炎患者骨折风险及相关临床危险因素的研究

目的运用FRAX探究中国RA患者骨折风险及相关临床危险因素。方法纳入52例RA、47例p SS以及41例体检健康者分别为RA组、p SS组、对照组,RA组患者检测ACPA、RF、ESR、CRP并计算DAS28-ESR、HAQ-DI,所有纳入者以双能X线吸收测定法测定骨密度并通过FRAX官方网站预估10年骨折风险。所有统计分析采用SPSS统计软件。结果 FRAX相关骨折危险因素包括身高、吸烟、饮酒、既往骨折、父母骨折,在3组间差异未见统计学意义。RA组糖皮质激素累积服用天数高于p SS组(P0.05)。通过FRAX无论是否结合骨密度评估,RA组主要骨质疏松性骨折风险及髋关节骨折风险均较对照组高(P0.01),主要骨质疏松性骨折风险亦较p SS组高(P0.05或P0.01)。通过FRAX结合骨密度评估,从年龄、糖皮质激素、绝经方面分析,RA组主要骨质疏松性骨折及髋关节骨折风险均较对照组高(P0.05或P0.01)。通过FRAX结合BMD评估RA组10年主要骨质疏松性骨折风险发生率分为低危、中危、高危组,ACPA、RF、ESR、CRP、DAS28-ESR、HAQ-DI在三组中均值呈上升趋势,差异均有统计学意义(P0.01)。结论 RA患者骨折风险评估可结合FRAX与骨密度;长期、大量服用糖皮质激素以及高龄、绝经后女性RA患者更应重视骨折风险评估;有效控制RA疾病活动度、改善关节功能情况有助于骨质疏松性骨折的预防。     

系统应用糖皮质激素患者的FRAX骨折风险评估分析

目的 通过使用糖皮质激素（glucocorticoid,GC）校正的骨折危险性评估工具（fracture risk assessment tool,FRAX）,评估系统应用GC对风湿病患者群体骨折风险的影响。方法 纳入2019年1月至2020年1月于解放军总医院第四医学中心就诊且行髋部和腰椎骨密度检测的风湿病患者180例和同期健康体检者180名,风湿病患者均系统性使用GC治疗超过3个月,按照日均GC剂量（等同于醋酸泼尼松）分为GC≤7.5 mg组,7.5 mg＜GC＜30 mg组和≥30 mg组,并对剂量超过7.5 mg的两组进行骨折风险校正,使用FRAX评估系统评估未来10年主要骨质疏松性骨折（PMOF）和髋部骨折（PHF）发生概率,并比较组间的差异。结果 ①激素使用组PMOF和PHF高于健康对照组,且差异有统计学意义（P＜0.05）;②按GC使用时间分为＞2年组和≤2年组,GC使用＞2年组PMOF和PHF均高于≤2年组,且差异有统计学意义;③FRAX校正前GC≤7.5 mg组的PMOF与PHF高于另外两组,差异有统计学意义;④FRAX校正后GC≤7.5 mg组PMOF与PHF仍高于另外两组,与GC≥30 mg组相比差异有统计学意义;⑤按骨质疏松治疗阈值PMOF 20 %、PHF 3 %计算,激素使用组达到PMOF和PHF治疗阈值者分别为0例和9例（5 %）;按2017年GIOP推荐的骨质疏松治疗阈值PMOF 10 %、PHF 1 %计算,达治疗阈值者分别为8例（4.44 %）和41例（22.78 %）。结论 经GC校正后可提高基于FRAX计算出的风湿病患者的骨折风险,且校正后增加了达到骨质疏松治疗阈值的人数,能更有效的预测使用GC的风湿病群体骨折概率,尽早实施预防骨质疏松,从而降低骨折概率。     

