联合临床风险指数与跟骨定量超声测量以识别泰国绝经后女性的骨质疏松症

Combined clinical risk indices with quantitative ultrasound calcaneus measurement for identifying osteoporosis in Thai postmenopausal women.

作者信息

Pongchaiyakul Chatlert, Panichkul Suthee, Songpatanasilp Thawee

机构信息

Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

出版信息

J Med Assoc Thai. 2007 Oct;90(10):2016-23.

PMID:18041418

Abstract

OBJECTIVE

To examine the diagnostic performance of clinical risk indices combined with quantitative ultrasound calcaneus measurement (QUS) for identifying osteoporosis in Thai postmenopausal women.

MATERIAL AND METHOD

The present study was designed as a cross-sectional investigation in 300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS score was calculated for each woman using her age and weight Women with OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively.

RESULTS

Using DXA as the gold standard, the sensitivity of QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60 vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS. The sensitivity increased when using OSTA/KKOS combined with QUS to identify osteoporosis (approximately 87-89%) while the specificity, PPV and NPV were comparable with using clinical risk indices alone. The risk (odds ratio; OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35, 95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS). Furthermore, individuals were classified "high risk" from OSTA/KKOS with QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68, 95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and KKOS, respectively).

CONCLUSION

Using the clinical risk indices combined with QUS could improve the accuracy of osteoporosis identification. This approach could be used in a primary care setting or community-based hospital where a DXA machine is not available.

摘要

目的

探讨临床风险指数联合定量跟骨超声测量（QUS）对泰国绝经后女性骨质疏松症的诊断效能。

材料与方法

本研究为横断面调查，纳入300名年龄在38至85岁之间（平均年龄：58岁）的泰国女性。采用双能X线吸收法（DXA，美国马萨诸塞州贝德福德市Hologic公司的QDR - 4500型）测量股骨颈骨密度（BMD）。BMD T值≤ -2.5被定义为“骨质疏松症”；否则为“非骨质疏松症”。使用美国威斯康星州麦迪逊市GE Lunar公司的Achilles+仪器测量QUS并转换为T值。根据每位女性的年龄和体重计算OSTA和KKOS评分。OSTA/KKOS评分≤ -1和＞ -1的女性分别被归类为“高风险”和“低风险”。

结果

以DXA作为金标准，QUS诊断骨质疏松症的敏感性低于OSTA/KKOS（60%对71%/74%），但QUS的特异性和阳性预测值高于OSTA/KKOS。当联合使用OSTA/KKOS和QUS诊断骨质疏松症时，敏感性增加（约87% - 89%），而特异性、阳性预测值和阴性预测值与单独使用临床风险指数时相当。单独QUS T值≤ -2.5时患骨质疏松症的风险（比值比；OR）为9.94（95%可信区间：4.74 - 20.87），高于单独OSTA/KKOS高风险（OSTA的OR：6.35，95%可信区间：2.99 - 13.47；KKOS的OR：8.15，95%可信区间：3.76 - 17.66）。此外，对于OSTA/KKOS分类为“高风险”且QUS T值≤ -2.5标准差的个体，患骨质疏松症的风险增加（OSTA的OR：43.68，95%可信区间：13.89 - 137.36；KKOS的OR：60.92，95%可信区间：17.69 - 209.76）。