Petley G W, Taylor P A, Murrills A J, Dennison E, Pearson G, Cooper C
Department of Medical Physics and Bioengineering, Southampton University Hospitals NHS Trust, UK.
Osteoporos Int. 2000;11(8):675-9. doi: 10.1007/s001980070065.
This paper describes a study to assess the clinical value of bilateral femoral neck bone mineral density (BMD) measurements. Although a range of factors will determine clinical decisions, the classification of the site with the lowest T-score is likely to have significant bearing on the management of a patient. While it is common practice to measure BMD at the lumbar spine and a single neck of femur, knowledge of the BMD of the second femur may also be of diagnostic value. Using dual-energy X-ray absorptiometry, BMD of the lumbar spine and right and left femoral neck was measured in a group of 2372 white, Caucasian women (mean age +/- SD, 56.6 +/- 13.9 years) routinely referred for bone densitometry. Analysis of the measurements showed a significant (p = 0.02) but small difference between the mean BMD of the right (0.840 +/- 0.152 g/cm2) and left (0.837 +/- 0.150 g/cm2) femoral neck. Further investigation of femur scans revealed 79 (3.3%) patients in whom one side was osteoporotic while the other side and spine were normal or osteopenic using the World Health Organization diagnostic criteria in combination with manufacturer's reference data. Patients in whom the femoral neck BMD measurements differed by less than the precision error of the system were then excluded. This left only 51 (2.2%) patients, that is 29 (1.2%) for right femur and spine scan and 22 (0.9%) for left femur and spine scan, in whom knowledge of both femoral neck BMD measurements could have altered the classification of the lowest site assessed to osteoporotic. These data suggest that there is only a small benefit from performing bilateral femoral neck BMD measurements. Since BMD measurements are only one of a range of factors considered as part of a patient's management, it is suggested that the extra time, cost and radiation dose associated with measurement of the second femur may not be justified.
本文描述了一项评估双侧股骨颈骨密度（BMD）测量临床价值的研究。尽管一系列因素将决定临床决策，但T值最低部位的分类可能对患者的管理具有重要影响。虽然在腰椎和单个股骨颈测量骨密度是常见做法，但了解第二侧股骨的骨密度也可能具有诊断价值。使用双能X线吸收法，对一组2372名白人、高加索女性（平均年龄±标准差，56.6±13.9岁）进行了腰椎和左右股骨颈的骨密度测量，这些女性因常规骨密度检测而就诊。测量分析显示，右侧（0.840±0.152g/cm²）和左侧（0.837±0.150g/cm²）股骨颈的平均骨密度之间存在显著差异（p = 0.02），但差异较小。对股骨扫描的进一步研究发现，根据世界卫生组织诊断标准并结合制造商参考数据，有79名（3.3%）患者一侧为骨质疏松，而另一侧和脊柱正常或骨量减少。然后排除股骨颈骨密度测量差异小于系统精度误差的患者。这样仅剩下51名（2.2%）患者，即右侧股骨和脊柱扫描的29名（1.2%）患者以及左侧股骨和脊柱扫描的22名（0.9%）患者，在这些患者中，双侧股骨颈骨密度测量结果可能会改变评估为骨质疏松的最低部位的分类。这些数据表明，进行双侧股骨颈骨密度测量仅带来微小益处。由于骨密度测量只是患者管理所考虑的一系列因素之一，因此建议与测量第二侧股骨相关的额外时间、成本和辐射剂量可能并不合理。
