Ross P D, Heilbrun L K, Wasnich R D, Davis J W, Vogel J M
Kuakini Medical Center, Honolulu, HI 96817.
J Bone Miner Res. 1989 Oct;4(5):649-56. doi: 10.1002/jbmr.5650040502.
Techniques for measuring bone mineral content (BMC) were developed for the purpose of providing an objective and noninvasive indication of bone strength (or lack thereof) and fracture risk, to the extent that strength relates to bone mass. As such, BMC measurements could help to (1) identify those who are most likely to experience nonviolent fractures in the future and who would therefore benefit most from preventive measures, (2) improve their treatment compliance, and (3) monitor the efficacy of treatments intended to reduce bone loss. All these potential uses require that the measurement provide an indication of fracture risk (probability of fractures). During the past 10-15 years there have been conflicting reports regarding the association of reduced BMC with nonviolent fractures. Some authors have criticized the usefulness of BMC measurements, whereas others have questioned the value of one or more techniques. However, the epidemiology of osteoporosis has only recently been subjected to rigorous study. The use of appropriate statistical methods for relating fracture risk to bone mass may be no more widely practiced in osteoporosis epidemiology today than it was for studying risk factors (e.g., blood pressure) in cardiovascular epidemiology during the 1960s. The intent of this article is to explore three areas that may have contributed to controversy in the study of bone mass and fracture occurrence: (1) perspective of the investigators, (2) study design, and (3) analytic methodology. Although the focus of this paper is on bone mass, these considerations are equally applicable to some investigations of other risk factors for osteoporotic fractures (e.g., bone architecture, bone turnover and loss rate, or biochemical markers of bone loss).
测量骨矿物质含量（BMC）的技术是为了在骨强度（或缺乏骨强度）与骨折风险相关的程度上，提供一种客观且无创的骨强度指标而开发的。因此，BMC测量有助于：（1）识别那些未来最有可能发生非暴力骨折且因此能从预防措施中获益最多的人；（2）提高他们的治疗依从性；（3）监测旨在减少骨质流失的治疗效果。所有这些潜在用途都要求测量能够提供骨折风险（骨折概率）的指标。在过去10到15年里，关于BMC降低与非暴力骨折之间的关联存在相互矛盾的报告。一些作者批评了BMC测量的有用性，而另一些人则质疑了一种或多种技术的价值。然而，骨质疏松症的流行病学直到最近才受到严格研究。如今，在骨质疏松症流行病学中，将骨折风险与骨量相关联的适当统计方法的应用，可能并不比20世纪60年代在心血管流行病学中研究风险因素（如血压）时更为广泛。本文旨在探讨可能导致骨量与骨折发生研究中出现争议的三个领域：（1）研究者的视角；（2）研究设计；（3）分析方法。尽管本文的重点是骨量，但这些考虑同样适用于对骨质疏松性骨折其他风险因素（如骨结构、骨转换和流失率或骨流失的生化标志物）的一些研究。
