Bouxsein M L, Palermo L, Yeung C, Black D M
Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Osteoporos Int. 2002 May;13(5):358-65. doi: 10.1007/s001980200040.
Digital X-ray radiogrammetry (DXR) is a technique that uses automated image analysis of standard hand radiographs to estimate bone mineral density (DXR-BMD). Previous studies have shown that DXR-BMD measurements have high precision, are strongly correlated with forearm BMD and are lower in individuals with prevalent fractures. To determine whether DXR-BMD measurements predict wrist, hip and vertebral fracture risk we conducted a case-cohort study within a prospective study of 9704 community-dwelling elderly women (the Study of Osteoporotic Fractures). We compared DXR-BMD, and BMD of the radius (proximal and distal), calcaneus, femoral neck and posteroanterior lumbar spine in women who subsequently suffered a wrist (n = 192), hip (n = 195), or vertebral fracture (n = 193) with randomly selected controls from the same cohort (n = 392-398). DXR-BMD was estimated from hand radiographs acquired at the baseline visit. The radiographs were digitized and the Pronosco X-posure System was used to compute DXR-BMD from the second through fourth metacarpals. Wrist fractures were confirmed by radiographic reports and hip fractures were confirmed by radiographs. Vertebral fractures were defined using morphometric analysis of lateral spine radiographs acquired at baseline and an average of 3.7 years later. Age-adjusted odds ratio (OR, vertebral fracture) or relative hazard (RH, wrist and hip fracture) for a 1 SD decrease in BMD were computed. All BMD measurements were similar for prediction of wrist (RH = 1.5-2.1) and vertebral fracture (OR = 1.8-2.5). Femoral neck BMD best predicted hip fracture (RH = 3.0), while the relative hazards for all other BMD measurements were similar (RH = 1.5-1.9). These prospective data indicate that DXR-BMD performs as well as other peripheral BMD measurements for prediction of wrist, hip and vertebral fractures. Therefore, DXR-BMD may be useful for prediction of fracture risk in clinical settings where hip BMD is not available.
数字X线摄影测量法（DXR）是一种利用标准手部X光片的自动图像分析来估算骨密度（DXR-BMD）的技术。以往研究表明，DXR-BMD测量具有高精度，与前臂骨密度密切相关，且在有既往骨折的个体中较低。为了确定DXR-BMD测量能否预测腕部、髋部和椎体骨折风险，我们在一项对9704名社区居住老年女性的前瞻性研究（骨质疏松性骨折研究）中开展了一项病例队列研究。我们比较了随后发生腕部骨折（n = 192）、髋部骨折（n = 195）或椎体骨折（n = 193）的女性与同一队列中随机选择的对照者（n = 392 - 398）的DXR-BMD以及桡骨（近端和远端）、跟骨、股骨颈和腰椎前后位的骨密度。DXR-BMD是根据基线访视时获取的手部X光片估算得出。X光片被数字化，并使用Pronosco X-posure系统从第二至第四掌骨计算DXR-BMD。腕部骨折通过X光报告确诊，髋部骨折通过X光片确诊。椎体骨折采用基线时及平均3.7年后获取的脊柱侧位X光片的形态计量学分析来定义。计算骨密度每降低1个标准差时的年龄调整比值比（OR，椎体骨折）或相对风险（RH，腕部和髋部骨折）。所有骨密度测量对于预测腕部骨折（RH = 1.5 - 2.1）和椎体骨折（OR = 1.8 - 2.5）的效果相似。股骨颈骨密度对髋部骨折的预测最佳（RH = 3.0），而所有其他骨密度测量的相对风险相似（RH = 1.5 - 1.9）。这些前瞻性数据表明，DXR-BMD在预测腕部、髋部和椎体骨折方面与其他外周骨密度测量方法表现相当。因此，在无法获得髋部骨密度的临床环境中，DXR-BMD可能有助于预测骨折风险。
