The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
Bone. 2017 Nov;104:73-83. doi: 10.1016/j.bone.2017.03.050. Epub 2017 May 2.
Hip fracture is one of the most serious complications of osteoporosis. More than 50% of hip and other fractures occur in patients without densitometric osteoporosis. Therefore, areal bone mineral density (aBMD) may not be the best way to assess fracture risk. In order to improve assessment of fracture risk, many other approaches have been taken. At the present time, the Fracture Risk Algorithm (FRAX©) is one of the most notable ways to improve assessment of fracture risk. However, since early in the initiation of the dual energy x-ray absorptiometry (DXA) era, several non-BMD DXA approaches to the assessment of hip fracture risk have been proposed. This review will cover some of those methodologies, including hip-axis length (HAL), hip-structural analysis (HSA), finite element analysis (FEA) by DXA, and body composition of the thigh by DXA (BCT). These methods have been utilized in models of hip fracture occurrence and in pharmacological clinical trials. How they should be used in clinical practice or if they should be used in clinical practice is more of an issue. In addition, we will discuss the recent proposal of the use of Long Femur Scan Field in the effort to diagnose atypical femoral fractures.
髋部骨折是骨质疏松症最严重的并发症之一。超过 50%的髋部和其他部位骨折发生在没有骨密度仪骨质疏松症的患者中。因此，面积骨矿物质密度（aBMD）可能不是评估骨折风险的最佳方法。为了提高骨折风险评估，已经采取了许多其他方法。目前，骨折风险算法（FRAX©）是提高骨折风险评估的最显著方法之一。然而，自从双能 X 射线吸收仪（DXA）时代开始，就已经提出了几种非 BMD DXA 评估髋部骨折风险的方法。本综述将介绍其中的一些方法，包括髋关节轴长（HAL）、髋关节结构分析（HSA）、DXA 的有限元分析（FEA）以及 DXA 的大腿骨成分（BCT）。这些方法已用于髋部骨折发生的模型和药理学临床试验中。它们应该如何在临床实践中使用，或者是否应该在临床实践中使用，是一个更重要的问题。此外，我们将讨论最近提出的使用长股骨扫描场来诊断非典型股骨骨折的建议。
