Garton M J, Robertson E M, Gilbert F J, Gomersall L, Reid D M
Department of Rheumatology, City Hospital, Aberdeen.
Clin Radiol. 1994 Feb;49(2):118-22. doi: 10.1016/s0009-9260(05)83453-1.
The main purpose of this study was to compare subjective estimates of vertebral ostepenia with bone mineral density (BMD) measurements of the same region in 200 (107 male, 93 female) subjects, aged 52-90 years, invited randomly from the community. Standardized plain thoracolumbar radiographs were examined by three senior radiologists, and given a semiquantitative osteopenia score using the method of Saville. The BMD of the anteroposterior (AP) lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. In addition BMD measurements were compared in subjects without significant vertebral deformity, and those with mild (20-25%) or definite (> 25%) reductions of vertebral height. For the Saville score, intraobserver agreement was moderate to good (kappa 0.46-0.57), and interobserver agreement was fair to moderate (kappa 0.25-0.41). Although the overlap between gradings was considerable, BMD was significantly related to visually estimated osteopenia. Subjects without apparent radiographic osteopenia (Saville grade 0) had a low risk (9-15%), compared to those with definite osteopenia (64-86%), of falling below the lowest quartile of BMD at either the femoral neck or the AP spine. In women (but not men), BMD measured at the hip and spine was related to vertebral deformity.
本研究的主要目的是比较200名（107名男性，93名女性）年龄在52至90岁之间、从社区随机邀请的受试者对椎体骨质减少的主观估计与同一区域的骨密度（BMD）测量结果。三位资深放射科医生对标准化的胸腰椎X线平片进行检查，并使用萨维尔方法给出半定量骨质减少评分。通过双能X线吸收法测量腰椎前后位（AP）和股骨颈的骨密度。此外，对无明显椎体畸形的受试者以及椎体高度轻度（20 - 25%）或明显（> 25%）降低的受试者的骨密度测量结果进行了比较。对于萨维尔评分，观察者内一致性为中等至良好（kappa 0.46 - 0.57），观察者间一致性为一般至中等（kappa 0.25 - 0.41）。尽管分级之间的重叠相当大，但骨密度与视觉估计的骨质减少显著相关。与明确骨质减少的受试者（64 - 86%）相比，无明显放射学骨质减少（萨维尔分级0）的受试者在股骨颈或腰椎前后位骨密度低于最低四分位数的风险较低（9 - 15%）。在女性（而非男性）中，髋部和脊柱测量的骨密度与椎体畸形有关。
