Cherian Kripa Elizabeth, Kapoor Nitin, Asha Hesarghatta Shyamasunder, Thomas Nihal, Paul Thomas Vizhalil
Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):579-583. doi: 10.4103/ijem.IJEM_77_18.
Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density (BMD) of Caucasian population to calculate T scores and categorise BMD. We studied the influence of various databases on classification of BMD in south-Indian postmenopausal women aged above 50 years.
This was a cross-sectional study. Hologic DXA scanner was used to estimate BMD at lumbar spine (LS) and femoral neck (FN). T scores of ≤-2.5, -2.4 to -1, -0.9 to +1 were diagnostic of osteoporosis, osteopenia and normal respectively. Three reference databases(Italian, Korean and north Indian) were used to recalculate T scores. The agreement (K=kappa) between manufacturer provided database and the other databases was studied. The impact of different databases in diagnosing osteoporosis in subjects with FN fracture was assessed.
A total of 1956 postmenopausal women with mean (SD) age of 62 (4.3) years and 211 femoral neck(FN) fracture subjects with mean(SD) age of 68 (7.2) years were recruited. In subjects with fracture, osteoporosis at FN was found in 72% with Caucasian, 88% with North Indian, 56% with Italian, and 45% with Korean database. On comparing manufacturer provided database with the other population-specific reference, there was perfect agreement with north Indian (κ = 0.81 [FN], κ = 0.82 [LS]) and good agreement with the Italian database (κ = 0.78 [FN], κ = 0.74 [LS]).
North-Indian database identified most of the participants with FN fracture as having osteoporosis and had perfect agreement with the manufacturer's database. Follow up studies will further validate the impact of utilizing this database in clinical practice.
目前可用的双能X线吸收法（DXA）扫描仪利用白种人群的骨矿物质密度（BMD）来计算T值并对BMD进行分类。我们研究了各种数据库对50岁以上南印度绝经后女性BMD分类的影响。
这是一项横断面研究。使用Hologic DXA扫描仪评估腰椎（LS）和股骨颈（FN）的BMD。T值≤-2.5、-2.4至-1、-0.9至+1分别诊断为骨质疏松症、骨质减少和正常。使用三个参考数据库（意大利、韩国和北印度）重新计算T值。研究了制造商提供的数据库与其他数据库之间的一致性（K=kappa）。评估了不同数据库对FN骨折患者骨质疏松症诊断的影响。
共招募了1956名平均（标准差）年龄为62（4.3）岁的绝经后女性和211名平均（标准差）年龄为68（7.2）岁的股骨颈（FN）骨折患者。在骨折患者中，使用白种人数据库时FN骨质疏松症的检出率为72%，北印度数据库为88%，意大利数据库为56%，韩国数据库为45%。将制造商提供的数据库与其他特定人群参考数据库进行比较时，与北印度数据库完全一致（κ=0.81[FN]，κ=0.82[LS]），与意大利数据库一致性良好（κ=0.78[FN]，κ=0.74[LS]）。
北印度数据库将大多数FN骨折参与者识别为患有骨质疏松症，并且与制造商的数据库完全一致。后续研究将进一步验证在临床实践中使用该数据库的影响。
