Lashin H, Davie M W J
Charles Salt Centre, Robert Jones and Agnes Hunt Hospital, Oswestry, Shropshire, UK.
Int J Clin Pract. 2008 Mar;62(3):388-93. doi: 10.1111/j.1742-1241.2007.01395.x. Epub 2007 May 29.
Women with distal forearm fracture (DFF) may have low bone mineral density (BMD) and merit Dual Energy Xray (DXA) scanning. However patient age at fracture and the database for 'healthy' subjects may influence how many have osteoporosis and require DXA scans. Osteoporosis prevalence in DFF patients by age was investigated using local or nHanes III databases for BMD.
A total of 186 women over 50 years consecutively referred with DFF over 1 year were audited without exclusion criteria. BMD of L2-4 and femoral neck (Hologic QDR4500A) was measured and T- and Z-scores calculated from a local database or nHanes III.
Of 90 patients aged 50-64 years, 21.1% had femoral neck T-score < -2.5 and 7.7% < -3.0 (local) and 8.8% and 4.4% respectively (nHanes III). Patients aged 65-74 years (n = 61) included 19.7% with T-score < -2.5 (nHanes III = 10%). 41.2% (nHanes III = 28.6%) of patients > 75 years had femoral neck osteoporosis. Including patients with spine T < -2.5 increased the proportion to 31.1% (50-64 years) and 34.4% (65-74 years) with no extra over 75 years. Weight predicted low BMD ineffectively (area under ROC = 70%).
Osteoporosis is infrequent in women with DFF below 65 years. As fracture prevention treatment yields significant fracture reduction only in patients with T-score < -2.5, DXA scanning below 65 years is not justified. After 65 years scanning is justified at all ages, as even in the elderly patients osteoporosis is present in < 50% of patients with DFF. Using nHanes III limits the number of DFF patients warranting treatment. Low body weight is unreliable for identifying osteoporosis.
前臂远端骨折（DFF）女性可能存在低骨密度（BMD），值得进行双能X线（DXA）扫描。然而，骨折时的患者年龄以及“健康”受试者数据库可能会影响骨质疏松症患者的数量以及需要进行DXA扫描的人数。本研究使用本地或美国国家健康与营养检查调查（nHanes）III数据库中的BMD数据，调查了DFF患者中按年龄划分的骨质疏松症患病率。
对连续1年转诊的186例50岁以上的DFF女性进行审核，无排除标准。测量第2-4腰椎和股骨颈的BMD（Hologic QDR4500A），并根据本地数据库或nHanes III计算T值和Z值。
在90例年龄在50-64岁的患者中，21.1%的患者股骨颈T值＜-2.5，7.7%＜-3.0（本地数据），分别为8.8%和4.4%（nHanes III数据）。65-74岁的患者（n = 61）中，19.7%的患者T值＜-2.5（nHanes III数据为10%）。75岁以上患者中，41.2%（nHanes III数据为28.6%）存在股骨颈骨质疏松症。纳入脊柱T值＜-2.5的患者后，50-64岁患者的比例增至31.1%，65-74岁患者增至34.4%，75岁以上患者无额外增加。体重对低BMD的预测效果不佳（ROC曲线下面积 = 70%）。
65岁以下DFF女性中骨质疏松症并不常见。由于骨折预防治疗仅在T值＜-2.5的患者中能显著降低骨折风险，因此65岁以下进行DXA扫描并无必要。65岁及以上各年龄段进行扫描都是合理的，因为即使在老年患者中，DFF患者中骨质疏松症的患病率也不到50%。使用nHanes III数据会限制需要治疗的DFF患者数量。低体重对于识别骨质疏松症并不可靠。
