Khatib Joanna, Stote Kim, Gosmanov Aidar R
Department of Medicine, Albany Medical College, Albany, New York, USA.
Department of Nutrition, Health Sciences, SUNY, Empire State College, Albany, New York, USA.
J Investig Med. 2018 Feb;66(2):298-303. doi: 10.1136/jim-2017-000557. Epub 2017 Oct 2.
Dual energy X-ray absorptiometry (DXA) is recommended for osteoporosis screening in men aged 70 years and older but supportive data is limited. The aim of this study was to determine the efficacy of DXA for the diagnosis of increased fragility in this group of subjects. We retrospectively identified men aged 70 years and older without prior history of fracture and/or conditions predisposing to low bone mineral density (BMD) who attended the VA endocrinology clinic and performed DXA for osteoporosis screening. We analyzed the relationship between BMD and demographic, anthropometric data and biochemical parameters using linear regression models. Out of 55 subjects identified, 13 (24%) men had normal BMD, 30 (54%) had osteopenia and 12 (22%) had a diagnosis of osteoporosis based on the femoral neck (FN) T-score. Lumbar spine T-scores were normal in all three groups. Weight and body mass index (BMI) were significantly higher in the normal BMD group compared with the osteopenia and osteoporosis groups (p<0.001). After adjustments for age, weight, BMI, vitamin D concentrations, and diabetes status, differences in the FN BMD among the groups remained significant (p<0.001). Based on the Fracture Risk Assessment Tool (FRAX) score calculations in 43 non-osteoporotic patients, 15 patients with osteopenia had a 10-year hip fracture probability ≥3%. Screening with DXA in male US veterans aged 70 years and older without known osteoporosis risk factors revealed that up to 50% of men may qualify for diagnostic workup to determine the etiology of low BMD and/or to meet criteria to initiate pharmacological therapy to reduce future fracture risk.
双能X线吸收法（DXA）被推荐用于70岁及以上男性的骨质疏松症筛查，但支持数据有限。本研究的目的是确定DXA在诊断该组受试者骨折风险增加方面的有效性。我们回顾性地确定了70岁及以上、无骨折病史和/或无导致低骨密度（BMD）易患因素的男性，这些男性前往退伍军人事务部内分泌诊所进行DXA骨质疏松症筛查。我们使用线性回归模型分析了BMD与人口统计学、人体测量数据和生化参数之间的关系。在确定的55名受试者中，13名（24%）男性BMD正常，30名（54%）患有骨质减少，12名（22%）根据股骨颈（FN）T评分被诊断为骨质疏松症。三组的腰椎T评分均正常。与骨质减少和骨质疏松组相比，正常BMD组的体重和体重指数（BMI）显著更高（p<0.001）。在对年龄、体重、BMI、维生素D浓度和糖尿病状态进行调整后，各组间FN BMD的差异仍然显著（p<0.001）。根据43名非骨质疏松患者的骨折风险评估工具（FRAX）评分计算，15名骨质减少患者的10年髋部骨折概率≥3%。对70岁及以上无已知骨质疏松风险因素的美国男性退伍军人进行DXA筛查发现，高达50%的男性可能符合诊断性检查标准，以确定低BMD的病因和/或满足启动药物治疗以降低未来骨折风险的标准。
