身高降低、椎体骨折与骨质疏松症的误诊。
Height loss, vertebral fractures, and the misclassification of osteoporosis.
机构信息
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Bone. 2011 Feb;48(2):307-11. doi: 10.1016/j.bone.2010.09.027. Epub 2010 Sep 24.
BACKGROUND
The presence of a vertebral fracture identifies a patient who has clinical osteoporosis. However, approximately 2/3 to 3/4 of VFs are asymptomatic. Vertebral Fracture Assessment is a method derived from dual-energy X-ray absorptiometry (DXA) to assess vertebral fractures. The objectives of this study were 1) to determine the association between the degree of height loss in older men and women and the risk of a vertebral fracture, and 2) to determine if the knowledge of vertebral fractures will alter the classification of osteoporosis based on bone mineral density alone.
METHODS
231 men and women over the age of 65 underwent DXA scan of their spine and hip (including bone mineral density and Vertebral Fracture Assessment), measurement of their height, and a questionnaire.
RESULTS
We found that height loss was significantly associated with a vertebral fracture (p=0.0160). The magnitude of the association translates to a 19% increase in odds for 1/2 in. and 177% for 3 in. Although 45% had osteoporosis by either bone mineral density or fracture criteria, 30% would have been misclassified if bone mineral density criteria were used alone.
CONCLUSIONS
Height loss is an indicator for the presence of vertebral fractures. Bone mineral density criteria alone may misclassify older patients who have osteoporosis.
背景
椎体骨折的存在表明患者患有临床骨质疏松症。然而，大约 2/3 到 3/4 的椎体骨折是无症状的。椎体骨折评估是一种源自双能 X 射线吸收法（DXA）的方法，用于评估椎体骨折。本研究的目的是：1）确定老年男性和女性身高损失程度与椎体骨折风险之间的关系，以及 2）确定是否了解椎体骨折会改变仅基于骨密度的骨质疏松症分类。
方法
231 名年龄在 65 岁以上的男性和女性接受了脊柱和髋部的 DXA 扫描（包括骨矿物质密度和椎体骨折评估）、身高测量和问卷调查。
结果
我们发现身高损失与椎体骨折显著相关（p=0.0160）。这种关联的程度相当于身高损失每增加 1/2 英寸，患病几率增加 19%，而身高损失增加 3 英寸，患病几率增加 177%。尽管 45%的患者通过骨密度或骨折标准被诊断为骨质疏松症，但如果仅使用骨密度标准，30%的患者会被错误分类。
结论
身高损失是椎体骨折存在的指标。仅基于骨密度标准可能会错误分类患有骨质疏松症的老年患者。
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