Cole Raymond, Larson Jacob
Department of Internal Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, USA.
J Clin Densitom. 2006 Apr-Jun;9(2):210-6. doi: 10.1016/j.jocd.2006.02.003. Epub 2006 May 2.
The aim of this study was to determine if measurement of the contralateral femora has an effect on osteoporosis diagnosis and treatment classification if the spine is not included in the bone mineral density (BMD) scan. The method used was the T-score discordance from the dual femur BMD scans of 537 women (mean age: 61.2 yr; standard deviation: 10.5; age range: 32-90 yr) who were evaluated to determine if inclusion of the contralateral hip in the BMD study made a difference in clinical diagnosis and treatment classification when the spine was not included in the BMD scan. Clinical diagnosis and treatment classification was based on the lowest T-score at each hip of three femur sites: the neck, the trochanter, and the total femur. The results of the diagnosis classification (i.e., normal, osteopenia, and osteoporosis) differed in the right versus the left femora in 28% of subjects at one or more sites, and in 14%, 15%, and 10% of subjects at the neck, trochanter, and total femur, respectively. Diagnosis discordance increased in subjects who were aged 65 yr and older. Treatment classification (T>or=-1.5; T<-1.5; T<-2.0) differed in the right versus the left femora in 33% of subjects at one or more sites, and in 18%, 14%, and 12% of subjects at the neck, trochanter, and total femur, respectively. Treatment discordance increased in subjects age 65 yr and older. Using the lowest T-score for clinical diagnosis classification, when the contralateral hip was considered, a clinical difference in diagnosis from normal-->osteopenia occurred in 3.9% of subjects, and from osteopenia-->osteoporosis in 1.3% of subjects. A clinical difference in treatment category from T>or=-1.5-->T<-1.5 occurred in 2.7% of subjects, and from T>or=-2-->T<-2 in 2.7% of subjects. In conclusion, inclusion of the bilateral hip in the BMD study made a clinical difference in diagnosis classification in 5.2% of subjects and in treatment classification in 5.4% of subjects. T-score differences between the contralateral hips increased with age. In the subgroup of subjects age 65 yr and older, a clinical difference in classification to a more severe diagnosis or treatment category occurred in 5.35% and 7.25% of subjects, respectively.
本研究的目的是确定在骨密度（BMD）扫描未包括脊柱的情况下，对侧股骨测量是否会对骨质疏松症的诊断和治疗分类产生影响。所采用的方法是对537名女性（平均年龄：61.2岁；标准差：10.5；年龄范围：32 - 90岁）的双侧股骨BMD扫描进行T评分不一致分析，以确定当BMD扫描未包括脊柱时，将对侧髋部纳入BMD研究是否会在临床诊断和治疗分类上产生差异。临床诊断和治疗分类基于三个股骨部位（颈部、大转子和全股骨）每个髋部的最低T评分。在1个或更多部位，28%的受试者右侧与左侧股骨的诊断分类结果（即正常、骨量减少和骨质疏松）不同，在颈部、大转子和全股骨部位，分别有14%、15%和10%的受试者出现这种情况。65岁及以上受试者的诊断不一致情况增加。在1个或更多部位，33%的受试者右侧与左侧股骨的治疗分类（T≥ - 1.5；T＜ - 1.5；T＜ - 2.0）不同，在颈部、大转子和全股骨部位，分别有18%、14%和12%的受试者出现这种情况。65岁及以上受试者的治疗不一致情况增加。使用最低T评分进行临床诊断分类时，考虑对侧髋部时，3.9%的受试者诊断从正常变为骨量减少，1.3%的受试者从骨量减少变为骨质疏松。治疗类别从T≥ - 1.5变为T＜ - 1.5的受试者有2.7%，从T≥ - 2变为T＜ - 2的受试者有2.7%。总之，在BMD研究中纳入双侧髋部，5.2%的受试者在诊断分类上有临床差异，5.4%的受试者在治疗分类上有临床差异。对侧髋部之间的T评分差异随年龄增加。在65岁及以上的受试者亚组中，分别有5.35%和7.25%的受试者在分类上出现向更严重诊断或治疗类别的临床差异。
