Wat Shiu Yan Josephine, Seshadri Nagabhushan, Markose George, Balan Kottekkattu
Department of Nuclear Medicine, Addenbrookes Hospital, Cambridge, UK.
Nucl Med Commun. 2007 Mar;28(3):179-85. doi: 10.1097/MNM.0b013e328014690a.
We have undertaken a retrospective review of 1017 Tc-methylene diphosphonate (Tc-MDP) skeletal scintigrams performed in patients over 70 years of age in order to identify those with insufficiency fractures.
Patients with the diagnosis of insufficiency fracture then underwent clinical follow-up of 2 years for mortality, which was compared to the national aged-matched population.
One hundred and ninety-four patients were found to have scintigraphic evidence of fractures categorized as insufficiency fractures. Typical H-shaped sacral fractures were present in only 17 (4%) patients. Multiple sites of fracture were observed in 114 patients; the commonest being in the vertebrae. Radiological corroboration was available in 161 patients (83%) and bone scintigraphic findings were concordant with at least one of plain radiograph, computed tomography or magnetic resonance imaging in 107 (55%) patients. Of the 48 patients with insufficiency fracture who had undergone measurement for bone mineral density (BMD), 38 were found to have osteoporosis/osteopenia. Eighty-six patients died during the follow-up period, which was markedly higher than expected in the age-matched population. There was no definite relationship between the mortality in insufficiency fracture and BMD or the number of fractures.
Our findings demonstrate that insufficiency fractures are common in the elderly and generally occur at multiple sites. The typical H-shaped fractures are rare and their absence should not lead to any mistaken diagnosis. The patients with insufficiency fractures appear to have poor survival but this does not appear to have any significant relationship with either BMD or the number of fractures. Finally, insufficiency fracture is an important diagnosis to make because survival may be improved if specific management is used.
我们对70岁以上患者进行的1017例锝-亚甲基二膦酸盐（Tc-MDP）骨闪烁扫描进行了回顾性研究，以确定那些患有骨质疏松性骨折的患者。
诊断为骨质疏松性骨折的患者随后接受了为期2年的临床随访以观察死亡率，并与全国年龄匹配的人群进行比较。
发现194例患者有骨折的闪烁扫描证据，归类为骨质疏松性骨折。典型的H形骶骨骨折仅见于17例（4%）患者。114例患者观察到多个骨折部位；最常见于椎体。161例患者（83%）有放射学证据支持，107例（55%）患者的骨闪烁扫描结果与平片、计算机断层扫描或磁共振成像中的至少一项一致。在48例接受骨密度（BMD）测量的骨质疏松性骨折患者中，38例被发现患有骨质疏松症/骨质减少症。86例患者在随访期间死亡，明显高于年龄匹配人群的预期。骨质疏松性骨折患者的死亡率与BMD或骨折数量之间没有明确关系。
我们的研究结果表明，骨质疏松性骨折在老年人中很常见，通常发生在多个部位。典型的H形骨折很少见，其不存在不应导致任何误诊。骨质疏松性骨折患者的生存率似乎较低，但这似乎与BMD或骨折数量均无显著关系。最后，骨质疏松性骨折是一个重要的诊断，因为如果采用特定的治疗方法，生存率可能会提高。
