Miller Paul D, Njeh Christopher F, Jankowski Larry G, Lenchik Leon
J Clin Densitom. 2002;5 Suppl:S39-45. doi: 10.1385/jcd:5:3s:s39.
Measurement of bone mineral density (BMD) at central skeletal sites with dual X-ray absorptiometry is the "gold standard" both for the diagnosis of osteoporosis using the criteria of the World Health Organization (WHO) and for monitoring individuals receiving antiresorptive treatment for osteoporosis. Measurement of BMD at peripheral sites (peripheral BMD) can be used to assess fracture risk, but application of the WHO criteria gives different prevalence values for "osteoporosis" with peripheral devices, and different risks for fracture at the same cut points. The International Society for Clinical Densitometry Position Development Conference panelists reached the following conclusions about peripheral BMD testing: First, WHO T-score criteria should not be used with peripheral devices. Second, for the identification of a level for peripheral BMD measurements above which osteoporosis is unlikely, device-specific cut points for peripheral BMD should be identified that have 90% sensitivity for identifying patients who have osteoporosis (T-score of -2.5 or below) based on measurements of the spine and hip. If central BMD testing is available, patients who have peripheral BMD below the 90% sensitivity level should have a central BMD measurement. If central BMD testing is not available, peripheral BMD might be used for identification of patients who are likely to have osteoporosis. Risk-based cut points were preferred to prevalence based cut points, and, again, device-specific cut points are needed. For patients tested only with a peripheral BMD device whose result is intermediate, clinical judgment would be needed. Third, peripheral BMD testing should not be used for monitoring patients who are taking antiresorptive therapy for osteoporosis. Fourth, peripheral BMD testing performs best when used for postmenopausal women. Further research on all these issues is needed.
采用双能X线吸收法测量中轴骨部位的骨密度（BMD），无论是按照世界卫生组织（WHO）的标准诊断骨质疏松症，还是监测接受抗骨质疏松症抗吸收治疗的个体，都是“金标准”。测量外周部位的骨密度（外周BMD）可用于评估骨折风险，但应用WHO标准时，外周设备所测得的“骨质疏松症”患病率值不同，且在相同切点处骨折风险也不同。国际临床骨密度测量学会立场发展会议的专家小组就外周BMD检测得出了以下结论：第一，WHO T值标准不适用于外周设备。第二，为确定外周BMD测量的一个水平，高于该水平则不太可能患有骨质疏松症，应确定外周BMD的设备特定切点，这些切点对于根据脊柱和髋部测量结果识别患有骨质疏松症（T值≤-2.5）的患者具有90%的敏感性。如果可以进行中轴骨BMD检测，外周BMD低于90%敏感性水平的患者应进行中轴骨BMD测量。如果无法进行中轴骨BMD检测，外周BMD可用于识别可能患有骨质疏松症的患者。基于风险的切点优于基于患病率的切点，同样，需要设备特定的切点。对于仅使用外周BMD设备进行检测且结果处于中间范围的患者，需要临床判断。第三，外周BMD检测不应被用于监测接受骨质疏松症抗吸收治疗的患者。第四，外周BMD检测用于绝经后女性时效果最佳。所有这些问题都需要进一步研究。
