Vokes Tamara J, Gillen Daniel L, Lovett Jeanne, Favus Murray J
Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
J Clin Densitom. 2005 Summer;8(2):206-15. doi: 10.1385/jcd:8:2:206.
It is not clear how bone mineral density (BMD) measurements from several regions of lumbar spine and proximal femur should be utilized in assessing fracture risk. We examined how well the newest ISCD recommendations differentiate subjects with and without prevalent vertebral fractures in 187 postmenopausal women presenting for routine bone densitometry. The association between T-scores from proximal femur and lumbar spine sites and the probability of having a vertebral fracture was modeled via logistic regression with adjustment for age. The lowest T-score of any hip or spine sites (the current ISCD recommendation) and the proximal femur measurements, particularly the femoral neck and total hip, displayed the strongest association with the probability of vertebral fractures.Subjects with a T-score < -2.5 at multiple hip sites had a higher probability of having a vertebral fracture. The sensitivity and specificity associated with particular T-score cutoff values varied greatly depending on the site of measurement.Consequently, T-score values from different sites that had comparable sensitivity/specificity for detecting the presence of vertebral fractures differed by as much as 1.5 T-score units. This finding implies that a single cutoff value, such as -2.5, might not be clinically acceptable when applied to T-scores from different sites.
目前尚不清楚如何利用腰椎和股骨近端多个区域的骨密度（BMD）测量值来评估骨折风险。我们研究了最新的国际临床骨密度学会（ISCD）建议在区分187名前来进行常规骨密度测量的绝经后女性中有无椎体骨折方面的效果。通过对年龄进行调整的逻辑回归模型，对股骨近端和腰椎部位的T值与发生椎体骨折的概率之间的关联进行了建模。任何髋部或脊柱部位的最低T值（当前ISCD建议）以及股骨近端测量值，尤其是股骨颈和全髋，与椎体骨折概率的关联最为强烈。多个髋部部位T值＜-2.5的受试者发生椎体骨折的概率更高。与特定T值临界值相关的敏感性和特异性因测量部位而异。因此，对于检测椎体骨折具有可比敏感性/特异性的不同部位的T值相差多达1.5个T值单位。这一发现意味着，当应用于不同部位的T值时，单一的临界值（如-2.5）在临床上可能不可接受。
