La Fianza A, Taverna E, Parrini M, Campani R
Divisione di Radiologia, Ospedale di Cuggiono (Milano), Università di Milano.
Radiol Med. 1994 Oct;88(4):359-63.
Over 90% of the calcaneum is made of trabecular bone, whose turnover is high and which is therefore very sensitive to bone metabolism changes. Thus, we evaluated the mineral content of the calcaneum with the semiquantitative Jhamaria index adapted by Aggarwal et al. (1986) and ultrasound measurements. With the latter method, broadband ultrasound attenuation (BUA) values were calculated, which indicate ultrasound signal breadth reduction when passing through the bone. The two techniques were used to examine 99 women, whose age ranged 65-79 years, referred for dorsolumbar pain and suspected senile osteoporosis. This condition was diagnosed with dorsolumbar spine radiographs and considering as osteoporotic only the patients with one or more vertebral collapses. Thus, any other cause of osteopenia was excluded with bone metabolism serourinary indices. The two groups of patients thus obtained (group A: 42 osteoporotic women with vertebral collapse and group B: 57 osteoporotic women with no vertebral collapse) exhibited significantly different Jhamaria index and BUA values (group A: 2.5 +/- 0.9, B: 3.7 +/- 0.96, A: 46.3 +/- 13.6, B: 60.2 +/- 15.6) (p < 0.001). The diagnostic accuracy of calcaneal BUA and Jhamaria indices, in the two groups, was 85.7% and 81%, respectively. The analysis of the mean values showed no significant correlation between BUA and Jhamaria index in the group of patients with vertebral collapse. On the contrary, the correlation of the two indices in the group of patients with no vertebral collapse exhibited slight statistical significance (r = 0.38). To conclude, on the basis of our results the calcaneum is confirmed as a reliable peripheral index of vertebral BMC and ultrasound measurements are suggested as a simple noninvasive method which can be used to diagnose senile osteoporosis.
跟骨超过90%由松质骨构成，其更新率高，因此对骨代谢变化非常敏感。因此，我们采用Aggarwal等人（1986年）改编的半定量Jhamaria指数和超声测量法评估跟骨的矿物质含量。采用后一种方法计算宽带超声衰减（BUA）值，该值表示超声信号穿过骨骼时的宽度减小。这两种技术用于检查99名年龄在65至79岁之间、因腰背痛和疑似老年性骨质疏松症前来就诊的女性。通过胸腰椎X光片诊断该疾病，仅将有一处或多处椎体塌陷的患者视为骨质疏松症患者。因此，通过骨代谢血清学指标排除了任何其他骨质减少的原因。由此获得的两组患者（A组：42名有椎体塌陷的骨质疏松症女性；B组：57名无椎体塌陷的骨质疏松症女性）的Jhamaria指数和BUA值存在显著差异（A组：2.5±0.9，B组：3.7±0.96，A组：46.3±13.6，B组：60.2±15.6）（p<0.001）。两组中跟骨BUA和Jhamaria指数的诊断准确率分别为85.7%和81%。对平均值的分析表明，椎体塌陷患者组中BUA与Jhamaria指数之间无显著相关性。相反，无椎体塌陷患者组中这两个指数的相关性具有轻微统计学意义（r = 0.38）。总之，根据我们的结果，跟骨被确认为椎体骨矿物质含量的可靠外周指标，超声测量被认为是一种可用于诊断老年性骨质疏松症的简单非侵入性方法。