2型糖尿病患者FRAX评分及骨密度与BMI的相关性分析

目的探讨2型糖尿病患者骨折风险预测工具FRAX计算出的骨折风险及骨密度与BMI之间的关系。方法选取278例糖尿病人群,开展相关问卷调查,收集相关临床指标,并检测骨密度,计算FRAX评分。研究2型糖尿病患者FRAX评分及骨密度与BMI的关系。结果 2型糖尿病患者的L1-4、股骨颈的骨密度随着BMI的升高,呈逐渐升高的趋势(P0.05),10年主要骨质疏松性骨折发生概率(PMOF)和10年髋部骨折发生概率(PHF)在分组后无明显差异。结论 2型糖尿病患者骨密度与BMI有相关性,而FRAX评分与BMI无相关性。     

应用FRAX工具评估系统性红斑狼疮患者骨折风险及相关因素分析

目的 探讨骨折危险性评估工具(FRAX)评估系统性红斑狼疮(SLE)患者骨质疏松性骨折风险并进行相关因素分析.方法 纳入2018年1月至2019年6月我院治疗的90例SLE患者以及60例正常体检人员,分别设为研究组与对照组.采用双能X线骨密度仪测定骨密度,比较两组骨密度差异;采用FRAX评估SLE患者骨质疏松性骨折风险...     

骨密度联合脊柱骨折评估在中老年风湿病患者中的临床价值

目的：探讨骨密度联合脊柱骨折评估在风湿病患者骨质疏松症、重度骨质疏松症、骨质疏松性骨折诊断和治疗中的临床价值。方法：回顾性分析2017年12月至2019年3月在包头医学院第一附属医院诊断为风湿病的绝经后女性或年龄> 50岁的男性患者388例,所有患者均以双能X线吸收检测法(DXA)检测骨密度和脊柱骨折评估。结果：骨密度正常(T≥-1.0)患者136例(35.05%),低骨量(-2.5 -2.5相比,脊柱骨折率显著升高,差异有统计学意义(χ²=45.346,P <0.001)。脊柱骨折评估加骨密度加临床脆性骨折史可确诊骨质疏松症174例(44.85%)、重度骨质疏松症65例(16.75%),与单纯骨密度诊断法相比,骨质疏松症诊断率提高11.60%(P <0.001);与传统骨密度联合临床脆性骨折史诊断法相比,骨质疏松症诊断率提高7.22%...     

FRAX评估北京地区中老年人群骨折风险的回顾性研究

目的评价WHO发布的骨折风险评估工具FRAX对北京地区中老年人群的适用性,预测北京地区不同性别及年龄亚组中老年人群的骨折风险,讨论既往骨折病史对于FRAX的影响。方法对3021例北京地区中老年人群进行分组性研究。输入相关资料及FRAX工具中所包含的危险因素,计算未来10年内发生全身骨质疏松性骨折及髋部骨折的风险概率,比较既往骨折病史人群对FRAX预测结果影响。结果北京地区女性中老年人群未来10年内骨折风险远高于同年龄组男性;伴随年龄增大,未来10年内发生全身骨质疏松性骨折及髋部骨折的风险概率不分性别均同步增高。有既往骨折病史的老年人群10年内再发骨折风险远高于无骨折史人群。结论利用FRAX工具可以对北京地区中老年人群骨折风险做出有效评估,针对于不同性别、不同年龄亚组的人群,联合髋部BMD值后获取的FRAX预测在既往骨折或未骨折患者中均具有临床应用价值。FRAX评估工具在骨质疏松的诊断、治疗及预后评价等方面具有良好的临床应用价值。     

FRAX评估南京地区中老年人群骨折风险的临床研究

目的评价WHO发布的骨折风险评估工具FRAX对南京地区中老年人群的适用性,预测本地区不同性别组中老年人群的骨折风险,讨论联合股骨颈BMD及既往骨折病史对于FRAX的影响。材料和方法对1383例南京地区中老年人群进行分组性研究。输入相关资料及FRAX工具中所包含的危险因素,计算10年内髋部骨折及全身骨质疏松性骨折风险概率,比较骨折既往病史人群及髋部BMD对FRAX预测结果影响。结果南京地区女性中老年人群未来10年内骨折风险远高于同年龄组男性;伴随年龄增大,髋部及全身骨折风险概率均同步增高;有既往骨折史的老年人群10年内再发骨折风险远高于无骨折史人群。除外既往骨折史,联合或不联合BMD后预测髋部及全身骨折结果无显著性差异。结论 FRAX工具可以对南京中老年人群骨折风险做出有效评估,联合髋部BMD值后获取的FRAX预测在既往骨折或未骨折患者中均具有临床应用价值。     

