Pisani Paola, Renna Maria Daniela, Conversano Francesco, Casciaro Ernesto, Muratore Maurizio, Quarta Eugenio, Paola Marco Di, Casciaro Sergio
Paola Pisani, Maria Daniela Renna, Francesco Conversano, Ernesto Casciaro, Marco Di Paola, Sergio Casciaro, National Council of Research, Institute of Clinical Physiology, 73100 Lecce, Italy.
World J Radiol. 2013 Nov 28;5(11):398-410. doi: 10.4329/wjr.v5.i11.398.
Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinically-available diagnostic methods are mainly based on the use of either X-rays or ultrasound (US). All X-ray based methods provide a measure of bone mineral density (BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry (DXA) is considered the current "gold standard" for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations (e.g., use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population screenings and primary care diagnosis. This has resulted in an increasing interest in developing reliable pre-screening tools for osteoporosis such as quantitative ultrasound (QUS) scanners, which do not involve ionizing radiation exposure and represent a cheaper solution exploiting portable and widely available devices. Furthermore, the usefulness of QUS techniques in fracture risk prediction has been proven and, with the last developments, they are also becoming a more and more reliable approach for assessing bone quality. However, the US assessment of osteoporosis is currently used only as a pre-screening tool, requiring a subsequent diagnosis confirmation by means of a DXA evaluation. Here we illustrate the state of art in the early diagnosis of this "silent disease" and show up recent advances for its prevention and improved management through early diagnosis.
有效的骨质疏松症预防和管理需要适用于人群筛查和早期诊断的方法。目前临床可用的诊断方法主要基于X射线或超声（US）的使用。所有基于X射线的方法都能测量骨密度（BMD），但已证明骨骼的其他结构方面在确定骨折风险时也很重要，如力学特征和弹性特性，而这些无法使用密度测量技术进行评估。在最常用的技术中，双能X线吸收法（DXA）被认为是目前骨质疏松症诊断和骨折风险预测的“金标准”。不幸的是，与其他基于X射线的技术一样，DXA有特定的局限性（例如，使用电离辐射、设备体积大、成本高、可用性有限），这阻碍了其在人群筛查和初级保健诊断中的应用。这导致人们越来越有兴趣开发可靠的骨质疏松症预筛查工具，如定量超声（QUS）扫描仪，其不涉及电离辐射暴露，是一种利用便携式且广泛可用设备的更便宜解决方案。此外，QUS技术在骨折风险预测中的有用性已得到证实，随着最新进展，它们也正成为评估骨质量越来越可靠的方法。然而，目前超声对骨质疏松症的评估仅用作预筛查工具，需要通过DXA评估进行后续诊断确认。在此，我们阐述了这种“无声疾病”早期诊断的现状，并展示了通过早期诊断在其预防和改善管理方面的最新进展。
