Giannotti Stefano, Bottai Vanna, Dell'osso Giacomo, Donati Daniela, Bugelli Giulia, De Paola Gaia, Guido Giulio
Orthopaedic Clinic, University of Pisa, Pisa, Italy.
Clin Cases Miner Bone Metab. 2012 Jan;9(1):37-9. Epub 2012 May 29.
Osteoporotic fractures are now a social problem for incidence and costs. Fractures of the proximal humerus events are frequent and constantly increasing. It is estimated that they are 20% of all osteoporotic fractures. Bone densitometry in most cases underestimates the real humeral bone density.There is little information about osteoporotic changes in the proximal humerus and their association with the cortical thickness of the humeral shaft. The ratio between the thickness of the cortical and the total diameter of the humeral diaphysis is the cortical index. Fracture risk limit value is 0.231. Convinced of the need to quantify in a reproducible way the real local humerus bone density, we performed a comparative evaluation of bone density of the humerus and femur in patients admitted to our clinic for fractures of the humerus and femur.We evaluated 28 women treated surgically for a fragility fracture of the proximal humerus or femur neck in 2010. All cortical index obtained were lower than the limit for fracture risk set at 0.231, so the IC was more predictive of neck medial fractures of the femur than had DEXA and the U.S. The information about the cortical index may provide a simple way of determining the bone quality of the proximal humerus and of facilitating decision-making in the surgical treatment of patients with fractures of the humerus. So we want to emphasize the importance of therapy for osteoporosis even in patients with fractures of the proximal humerus, which often have not critical densitometric values of femur or column, but they are at risk of new fractures.
骨质疏松性骨折目前已成为一个涉及发病率和成本的社会问题。肱骨近端骨折事件频发且持续增加。据估计，此类骨折占所有骨质疏松性骨折的20%。在大多数情况下，骨密度测定会低估肱骨的实际骨密度。关于肱骨近端骨质疏松性变化及其与肱骨干皮质厚度的关联，相关信息较少。皮质厚度与肱骨干总直径的比值即为皮质指数。骨折风险极限值为0.231。鉴于需要以可重复的方式量化肱骨局部的实际骨密度，我们对因肱骨和股骨骨折入住我院的患者的肱骨和股骨骨密度进行了比较评估。我们评估了2010年因肱骨近端或股骨颈脆性骨折接受手术治疗的28名女性。所有获得的皮质指数均低于设定的骨折风险极限值0.231，因此皮质指数比双能X线吸收法（DEXA）和超声更能预测股骨颈内侧骨折。关于皮质指数的信息可能为确定肱骨近端的骨质质量以及辅助肱骨骨折患者手术治疗的决策提供一种简单方法。所以我们想强调，即使对于肱骨近端骨折患者，骨质疏松治疗也很重要，这些患者的股骨或脊柱骨密度值通常并不危急，但他们仍有再次骨折的风险。
