Frost M L, Blake G M, Fogelman I
Osteoporosis Screening and Research Unit, Guy's Hospital, London, UK.
Osteoporos Int. 2001;12(6):471-7. doi: 10.1007/s001980170092.
The widespread availability of quantitative ultrasound (QUS) and X-ray absorptiometry densitometers raises the question of whether a combination of QUS and bone mineral density (BMD) measurements could provide a clinically useful method of enhancing the prediction of fracture risk. The aim of this study was to examine whether a combination of axial BMD and calcaneal QUS measurements can enhance fracture discrimination compared with either method alone. The study population consisted of 154 postmenopausal women with a history of atraumatic fracture at the spine, hip or forearm and 221 healthy postmenopausal women with no clinical risk factors for osteoporosis. Subjects had dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine (LS), femoral neck (FN) and total hip (THIP) and calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS) measurements on the Hologic Sahara (SAH) and Osteometer DTUone (DTU). Z-scores were calculated using the mean and SD obtained from the healthy postmenopausal group. Logistic regression analysis yielded odds ratios for BMD measurements at the LS, FN and THIP of 2.2, 2.2 and 2.3, respectively. The odds ratios obtained for QUS measurements ranged from 2.5 for DTU BUA to 3.3 for SAH SOS. While these odds ratios for QUS measurements were higher than those obtained for BMD measurements, the differences were not statistically significant. When the odds ratios for QUS were adjusted for BMD at the spine and hip, the odds ratios remained significant in all cases indicating that QUS and BMD variables contribute independently to fracture discrimination. When the BMD-adjusted odds ratios were compared with those for QUS alone, they were slightly lower but not significantly so. When the QUS measurements were adjusted for THIP BMD, the odds ratios for QUS tended to be lower than when adjusted for LS and FN BMD. The Z-scores for each of the QUS measurement variables were combined with spine or hip Z-scores. Logistic regression analysis of the QUS and BMD combined Z-scores yielded slightly higher odds ratios of approximately 3.1 (compared with 2.9 obtained for QUS alone) and increases in the area under the curve of approximately 2%. However, these increases were not clinically significant. In conclusion, the combination of axial BMD and calcaneal QUS measurements did not significantly improve fracture discrimination compared with either method alone.
定量超声（QUS）和X线吸收骨密度仪的广泛应用引发了一个问题，即QUS与骨矿物质密度（BMD）测量相结合是否能提供一种临床上有用的方法来增强对骨折风险的预测。本研究的目的是检验与单独使用任何一种方法相比，腰椎BMD与跟骨QUS测量相结合是否能增强骨折鉴别能力。研究人群包括154名有脊柱、髋部或前臂非创伤性骨折病史的绝经后女性以及221名无骨质疏松临床风险因素的健康绝经后女性。受试者接受了腰椎（LS）、股骨颈（FN）和全髋（THIP）的双能X线吸收法（DXA）测量以及在Hologic Sahara（SAH）和Osteometer DTUone（DTU）上进行的跟骨宽带超声衰减（BUA）和声速（SOS）测量。使用从健康绝经后组获得的均值和标准差计算Z评分。逻辑回归分析得出，LS、FN和THIP处BMD测量的比值比分别为2.2、2.2和2.3。QUS测量获得的比值比范围从DTU BUA的2.5到SAH SOS的3.3。虽然这些QUS测量的比值比高于BMD测量的比值比，但差异无统计学意义。当对脊柱和髋部的BMD校正QUS的比值比时，在所有情况下比值比仍然显著，表明QUS和BMD变量对骨折鉴别有独立贡献。当将BMD校正后的比值比与单独QUS的比值比进行比较时，它们略低但无显著差异。当对THIP BMD校正QUS测量值时，QUS的比值比往往低于对LS和FN BMD校正时。将每个QUS测量变量的Z评分与脊柱或髋部Z评分相结合。对QUS和BMD联合Z评分进行逻辑回归分析得出的比值比略高，约为3.1（与单独QUS获得的2.9相比），曲线下面积增加约2%。然而，这些增加在临床上并不显著。总之，与单独使用任何一种方法相比，腰椎BMD与跟骨QUS测量相结合并未显著改善骨折鉴别能力。
