Kanis John A, McCloskey Eugene V, Johansson Helena, Oden Anders, Melton L Joseph, Khaltaev Nikolai
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK.
Bone. 2008 Mar;42(3):467-75. doi: 10.1016/j.bone.2007.11.001. Epub 2007 Nov 17.
In 1994, the World Health Organization published diagnostic criteria for osteoporosis. Since then, many new technologies have been developed for the measurement of bone mineral at multiple skeletal sites. The information provided by each assessment will describe the clinical characteristics, fracture risk and epidemiology of osteoporosis differently. Against this background, there is a need for a reference standard for describing osteoporosis. In the absence of a true gold standard, this paper proposes that the reference standard should be based on bone mineral density (BMD) measurement made at the femoral neck with dual-energy X-ray absorptiometry (DXA). This site has been the most extensively validated, and provides a gradient of fracture risk as high as or higher than that of many other techniques. The recommended reference range is the NHANES III reference database for femoral neck measurements in women aged 20-29 years. A similar cut-off value for femoral neck BMD that is used to define osteoporosis in women can be used for the diagnosis of osteoporosis in men - namely, a value for BMD 2.5 SD or more below the average for young adult women. The adoption of DXA as a reference standard provides a platform on which the performance characteristics of less well established and new methodologies can be compared.
1994年，世界卫生组织发布了骨质疏松症的诊断标准。自那时以来，已经开发出许多新技术用于测量多个骨骼部位的骨矿物质。每次评估所提供的信息对骨质疏松症临床特征、骨折风险及流行病学的描述各不相同。在此背景下，需要一个描述骨质疏松症的参考标准。在缺乏真正金标准的情况下，本文提出参考标准应基于采用双能X线吸收法（DXA）测量的股骨颈骨密度（BMD）。该部位已得到最广泛的验证，并且提供的骨折风险梯度与许多其他技术一样高或更高。推荐的参考范围是美国国家健康与营养检查调查（NHANES）III中20 - 29岁女性股骨颈测量的参考数据库。用于定义女性骨质疏松症的股骨颈BMD类似临界值可用于男性骨质疏松症的诊断——即BMD值比年轻成年女性平均值低2.5个标准差或更多。采用DXA作为参考标准提供了一个平台，在此平台上可以比较较新的和新方法的性能特征。
