Lippuner K, Fuchs G, Ruetsche A G, Perrelet R, Casez J P, Neto I
Osteoporosis Unit, University Hospital of Berne, Switzerland.
J Clin Densitom. 2000 Fall;3(3):241-9. doi: 10.1385/jcd:3:3:241.
Dual energy X-ray absorptiometry (DXA) is widely accepted as the reference method for diagnosis and monitoring of osteoporosis and for assessment of fracture risk, especially at hip. However, axial-DXA is not suitable for mass screening, because it is usually confined to specialized centers. We propose a two-step diagnostic approach to postmenopausal osteoporosis: the first step, using an inexpensive, widely available screening technique, aims at risk stratification in postmenopausal women; the second step, DXA of spine and hip is applied only to potentially osteoporotic women preselected on the basis of the screening measurement. In a group of 110 healthy postmenopausal woman, the capability of various peripheral bone measurement techniques to predict osteoporosis at spine and/or hip (T-score < -2.5SD using DXA) was tested using receiver operating characteristic (ROC) curves: radiographic absorptiometry of phalanges (RA), ultrasonometry at calcaneus (QUS. CALC), tibia (SOS.TIB), and phalanges (SOS.PHAL). Thirty-three women had osteoporosis at spine and/or hip with DXA. Areas under the ROC curves were 0.84 for RA, 0.83 for QUS.CALC, 0.77 for SOS.PHAL (p < 0.04 vs RA) and 0.74 for SOS.TIB (p < 0.02 vs RA and p = 0.05 vs QUS.CALC). For levels of sensitivity of 90%, the respective specificities were 67% (RA), 64% (QUS.CALC), 48% (SOS.PHAL), and 39% (SOS.TIB). In a cost-effective two-step, the price of the first step should not exceed 54% (RA), 51% (QUS.CALC), 42% (SOS.PHAL), and 25% (SOS.TIB). In conclusion, RA, QUS.CALC, SOS.PHAL, and SOS.TIB may be useful to preselect postmenopausal women in whom axial DXA is indicated to confirm/exclude osteoporosis at spine or hip.
双能X线吸收法（DXA）被广泛认可为诊断和监测骨质疏松症以及评估骨折风险（尤其是髋部骨折风险）的参考方法。然而，轴向DXA不适用于大规模筛查，因为它通常局限于专业中心。我们提出了一种针对绝经后骨质疏松症的两步诊断方法：第一步，使用一种廉价且广泛可用的筛查技术，旨在对绝经后女性进行风险分层；第二步，仅对根据筛查测量预先选定的潜在骨质疏松症女性进行脊柱和髋部的DXA检查。在一组110名健康绝经后女性中，使用受试者操作特征（ROC）曲线测试了各种外周骨测量技术预测脊柱和/或髋部骨质疏松症（使用DXA时T值＜-2.5标准差）的能力：指骨放射吸收法（RA）、跟骨超声测量法（QUS.CALC）、胫骨超声测量法（SOS.TIB）和指骨超声测量法（SOS.PHAL）。33名女性通过DXA检查发现脊柱和/或髋部患有骨质疏松症。RA的ROC曲线下面积为0.84，QUS.CALC为0.83，SOS.PHAL为0.77（与RA相比，p＜0.04），SOS.TIB为0.74（与RA相比，p＜0.02；与QUS.CALC相比，p = 0.05）。对于90%的敏感度水平，各自的特异度分别为67%（RA）、64%（QUS.CALC）、48%（SOS.PHAL）和39%（SOS.TIB）。在具有成本效益的两步法中，第一步的成本不应超过54%（RA）、51%（QUS.CALC）、42%（SOS.PHAL）和25%（SOS.TIB）。总之，RA、QUS.CALC、SOS.PHAL和SOS.TIB可能有助于预先筛选出需要进行轴向DXA以确认/排除脊柱或髋部骨质疏松症的绝经后女性。
