Saleh M M A, Jørgensen H L, Lauritzen J B
Department of Orthopaedic Surgery, Hvidovre Hospital, Denmark.
Clin Physiol Funct Imaging. 2002 Jan;22(1):58-63. doi: 10.1046/j.1475-097x.2002.00399.x.
Dual-energy X-ray absorptiometry (DXA) measured at the lumbar spine and particularly at the hip remain the gold-standard for diagnosing osteoporosis. However, devices for assessing the peripheral skeleton present several advantages in terms of lower price and portability. A major concern when using peripheral densitometry is the poor correlation with the central measurements. The main aim of this study is, therefore, to assess the possibility of expressing ultrasound measurements at the heel and bone mineral density (BMD) measured at the distal forearm as fracture odds ratios rather than an absolute measure of bone mass.
A total of 76 women with lower forearm fracture, 47 women with hip fracture and 231 age-matched women (controls) were included. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel using the DTU-one ultrasound scanner as well as BMD measured by dual X-ray absorptiometry on the DTX-200 at the distal forearm.
BUA, SOS and BMD at the distal forearm were all significantly lower in fracture patients compared with their respective control groups. The odds ratio for lower forearm fracture was 3.1 (95% CI: 1.8; 5.2) for heel-BUA (T-score cutoff: -2.3), 4.1 (2.3; 7.4) for heel-SOS (-2.1) and 2.2 (1.3; 3.7) for lower forearm BMD (-2.7). The odds ratio for hip fracture was 3.4 (1.5-7.7) for heel-BUA (-2.7), 3.6 (1.6; 8.1) for heel-SOS (-2.6) and 3.2 (1.4; 7.4) for lower forearm BMD (-2.9).
Peripheral densitometry can discriminate between hip- and lower forearm fracture patients and age-matched controls. Significantly elevated odds ratios for incurring these fractures can be calculated using device- and site specific t-score cutoff values. The results from this case-control study need to be confirmed by prospective cohort studies.
腰椎尤其是髋部的双能X线吸收法（DXA）测量仍是诊断骨质疏松症的金标准。然而，评估外周骨骼的设备在价格和便携性方面具有诸多优势。使用外周骨密度测量时的一个主要问题是与中心测量值的相关性较差。因此，本研究的主要目的是评估将足跟处的超声测量值和远端前臂的骨矿物质密度（BMD）表示为骨折比值比而非骨量绝对测量值的可能性。
共纳入76例前臂远端骨折女性、47例髋部骨折女性和231例年龄匹配的女性（对照组）。所有人均使用DTU-one超声扫描仪测量足跟处的宽带超声衰减（BUA）和声速（SOS），并使用DTX-200双能X线吸收仪测量远端前臂的BMD。
与各自的对照组相比，骨折患者的远端前臂BUA、SOS和BMD均显著降低。前臂远端骨折的比值比，足跟BUA（T值临界值：-2.3）为3.1（95%CI：1.8；5.2），足跟SOS（-2.1）为4.1（2.3；7.4），前臂远端BMD（-2.7）为2.2（1.3；3.7）。髋部骨折的比值比，足跟BUA（-2.7）为3.4（1.5 - 7.7），足跟SOS（-2.6）为3.6（1.6；8.1），前臂远端BMD（-2.9）为3.2（1.4；7.4）。
外周骨密度测量可以区分髋部和前臂远端骨折患者与年龄匹配的对照组。使用设备和部位特定的T值临界值可以计算出发生这些骨折的显著升高的比值比。本病例对照研究的结果需要前瞻性队列研究加以证实。
