Bitterling H, Vogel T, Dobler T, Mutschler W, Pfeifer K-J, Reiser M, Eibel R
Klinikum der LMU, Institut für Klinische Radiologie, Innenstadt, München.
Rofo. 2005 Dec;177(12):1663-9. doi: 10.1055/s-2005-858549.
To evaluate the current bone mineral density (BMD) distribution in elderly patients hospitalized due to traumatic hip fracture and to assess the necessity of concomitant pharmacotherapy of underlying osteoporosis.
58 female patients > or = 50 years (mean 81 years) with proven hip fracture were included. The diagnosis of fracture was established either by conventional radiography (CR) or by computed tomography (CT). BMD was assessed prospectively by means of dual energy X-ray absorption (DXA) measurement of the lumbar spine and/or femoral neck. DXA data was routinely achieved by analysis of T- and Z-values of the BMD. Distribution of BMD was assessed. Results for both measurement sites were compared using T-test and Pearson correlation analysis.
56/58 patients with proven hip fracture received DXA of the lumbar spine, 51 DXA of the femoral neck. The mean BMD was 0.829 +/- 0.137 g/cm (2) (lumbar spine) and 0.451 +/- 0.126 g/cm (2) (femur). T-values were - 2.8 +/- 1.14 (lumbar spine) and - 3.53 +/- 0.97 (femur). Compared to the normal distribution (lumbar spine), 53 patients (94.6 %) had diminished BMD (T < or = - 1). Of these 15 (26.8 %) had osteopenia (T > - 2.5) and 38 (67.9 %) had osteoporosis (T < or = - 2.5) according to WHO definition. With respect to femoral bone measurement, all patients (100 %) had diminished BMD (T < or = - 1), 9 patients (17.6 %) had osteopenia (T > - 2.5) and 42 patients (82.4 %) had osteoporosis (T < or = - 2.5). Results for different measurement sites differed significantly and were weakly correlated.
This data indicate that diminished BMD in terms of osteopenia or osteoporosis is a frequent finding in hip fractures of elderly females. A large majority of these elderly patients therefore should be treated according to recent guidelines for treatment of osteoporosis. Our data indicate that this entity is potentially underdiagnosed and should be considered by radiologists as well as traumatologists.
评估因创伤性髋部骨折住院的老年患者当前的骨密度（BMD）分布情况，并评估对潜在骨质疏松症进行联合药物治疗的必要性。
纳入58例年龄≥50岁（平均81岁）且确诊为髋部骨折的女性患者。骨折诊断通过传统X线摄影（CR）或计算机断层扫描（CT）确定。通过双能X线吸收法（DXA）对腰椎和/或股骨颈进行前瞻性骨密度评估。DXA数据通过分析骨密度的T值和Z值常规获得。评估骨密度分布情况。使用T检验和Pearson相关分析比较两个测量部位的结果。
58例确诊为髋部骨折的患者中，56例接受了腰椎DXA检查，51例接受了股骨颈DXA检查。平均骨密度为腰椎0.829±0.137g/cm²，股骨0.451±0.126g/cm²。T值分别为腰椎-2.8±1.14，股骨-3.53±0.97。与正常分布（腰椎）相比，53例患者（94.6%）骨密度降低（T≤-1）。根据世界卫生组织的定义，其中15例（26.8%）患有骨质减少（T＞-2.5），38例（67.9%）患有骨质疏松症（T≤-2.5）。就股骨测量而言，所有患者（100%）骨密度降低（T≤-1），9例（17.6%）患有骨质减少（T＞-2.5），42例（82.4%）患有骨质疏松症（T≤-2.5）。不同测量部位的结果差异显著且相关性较弱。
这些数据表明，骨质减少或骨质疏松导致的骨密度降低在老年女性髋部骨折中很常见。因此，大多数此类老年患者应根据最新的骨质疏松症治疗指南进行治疗。我们的数据表明，这一情况可能未得到充分诊断，放射科医生和创伤科医生都应予以考虑。
