Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.
Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA.
J Spinal Cord Med. 2020 Sep;43(5):685-695. doi: 10.1080/10790268.2019.1669957. Epub 2019 Oct 30.
To identify -score values at the total hip (TH) and femoral neck (FN) that correspond to the cutoff value of <0.60 g/cm for heightened risk of fracture at the distal femur (DF) and proximal tibia (PT Retrospective analysis of data in a research center's database. Community-based individuals with spinal cord injury (SCI). 105 unique individuals with SCI. DXA derived areal BMD (aBMD) and -score of the DF, PT, TH, and FN. The aBMD at the DF and PT regions were predictors of -scores at the TH ( = 0.63, < 0.001 and = 0.65, < 0.001) and FN ( = 0.55, < 0.001 and = 0.58, < 0.001). Using the DF and PT aBMD of 0.60 g/cm as a value below which fractures were more likely to occur, the predicted -score was -3.1 and -3.5 at the TH and -2.6 and -2.9 at the FN, respectively. However, when the predicted and observed -score values disagree outside the 95% limit of agreement, the predicted -score values are lower than the measured -score values, overestimating the measured values between -2.0 and -4.0 SD. The DF and PT cutoff value for aBMD of 0.60 g/cm was a moderate predictor of -score values at the TH and FN, with considerable inaccuracies outside the clinically acceptable limits of agreement. As such, the direct measurement of knee aBMD in persons with SCI should be performed, whenever possible, prior to prescribing weight bearing upright activities, such as robotic exoskeletal-assisted walking.
为了确定总髋（TH）和股骨颈（FN）的 -score 值，这些值对应于远端股骨（DF）和近端胫骨（PT）骨折风险增加的截断值<0.60 g/cm。对研究中心数据库中数据的回顾性分析。患有脊髓损伤（SCI）的社区个体。105 名患有 SCI 的个体。DXA 衍生的面积骨密度（aBMD）和 DF、PT、TH 和 FN 的 -score。DF 和 PT 区域的 aBMD 是 TH（ = 0.63， < 0.001 和 = 0.65， < 0.001）和 FN（ = 0.55， < 0.001 和 = 0.58， < 0.001）-score 的预测因子。使用 0.60 g/cm 的 DF 和 PT aBMD 值作为骨折更可能发生的下限值，预测的 -score 分别为 TH 的-3.1 和-3.5，FN 的-2.6 和-2.9。然而，当预测的和观察到的 -score 值在 95%一致性限之外不一致时，预测的 -score 值低于测量的 -score 值，在-2.0 到-4.0 个标准差之间高估了测量值。DF 和 PT 处 0.60 g/cm 的 aBMD 截断值是 TH 和 FN 处 -score 值的中度预测因子，但在临床可接受的一致性限之外存在相当大的不准确性。因此，应尽可能在开具负重直立活动（如机器人外骨骼辅助行走）之前，对 SCI 患者进行膝关节 aBMD 的直接测量。
