Ott S M, Kilcoyne R F, Chesnut C H
Department of Medicine, University of Washington School of Medicine, Seattle 98195.
J Clin Endocrinol Metab. 1988 Mar;66(3):501-7. doi: 10.1210/jcem-66-3-501.
Several techniques are now available for quantitation of bone mass, including total body calcium by neutron activation analysis (TBC), single and dual photon absorptiometry at the radius and spine, respectively (SPA and DPA), quantitative computed tomography of the spine (QCT), and cancellous bone volume from iliac crest bone biopsies. The aims of this study were to assess the correlation among these techniques and to determine if bone mass correlated with height loss or the severity of vertebral fractures in osteoporotic women. These measurements were performed in the same group of women (n = 122) with postmenopausal osteoporosis. TBC, SPA, DPA, and QCT correlated significantly with each other (r = 0.33-0.76). The correlation between QCT and DPA improved significantly (r = 0.33-0.57; P = 0.02) when integral QCT was used instead of the usual QCT of the central vertebra. The correlation was not improved by expressing DPA in different dimensions, but was improved by including normal women. Multiple linear regression analysis showed that TBC was predicted better using SPA, DPA, and QCT than by any single variable. Cancellous bone volume correlated weakly (r = 0.10-0.26) to the other measurements. Height loss and fracture index correlated significantly with each other (r = 0.66; P less than 0.001), but the correlations with bone mass measurements were weak (r = -0.09 to -0.47). For each patient, a bone mass index was defined using z scores from the SPA, DPA, QCT, and TBC measurements; this index correlated inversely with the fracture index (r = -0.29; P = 0.009). This correlation was not significant when controlled for age. Thus, bone mass measurements correlate moderately well with each other, but poorly with severity of fracture. Other factors in addition to low bone mass may be important in determining whether bone will fracture.
目前有几种技术可用于骨量定量，包括通过中子活化分析测定全身钙含量（TBC）、分别在桡骨和脊柱进行的单光子吸收法和双能光子吸收法（SPA和DPA）、脊柱定量计算机断层扫描（QCT）以及通过髂嵴骨活检测定松质骨体积。本研究的目的是评估这些技术之间的相关性，并确定骨量是否与骨质疏松女性的身高降低或椎体骨折的严重程度相关。这些测量是在同一组绝经后骨质疏松女性（n = 122）中进行的。TBC、SPA、DPA和QCT之间显著相关（r = 0.33 - 0.76）。当使用积分QCT而非通常的中央椎体QCT时，QCT与DPA之间的相关性显著改善（r = 0.33 - 0.57；P = 0.02）。通过以不同维度表示DPA，相关性并未改善，但纳入正常女性后相关性得到改善。多元线性回归分析表明，使用SPA、DPA和QCT预测TBC比任何单个变量都更好。松质骨体积与其他测量值的相关性较弱（r = 0.10 - 0.26）。身高降低和骨折指数之间显著相关（r = 0.66；P < 0.001），但与骨量测量值的相关性较弱（r = -0.09至 -0.47）。对于每位患者，使用来自SPA、DPA、QCT和TBC测量的z值定义了一个骨量指数；该指数与骨折指数呈负相关（r = -0.29；P = 0.009）。在控制年龄后，这种相关性不显著。因此，骨量测量值之间的相关性中等，但与骨折严重程度的相关性较差。除了低骨量之外的其他因素在决定骨骼是否会骨折方面可能很重要。
