DXA椎体骨折评价在骨质疏松诊断中的意义

目的比较双能X线骨密度仪的椎体骨折评价(vertebral fracture assessment,VFA)中Genant半定量法和6点定量法对椎体压缩诊断的差异,探讨联合应用VFA在骨质疏松诊断中的意义。方法对85名主诉有腰背痛或身高变矮的患者行骨密度检查(男12例,女73例),平均年龄68.1±10.4岁;女性绝经年龄49.4±3.4岁。同时应用VFA软件分析椎体是否存在压缩,分别采用Genant半定量法和6点定量法进行分析。结果骨密度采用世界卫生组织(WHO)诊断标准,诊断骨质疏松66人,低骨量14人,5人骨量正常,骨质疏松诊断率为77.65%。采用Genant半定量法判断椎体Ⅰ~Ⅲ度压缩76人,6点定量法判断椎体压缩64人,两种方法的椎体压缩诊断率有差异(P0.01),两种方法的Ⅱ、Ⅲ度椎体压缩的诊断率无差异(P0.05)。6例通过骨密度T值诊断的非骨质疏松患者用VFA分析诊断有椎体骨折(压缩Ⅱ~Ⅲ度),应用T值联合VFA椎体压缩Ⅱ~Ⅲ度诊断的骨质疏松率为84.71%,与单独使用T值相比诊断率有差异(P0.05)。结论使用双能X线骨密度仪进行椎体骨折评价时,Genant半定量法和6点定量法对椎体压缩程度为Ⅱ、Ⅲ度的诊断率无差异、一致性好。骨密度检查时联合行VFA可增加骨质疏松的诊断率。

The significance of DXA-assisted vertebral fracture assessment for diagnosis of osteoporosis

Objective To compare the difference between Genant semi-quantitative method and 6-point quantitative method for the diagnosis of vertebral compression fracture using dual-energy X-ray absorptiometry-assisted vertebral fracture assessment (VFA), and to explore the significance of VFA application in the diagnosis of osteoporosis. Methods Bone mineral density examination was performed in 85 patients (12 males and 73 females) with low back pain or shortening in height. They were 68.1±10.4 years old, and their menopausal age was 49.4±3.4 years in women. Vertebral fracture assessment was conducted to analyze the existence of vertebral compression by both Genant semi-quantitative method and 6-point quantitative method. Results The bone mineral density was analyzed according to the criteria of the World Health Organization (WHO). 66 patients were diagnosed as osteoporosis, 14 patients had low bone mass, and 5 patients had normal bone mass. The diagnosis rate of osteoporosis was 77.65%. 76 patients with vertebral compression were detected by Genant semi-quantitative method, while 64 patients were detected by 6-point quantitative method. The diagnosis rate of vertebral compression by two methods was statistically different (P<0.01). The diagnosis rate of vertebral compression in grade 2 to 3 by two methods was not statistically different (P>0.05). Vertebral fracture (vertebral compression of grade 2 or 3) was detected in 6 non osteoporosis patients according to T-score. The diagnosis rate of osteoporosis was 84.71% using combination of T-score with grade 2 to 3 vertebral compression, which was statistically different comparing with the diagnosis rate according to T-score alone (P<0.05). Conclusion Diagnosis rate of vertebral compression in grade 2 to 3 is not statistically different between Genant semi-quantitative method and 6-point method in DXA-assisted VFA, and the consistency is good. The diagnosis rate of osteoporosis increases when bone mineral density examination combines with VFA.