吸入糖皮质激素治疗对COPD患者的骨密度及骨折风险的影响

目的观察吸入糖皮质激素治疗对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者的骨密度及骨折风险的影响。方法 122例COPD患者,70例吸入糖皮质激素的当前使用者和52例从未接受过糖皮质激素治疗的患者,进行了骨密度(bone mineral density,BMD)和身体成分评估,并接受了椎体骨折评估(verterbral fracture assessment,VFA)。考虑用于分析的骨病的风险因素是年龄、性别、吸入糖皮质激素使用、体质量指数(body mass index,BMI)、肌肉质量指数(muscle mass index,MMI)和慢性阻塞性肺病全球倡议(GOLD)类别。同时还使用了针对汉族人群的骨折风险评估工具(FRAX)计算工具。结果这些组间在性别、BMI、MMI、GOLD等级、BMD T评分和Z评分的最低值,骨质疏松症的患病率或年龄的低BMD方面没有差异(P0.05)。在使用吸入糖皮质激素的14例患者中通过VFA鉴定椎骨骨折,并且在没有接受糖皮质激素的患者中通过VFA鉴定椎体骨折(P0.05)。MMI与骨质疏松症之间存在关联的趋势(P0.05),并且根据通过GOLD评分评估的COPD严重性,BMD Z评分逐渐降低。椎体骨折与骨质疏松症(P0.05)或低MMI(P0.05)无关。FRAX没有估计骨折风险。结论吸入糖皮质激素可导致骨密度降低,但是骨折风险未发现增加。     

Clinical risk factor status in patients with vertebral fracture but normal bone mineral density

BACKGROUND CONTEXTNormal bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA) is present in approximately 10% of older adults with fracture. BMD alone does not evaluate bone quality or clinical risk factors, and therefore, may not adequately capture a patient's fracture risk. Thus, despite a normal DXA-measured BMD, the underlying bone may be abnormal, suggesting that further bone health evaluation, and potentially, pharmacologic treatment may be warranted.PURPOSETo determine the prevalence of normal BMD, clinical fracture risk factors, and quantitative risk of fracture using the Fracture Risk Assessment Tool (FRAX) in vertebral fracture patients with normal BMD enrolled in the Own the Bone registry, thus facilitating identification of those who meet criteria for anti-osteoporosis therapy.STUDY DESIGN/SETTINGRetrospective, national registry-based cohort.PATIENT SAMPLEFrom July 2016 to July 2021, 1,807 patients age ≥50 who sustained a vertebral fracture and had DXA data available from within 2 years prior to enrollment in the American Orthopaedic Association's Own the Bone (AOA OTB) registry were included.OUTCOME MEASURESWorld Health Organization (WHO) DXA T-score based bone classification criteria; FRAX risk scores of major osteoporotic fracture or hip fracture.METHODSDemographic data, prior fracture site, and clinical fracture risk factors were collected. BMD status was classified by the WHO T-score criteria: ≥ -1.0 normal, -1.1 to -2.4 osteopenia, and ≤ -2.5 osteoporosis, with low bone mass including either osteopenia or osteoporosis. In normal BMD patients, FRAX scores were calculated with and without BMD, with the treatment threshold defined as a major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%.RESULTSMean±SD age was 72.0±9.7, 78.1% were female, and 92.4% were Caucasian. Normal BMD was present in 7.9%. Clinical fracture risk factors including alcohol use ≥3 units/day and history of ≥2 falls in the year prior to enrollment were more common in normal BMD (11.2% and 28%, respectively) compared to low bone mass patients (3.4% and 25.2%, respectively). A prior vertebral fracture had occurred in 49.5% with normal BMD compared to 45.8% with low bone mass, while a prior non-major osteoporotic fracture occurred in 28.9% and 29.3% of normal BMD and low bone mass patients, respectively. In normal BMD patients, either a prior fracture or FRAX risk with BMD meeting treatment thresholds was present in 85%.CONCLUSIONSClear indications for receipt of pharmacologic therapy, ie, prior fracture or elevated fracture risk, were present in most patients with vertebral fracture and normal BMD enrolled in the AOA OTB. Prior non-major osteoporotic fractures were common and may be useful indicators of underlying bone disease. Surgeons must recognize that other important risk factors apart from BMD may indicate poor bone health, and thus, help guide further bone health evaluation.     

