Varney L F, Parker R A, Vincelette A, Greenspan S L
Division of Bone and Mineral Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boson, MA, USA.
J Clin Densitom. 1999 Fall;2(3):275-83. doi: 10.1385/jcd:2:3:275.
Despite the availability of guidelines from the World Health Organization study group for the classification of osteoporosis in postmenopausal Caucasian women, confusion still exists about the number of sites used for diagnosis and the clinical utility of peripheral bone mass assessments. To examine the diagnosis of osteoporosis and osteopenia based on bone density measurements at single or multiple sites using central and peripheral measurements, we studied 115 ambulatory, community-dwelling, Caucasian postmenopausal women. Bone mineral density of the hip, PA spine, forearm, and finger were assessed by dual X-ray absorptiometry. Bone mass of the calcaneus was obtained using ultrasound. The diagnosis of osteoporosis based on a single measurement varied from 4% using the trochanteric region to 34% using Ward's triangle, 17% using the calcaneus, and 13% using the finger. Twenty-eight percent of the women had osteoporosis if the diagnosis was based on at least one osteoporotic value at three standard central sites (PA spine, total hip, femoral neck). Among these women, using T-scores provided by the manufacturers, 16% of osteoporotic patients would be misclassified as normal using the Sahara Clinical Bone Sonometer (Hologic, Waltham, MA) (heel) and 34% misclassified using the accuDEXA (Schick, New York, NY) (finger). We conclude that there is significant variability in the classification of osteoporosis based on site selection, with significant potential for misdiagnosis.
尽管世界卫生组织研究小组已发布绝经后白种女性骨质疏松症分类指南，但对于用于诊断的部位数量以及外周骨量评估的临床效用仍存在困惑。为了研究基于中央和外周测量的单部位或多部位骨密度测量来诊断骨质疏松症和骨质减少症，我们对115名社区居住的绝经后白种女性进行了研究。通过双能X线吸收法评估髋部、腰椎正位、前臂和手指的骨矿物质密度。使用超声获得跟骨的骨量。基于单次测量诊断骨质疏松症的比例从使用转子区的4%到使用沃德三角区的34%、使用跟骨的17%以及使用手指的13%不等。如果基于三个标准中央部位（腰椎正位、全髋、股骨颈）中至少一个骨质疏松值进行诊断，28%的女性患有骨质疏松症。在这些女性中，使用制造商提供的T值，16%的骨质疏松症患者使用Sahara临床骨超声仪（Hologic公司，马萨诸塞州沃尔瑟姆）（足跟）会被误分类为正常，34%使用accuDEXA（Schick公司，纽约州纽约）（手指）会被误分类。我们得出结论，基于部位选择的骨质疏松症分类存在显著差异，误诊可能性很大。
