Wáng Yì Xiáng J, Lentle Brian C
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
Quant Imaging Med Surg. 2020 Sep;10(9):1863-1876. doi: 10.21037/qims-2020-21.
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
随着年龄增长，男女都会出现骨质流失，但绝经相关的激素变化会使女性的骨质流失加剧。与女性不同，在诊断为骨质疏松症的男性中，几乎有一半会发生继发性骨质疏松症。此外，老年男性出现的椎体骨折（VF）更可能是高能创伤的结果。女性骨质疏松性椎体骨折（OVF）的X线诊断标准可能不适用于男性。应特别注意中胸段，此处经常出现过度诊断的情况。对于楔形椎体畸形（VD）或仅伴有前部高度降低的VD，诊断OVF需要格外谨慎，因为它们与骨密度（BMD）的相关性较差。对于年龄匹配的受试者，老年男性普遍存在的X线OVF可能约为老年女性的一半。这种男女比例与其他临床骨折（如髋部骨折）非常相似。即便如此，老年男性OVF的临床相关性可能低于老年女性。另一方面，对于基于髋部BMD诊断为骨质疏松症的老年男性，其OVF风险与骨质疏松症女性一样高。中国老年男性的OVF患病率低于年龄匹配的白种男性。