FRAX underestimates fracture risk in patients with diabetes

The study objective was to determine whether diabetes is a risk factor for incident hip or major osteoporotic fractures independent of the WHO fracture risk assessment tool (FRAX). Men and women with diabetes (n = 3518) and nondiabetics (n = 36,085) aged ≥50 years at the time of bone mineral density (BMD) testing (1990 to 2007) were identified in a large clinical database from Manitoba, Canada. FRAX probabilities were calculated, and fracture outcomes to 2008 were established via linkage with a population-based data repository. Multivariable Cox proportional hazards models were used to determine if diabetes was associated with incident hip fractures or major osteoporotic fractures after controlling for FRAX risk factors. Mean 10-year probabilities of fracture were similar between groups for major fractures (diabetic 11.1 ± 7.2 versus nondiabetic 10.9 ± 7.3, p = 0.116) and hip fractures (diabetic 2.9 ± 4.4 versus nondiabetic 2.8 ± 4.4, p = 0.400). Diabetes was a significant predictor of subsequent major osteoporotic fracture (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.42-1.83) after controlling for age, sex, medication use, and FRAX risk factors including BMD. Similar results were seen after adjusting for FRAX probability directly (HR = 1.59, 95% CI 1.40-1.79). Diabetes was also associated with significantly higher risk for hip fractures (p < 0.001). Higher mortality from diabetes attenuated but did not eliminate the excess fracture risk. FRAX underestimated observed major osteoporotic and hip fracture risk in diabetics (adjusted for competing mortality) but demonstrated good concordance with observed fractures for nondiabetics. We conclude that diabetes confers an increased risk of fracture that is independent of FRAX derived with BMD. This suggests that diabetes might be considered for inclusion in future iterations of FRAX.     

The relationship between bone mineral density and fracture risk

Osteoporosis is a disorder characterized by low bone density and impaired bone strength which is an important risk factor for fracture in older adults. The diagnosis of osteoporosis in postmenopausal women is now based on bone density testing by dual energy x-ray absorptiometry but not other methodologies. However, a specific but arbitrary diagnostic threshold must be distinguished from a strategy to assess fracture risk. In untreated postmenopausal women and older men, bone density is an important, but not the only, determinant for fracture risk. Combining bone density measurements with other independent and validated risk factors for fracture provides a much more accurate assessment of an individual patient’s risk for fracture than does bone density alone. The most important of these other risk factors are age and prior fracture history. Clinical guidelines will move away from recommending treatment at specific T scores toward intervention thresholds based on absolute fracture risk. By basing who to treat on fracture probability, therapy can be targeted to those patients who would receive the greatest benefit.     

