Rosenthall L, Caminis J, Tenehouse A
The Montreal General Hospital, McGill University, 1650 Cedar Ave., Montreal, Canada H3G 1A4.
Calcif Tissue Int. 1999 Mar;64(3):200-4. doi: 10.1007/s002239900602.
The object of this study was to determine the effectiveness of calcaneal ultrasonometry in the prediction of bone mineral changes in the lumbar spine and femoral neck in response to treatment of osteoporosis. There were 673 women in the study who had one or more follow-up measurements between 1 and 4 years after the initial baseline determination for a total of 881 same-day measurements of the calcaneus, spine, and femur. The LUNAR Achilles and LUNAR DPX (LUNAR Corporation, Madison, WI) were used. Patients were divided into three treatment time groups: Group 1, 1-<2 years, n = 461; Group 2, 2-<3 years, n = 278; Group 3, 3-<4 years, n = 142. There were significant increases in the bone mineral density (BMD) of the lumbar spine, femoral neck, and in the broadband ultrasonic attenuation (BUA) of the calcaneus for the three groups. In contrast, a significant decrease in speed of sound (SOS) was obtained in these time frames and the stiffness index remained unchanged. Spearmen correlations showed an inverse relationship between the percent changes in SOS and BUA, the reasons for which are speculative. Correlations between the percent changes in calcaneal parameters and the BMDs of the lumbar spine and femoral neck were weak, whether significant or not, rho varying from -0.12 to 0.20. There was a subset of 371 patient measurements that registered BMD increases in both the lumbar spine and femoral neck. This was considered to be an objective indication of adequate compliance with prescribed treatment. Analysis of this subset yielded parameter correlations similar to those of the entire group. It is concluded that changes in the calcaneal ultrasound parameters in response to treatment of osteoporosis are not a reflection of mineral changes occurring in the lumbar spine and femoral neck in a given individual, and in this regard, calcaneal ultrasonometry is not a substitute for direct-site dual X-ray absorptiometry (DXA) measurement of the lumbar spine and femur.
本研究的目的是确定跟骨超声检查在预测骨质疏松症治疗后腰椎和股骨颈骨矿物质变化方面的有效性。该研究中有673名女性，她们在初始基线测定后的1至4年之间进行了一次或多次随访测量，总共对跟骨、脊柱和股骨进行了881次同日测量。使用了LUNAR跟腱超声仪和LUNAR DPX（LUNAR公司，威斯康星州麦迪逊）。患者被分为三个治疗时间组：第1组，1 - <2年，n = 461；第2组，2 - <3年，n = 278；第3组，3 - <4年，n = 142。三组患者的腰椎、股骨颈骨密度（BMD）以及跟骨的宽带超声衰减（BUA）均有显著增加。相比之下，在这些时间段内声速（SOS）显著降低，而硬度指数保持不变。Spearmen相关性分析显示SOS和BUA的百分比变化之间呈负相关，其原因尚属推测。跟骨参数的百分比变化与腰椎和股骨颈BMD之间的相关性较弱，无论是否显著，相关系数rho在 -0.12至0.20之间。有371例患者测量结果显示腰椎和股骨颈的BMD均增加。这被认为是充分遵医嘱治疗的客观指标。对该亚组的分析得出的参数相关性与整个组相似。研究得出结论，骨质疏松症治疗后跟骨超声参数的变化并不能反映特定个体腰椎和股骨颈发生的矿物质变化，就此而言，跟骨超声检查不能替代腰椎和股骨的直接部位双能X线吸收法（DXA）测量。
