Wilczek Michael L, Kälvesten Johan, Bergström Ingrid, Pernow Ylva, Sääf Maria, Freyschuss Bo, Brismar Torkel B
Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Sectra AB, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
Maturitas. 2017 Jul;101:31-36. doi: 10.1016/j.maturitas.2017.04.006. Epub 2017 Apr 12.
To identify causes of low age-adjusted bone mass at digital X-ray radiogrammetry (DXR) in individuals attending an osteoporosis screening program.
In a descriptive observational cohort study, women aged 40-75 years who attended a general mammography screening program had their bone mass investigated with DXR and answered a questionnaire regarding several clinical risk factors for osteoporosis. Each month the 2% with the lowest Z-scores were selected for further clinical examination with DXA of the hip and lumbar spine and pre-defined blood tests.
Causes of secondary osteoporosis determined by clinical and laboratory evaluation.
14,783 women attended mammography screening and had their bone mass evaluated. In total, 327 women had a low DXR BMD and 281 accepted further DXA examination. Of these, 93 (33.1%) had osteoporosis. The diagnosis was new in 79 cases (84.9%) and in 32 (34.4%) a potential underlying cause was identified. Primary hyperparathyroidism was found in 8.6% and secondary hyperparathyroidism in 13.5%. Several self-reported risk factors for osteoporosis, including rheumatic disease, insulin-treated diabetes, cortisone treatment, smoking, reduced mobility, hyperparathyroidism, and malabsorption, were significantly more common among those selected for DXA referral than in the total cohort. For example, rheumatic disease and insulin-treated diabetes were reported 3.4 and 2.3 times as often, respectively.
The prevailing potential cause of secondary osteoporosis according to DXR was primary and secondary hyperparathyroidism. Most of the women with these conditions were previously undiagnosed, indicating that further follow-up of patients with low age-adjusted DXR BMD is justified.
确定参加骨质疏松症筛查项目的个体在数字X线骨密度测定（DXR）中年龄校正后骨量低的原因。
在一项描述性观察性队列研究中，年龄在40 - 75岁参加普通乳腺钼靶筛查项目的女性，通过DXR对其骨量进行检测，并回答一份关于骨质疏松症若干临床危险因素的问卷。每月选取Z值最低的2%的女性进行髋部和腰椎的双能X线吸收法（DXA）进一步临床检查以及预先设定的血液检查。
通过临床和实验室评估确定继发性骨质疏松症的原因。
14783名女性参加了乳腺钼靶筛查并对其骨量进行了评估。总共有327名女性DXR骨密度低，其中281名接受了进一步的DXA检查。在这些女性中，93名（33.1%）患有骨质疏松症。79例（84.9%）为新诊断病例，32例（34.4%）发现了潜在的潜在病因。原发性甲状旁腺功能亢进症的发现率为8.6%，继发性甲状旁腺功能亢进症的发现率为13.5%。在被转诊进行DXA检查的人群中，包括风湿性疾病、胰岛素治疗的糖尿病、皮质激素治疗、吸烟、活动能力下降、甲状旁腺功能亢进症和吸收不良等几种自我报告的骨质疏松症危险因素，比整个队列中的更为常见。例如，风湿性疾病和胰岛素治疗的糖尿病的报告频率分别是总队列的3.4倍和2.3倍。
根据DXR，继发性骨质疏松症最主要的潜在病因是原发性和继发性甲状旁腺功能亢进症。大多数患有这些疾病的女性之前未被诊断，这表明对年龄校正后DXR骨密度低的患者进行进一步随访是合理的。
