Black D M, Cummings S R, Genant H K, Nevitt M C, Palermo L, Browner W
Department of Epidemiology and Biostatistics, University of California, San Francisco.
J Bone Miner Res. 1992 Jun;7(6):633-8. doi: 10.1002/jbmr.5650070607.
To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry (DEXA) predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry (SPA) of appendicular sites, we prospectively studied 8134 nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass. A total of 208 nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0.7 years. The risk of fracture was inversely related to bone density at all measurement sites. After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1.40 for measurement at the proximal femur (95% confidence interval 1.20-1.63) and 1.35 (1.15-1.58) for measurement at the spine. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius. None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture (relative risk 1.64: 95% CI 1.13-2.37) than other sites, such as the lumbar spine (RR 1.56; CI 1.07-2.26), the femoral neck (RR 1.65; CI 1.12-2.41), or the calcaneus (RR 1.83; CI 1.26-2.64). We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.
为了确定通过双能X线吸收法（DEXA）测量髋部和脊柱骨量能否预测女性骨折，并比较DEXA与四肢部位单光子吸收法（SPA）的预测价值，我们对8134名65岁及以上的非黑人女性进行了前瞻性研究，这些女性均接受了DEXA和SPA骨量测量。在平均为期0.7年的随访期内，共发生了208例非脊柱骨折，其中包括37例腕部骨折。骨折风险与所有测量部位的骨密度呈负相关。在调整年龄后，近端股骨骨密度每降低1个标准差，发生任何骨折的相对风险为1.40（95%置信区间1.20 - 1.63），脊柱测量的相对风险为1.35（1.15 - 1.58）。近端股骨所有区域以及跟骨、桡骨远端和桡骨近端的SPA测量结果相似。这些测量方法中没有一种在预测骨折方面明显优于其他方法。此外，桡骨远端测量对于腕部骨折的预测（相对风险1.64：95%置信区间1.13 - 2.37）并不比其他部位更好，如腰椎（RR 1.56；CI 1.07 - 2.26）、股骨颈（RR 1.65；CI 1.12 - 2.41）或跟骨（RR 1.83；CI 1.26 - 2.64）。我们得出结论，对于髋部、脊柱和四肢部位的吸收测量，老年女性骨量与骨折风险之间的负相关关系相似。
