El Maghraoui A, Morjane F, Mounach A, Ghazi M, Nouijai A, Achemlal L, Bezza A, Ghozlani I
Rheumatology and Physical Rehabilitation Department, Military Hospital Mohammed V, Rabat, Morocco.
Rheumatol Int. 2009 Mar;29(5):551-6. doi: 10.1007/s00296-008-0751-0. Epub 2008 Oct 25.
Due to its low cost, portability, and nonionizing radiation, quantitative ultrasound (QUS) of the heel is an alternative to the measurement with dual X-ray absorptiometry (DXA) in the evaluation of bone status. The objective of the study is to compare in asymptomatic postmenopausal women the ability of QUS and DXA to discriminate between those with and without prevalent vertebral fractures (VFs). The study cohort consists of a population of 295 postmenopausal women aged between 60 and 84 (mean age, weight and BMI of 66.3 years, 72.0 kg and 29.4 kg/m(2), respectively). Lateral VFA images and scans of the lumbar spine and proximal femur were obtained by two technologists using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. All women had a calcaneous QUS examination. The mean age of the women in our sample was 66.3 (+/-5.3) years, ranging from 60 to 84 years. Eighty-seven (29.3%) women had VFs Genant grade 2 and 3. Patients with VFs had an age and a number of years of menopause higher to those without VFs, but showed lower height, weight, and BMI. All densitometric and ultrasonometric measurements were significantly reduced in women with VFs. The intercorrelations of BMD at different sites were high, and the correlations of BUA with BMD were lower. BUA correlated weakly with total hip BMD (r = 0.36), lumbar spine BMD (r = 0.32), and much less with femur BMD (r = 0.30); all correlations were significant (P < 0.01). Analysis of the AUC for the ROC curves showed lumbar spine T-score below -2.5 to provide consistently the highest AUC (0.64). Age-adjusted ORs after correction for confounding variables (years of menopause, weight, height, and BMI) for QUS and BMD measurements showed that only lumbar spine T-score below -2.5 could predict significantly the presence of VFs (OR, 1.94; 95%CI, 1.02-3.41). Lumbar spine BMD (and not QUS) was able to discriminate asymptomatic postmenopausal women with prevalent VFs from women without VFs and independently contributed to determining the association with fracture. The combination of QUS and BMD did not improve the diagnostic ability of either individual technique.
由于跟骨定量超声（QUS）成本低、便携且为非电离辐射，在评估骨状态时，它可作为双能X线吸收法（DXA）测量的替代方法。本研究的目的是比较在无症状绝经后女性中，QUS和DXA区分有和无既往椎体骨折（VF）者的能力。研究队列包括295名年龄在60至84岁之间的绝经后女性（平均年龄、体重和BMI分别为66.3岁、72.0 kg和29.4 kg/m²）。腰椎和近端股骨的侧位VFA图像及扫描由两名技术人员使用GE医疗的Lunar Prodigy骨密度仪获得。VF采用Genant半定量（SQ）方法和形态测量相结合的方式定义。所有女性均进行了跟骨QUS检查。我们样本中女性的平均年龄为66.3（±5.3）岁，年龄范围为60至84岁。87名（29.3%）女性有Genant 2级和3级VF。有VF的患者年龄和绝经年限高于无VF的患者，但身高、体重和BMI较低。所有骨密度测量和超声测量值在有VF的女性中均显著降低。不同部位骨密度（BMD）的相互相关性较高，而超声骨密度（BUA）与BMD的相关性较低。BUA与全髋BMD的相关性较弱（r = 0.36），与腰椎BMD的相关性为中等（r = 0.32），与股骨BMD的相关性更小（r = 0.30）；所有相关性均具有统计学意义（P < 0.01）。ROC曲线的AUC分析显示，腰椎T值低于 -2.5始终提供最高的AUC（0.64）。对QUS和BMD测量值校正混杂变量（绝经年限、体重、身高和BMI）后的年龄校正比值比显示，只有腰椎T值低于 -
