Younes Mohamed, Ben Hammouda Samch, Jguirim Mahbouba, Younes Kaouthar, Zrour Saoussen, Béjia Ismail, Touzi Mongi, Bergaoui Naceur
Tunis Med. 2014 Jan;92(1):1-5.
Diagnostic discordance for osteoporosis is the presence of different categories of T-scores in 2 skeletal sites of an individual patient, falling into 2 different diagnostic categories identified by the World Health Organization classification.
To determinate the prevalence and risk factors for T-score discordance between spine and hip measurement sites.
Demographic data, anthropometric measurements, and risk factors for osteoporosis were derived from a database of 1780 patients referred to the outpatient osteoporosis testing center of the departement of Rheumatology between September 2006 and February 2010. Bone mineral density (BMD) was performed by Dual-energy x-ray absorptiometry (DXA) on L1-L4 lumbar spine and total hips for all cases. Minor discordance was considered when the difference between 2 sites was no more than 1 World Health Organization diagnostic class. Major discordance was present when 1 site is osteoporotic and the other is normal.
In 1780 participants (1606 women and 174 males; mean age, 59.5 ± 14.3 years), concordance of T-scores, minor discordance, and major discordance were seen in 49.4%, 45.7%, and 4.8% of the cases, respectively. In both minor and major discordance BMD was lower in lumbar spine than total hips. In univariate and multivariate logistic regression analysis only menopause was identified as risk factors against T-score discordance with p<0.001 and [OR=5.47; IC: 2.61- 12.79]. The others factors: age, gender, BMI, fracture history, corticotherapy, rheumatoid arthritis, tobacco and diabetes were not associated with the T-score discordance.
Clinicians should expect that at least half of patients tested by DXA will demonstrate T-score discordance between spine and total hip measurement sites. T-score discordance can occur for a variety of reasons related to physiologic and pathologic patient factors as well as the performance or analysis of DXA itself.
骨质疏松症的诊断不一致是指个体患者的两个骨骼部位存在不同类别的T值，属于世界卫生组织分类确定的两种不同诊断类别。
确定脊柱和髋部测量部位之间T值不一致的患病率和危险因素。
人口统计学数据、人体测量数据和骨质疏松症危险因素来自2006年9月至2010年2月间转诊至风湿病科门诊骨质疏松检测中心的1780例患者的数据库。对所有病例均采用双能X线吸收法（DXA）测量L1-L4腰椎和全髋部的骨密度（BMD）。当两个部位之间的差异不超过1个世界卫生组织诊断类别时，认为是轻度不一致。当一个部位为骨质疏松症而另一个部位正常时，则存在重度不一致。
在1780名参与者（1606名女性和174名男性；平均年龄59.5±14.3岁）中，T值一致、轻度不一致和重度不一致的病例分别占49.4%、45.7%和4.8%。在轻度和重度不一致中，腰椎的BMD均低于全髋部。在单因素和多因素逻辑回归分析中，只有绝经被确定为T值不一致的危险因素，p<0.001，[OR=5.47；IC：2.61-12.79]。其他因素：年龄、性别、体重指数、骨折史、皮质激素治疗、类风湿关节炎、吸烟和糖尿病与T值不一致无关。
临床医生应预期，至少一半接受DXA检测的患者会出现脊柱和全髋部测量部位之间的T值不一致。T值不一致可能由于与患者生理和病理因素以及DXA本身的性能或分析相关的多种原因而发生。
