Department of Orthopaedic Trauma, Harris Methodist Fort Worth Hospital John Peter Smith Orthopaedic Surgery Residency Program, Fort Worth, TX 76104, USA.
J Orthop Trauma. 2010 Mar;24(3):176-80. doi: 10.1097/BOT.0b013e3181b8b036.
Osteoporosis remains underdiagnosed in orthopaedic trauma patients. Recently, protocols have emerged to identify and treat osteoporosis in this population. Our purpose was to compare the usefulness of quantitative ultrasound of calcaneus (QUS) with dual-energy x-ray absorptiometry (DXA) for identifying orthopaedic trauma patients at risk for osteoporotic fractures.
A retrospective review of an osteoporosis screening protocol comparing QUS and DXA.
Regional trauma center.
Three hundred sixty consecutive hospitalized orthopaedic trauma patients treated by a single surgeon.
QUS T-score and DXA bone mineral density T-scores (hip or radius) were obtained relative to U.S. normative data.
QUS and DXA data were statistically compared to analyze their relationship. Potential thresholds for osteoporosis risk were subsequently defined.
Testing was successfully performed with heel QUS in 350 patients and with DXA in 129 patients. One hundred twenty-six patients underwent testing with both modalities. According to World Health Organization criteria, 17% of patients tested with DXA had osteoporosis. A good predictive relationship between hip bone mineral density, as estimated by calcaneal QUS, and direct DXA measurement was seen (Pearson's r correlation coefficient of 0.53; area under the curve of 0.84 with 95% confidence interval=0.75-0.90; P=0.0001). QUS T-score cutoffs of greater than -0.9 resulted in 90% sensitivity (defining low osteoporosis risk) and a threshold of -1.6 or less resulted in a specificity of 80% (defining high osteoporosis risk).
Substantial logistical difficulties are inherent in attempting to obtain DXA scans in orthopaedic trauma patients at our regional trauma center. For those patients who did undergo DXA, a strong predictive relationship was seen between hip bone mineral density and QUS parameters. QUS thresholds in defining low- and high-risk subjects for osteoporosis in this population using this device are proposed. QUS is a simple, reliable, and relatively inexpensive tool for evaluating osteoporosis risk in orthopaedic trauma patients.
骨质疏松症在骨科创伤患者中仍未得到充分诊断。最近，已经出现了针对该人群识别和治疗骨质疏松症的方案。我们的目的是比较跟骨定量超声（QUS）和双能 X 射线吸收法（DXA）在识别骨科创伤患者骨质疏松性骨折风险方面的作用。
回顾性分析骨质疏松症筛查方案，比较 QUS 和 DXA。
区域创伤中心。
由一位外科医生治疗的 360 例连续住院的骨科创伤患者。
根据美国参考数据获得 QUS T 评分和 DXA 骨密度 T 评分（髋部或桡骨）。
对 QUS 和 DXA 数据进行统计学比较，分析其相关性。随后定义骨质疏松风险的潜在阈值。
350 例患者成功进行了足跟 QUS 检测，129 例患者进行了 DXA 检测。126 例患者同时接受了两种检测。根据世界卫生组织的标准，17%接受 DXA 检测的患者患有骨质疏松症。通过 QUS 估计的跟骨骨矿物质密度与直接 DXA 测量之间存在良好的预测关系（Pearson 相关系数为 0.53；曲线下面积为 0.84，95%置信区间为 0.75-0.90；P=0.0001）。QUS T 评分大于-0.9 的截点可获得 90%的敏感性（定义为低骨质疏松风险），而 T 评分小于等于-1.6 的截点可获得 80%的特异性（定义为高骨质疏松风险）。
在我们的区域创伤中心，尝试对骨科创伤患者进行 DXA 扫描存在很大的后勤困难。对于那些确实接受了 DXA 检查的患者，髋部骨矿物质密度与 QUS 参数之间存在很强的预测关系。使用该设备，针对该人群提出了用于定义骨质疏松低风险和高风险的 QUS 阈值。QUS 是一种简单、可靠且相对廉价的评估骨科创伤患者骨质疏松风险的工具。