北京南郊地区成年人桡骨远端骨密度及FRAX骨折风险评分与BMI的相关分析和探索研究

目的探讨北京南郊地区不同性别成年人非优势手臂桡骨远端骨密度及骨折风险预测工具FRAX计算出的全身骨折风险与身体质量指数(body mass index,BMI)及年龄之间的关系。方法回顾性分析2015年1月至2017年6月期间在我院接受双能X线骨密度检测(DEXA)的体检人群2 680名作为研究对象,其中男性944名,女性1 736名,收集相关临床指标,计算BMI值,检测受检者非优势手臂的桡骨远端骨密度,登录网站计算FRAX骨折风险评分。按年龄及BMI分组,采用方差分析的方法分别研究桡骨远端骨密度及FRAX骨折风险评分与BMI及年龄之间的关系。采用最小显著性差异法(least significant difference,LSD)分别比较BMI各组及各年龄组桡骨远端骨密度和FRAX骨折风险评分的组间差异。结果 (1)北京南郊地区成年人非优势手臂桡骨远端骨密度(bone mineral density,BMD)随年龄增高而降低,FRAX骨折风险评分即10年内发生全身骨质疏松性骨折的概率(probability of a major osteoporotic fracture,PMOF)随年龄增高而增高,差异均有统计学意义(P0.05),且各年龄组骨密度BMD值男性均高于女性,PMOF男性均低于女性,差异有统计学意义(P0.05)。(2)北京南郊地区成年人非优势手臂桡骨远端骨密度BMD随BMI的升高呈而增高,且差异有统计学意义(P0.05)。不论性别,PMOF在BMI为24~27.9(超重组)达高峰,正常体重组及肥胖组均低于超重组。(3)BMI各组中男性BMD值均高于女性,PMOF各BMI组中男性均低于女性,差异有统计学意义(P0.05)。结论桡骨远端骨密度BMD及PMOF与受检者性别、年龄、BMI均相关,其中同等年龄及BMI情况下,女性的骨折风险均高于男性;随着年龄增长,骨密度降低,骨折风险增加;随着BMI的增高,骨密度BMD逐渐增高,但此时骨折风险不随BMD的增高而降低,而表现为超重人群骨折风险最高,正常体重人群骨折风险最低,故超重亦是使骨折风险增加的危险因素。通过利用FRAX软件,测量桡骨远端骨密度的高低并充分考虑性别、年龄、BMI等因素可有效评估患者的骨折风险。     

RA患者骨密度的特点及影响骨折风险的因素

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨密度的特点及其骨折的风险度,并分析其影响因素。方法选取2016年1月至2017年12月于我院已确诊的RA患者共70例(RA组),体检的正常健康人群共79例(对照组),收集两组人群的病史及骨折风险相关的基本临床资料,且采用双能X线骨密度仪测定两组人群股骨的3D骨密度、二维骨密度,并进行骨折跌倒评分及FRAX评分,分析RA患者的骨密度变化情况、骨折风险性和疾病的活动度,探讨影响RA骨密度减低的因素。结果与正常对照组相比,RA组患者无论是体积骨密度还是皮质厚度都明显降低(t=6.135,P0.01),且均与二维BMD的变化趋势相一致;RA患者骨折风险度明显高于正常对照组人群(t=6.663,P0.01),RA患者疾病的活动度与骨密度的改变之间无明显相关性(r=-0.085,P0.05),但激素的使用是其骨量流失的影响因素(χ~2=12.366,P0.05)。结论RA患者存在明显的骨量流失和骨折风险性增加,骨密度的改变主要表现为骨小梁和骨皮质密度均减低,因此,积极控制原发病并预防糖皮质激素性骨质疏松有重要的临床意义。     

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.     

The measurement of bone mineral density of bilateral proximal humeri using DXA in patients with unilateral rotator cuff tear

Summary

We propose that the measurement of the bone mineral density (BMD) of the proximal humerus be standardized using the dual energy X-ray absorptiometry (DXA) in patients supposed to undergo rotator cuff repair surgery as well as those with the fracture of the proximal humerus as the BMD of the proximal humerus is decreased in these patients.

Introduction

We propose that the measurement of the BMD of the proximal humerus be standardized using the DXA in patients who are supposed to undergo rotator cuff repair surgery as well as those with the fracture of the proximal humerus.

Methods

We conducted the prospective study in 213 patients with unilateral rotator cuff tear but without contralateral shoulder pain or disease. In these patients, we preoperatively measured the BMD of the bilateral proximal humeri with a repeat measurement in 20 patients. We predefined three regions of interest (ROIs) in the proximal humerus with the consideration of the rotator cuff repair surgery as well as proximal humeral fractures.

Results

The measurement of the BMD of the proximal humerus using the DXA showed excellent reliability (intraclass correlation coefficient?>?.90). BMD values of all three ROIs in the affected shoulder were significantly lower than those in asymptomatic shoulder (all p?p?Conclusions It is imperative that the bone quality of the proximal humerus be accurately evaluated prior to surgery in patients who are supposed to undergo rotator cuff repair using suture anchors as well as in those with proximal humeral fractures. This is because the BMD of the proximal humerus is decreased in these patients.