Hans D, Dargent-Molina P, Schott A M, Sebert J L, Cormier C, Kotzki P O, Delmas P D, Pouilles J M, Breart G, Meunier P J
INSERM Unité 403, Lyon, France.
Lancet. 1996 Aug 24;348(9026):511-4. doi: 10.1016/s0140-6736(95)11456-4.
The ability of ultrasonographic measurements to discriminate between patients with hip fracture and age-matched controls has until now been tested mainly through cross-sectional studies. We report the results of a prospective study to assess the value of measurements with ultrasound in predicting the risk of hip fracture.
5662 elderly women (mean age 80.4 years) had both baseline calcaneal ultrasonography measurements and femoral radiography (dual-photon X-ray absorptiometry, DPXA) to assess their bone quality. Follow-up every 4 months enabled us to identify incident fractures. 115 hip fractures were recorded during a mean follow-up duration of 2 years.
Low calcaneal ultrasonographic variables (obtained from measurements of broadband ultrasound attenuation by, and speed of sound through the bone) were able to predict an increased risk of hip fracture, with similar accuracy to low femoral bone mineral density (BMD) obtained by DPXA. The relative risk of hip fracture for 1 SD reduction was 2.0 (95% CI 1.6-2.4) for ultrasound attenuation and 1.7 (1.4-2.1) for speed of sound, compared with 1.9 (1.6-2.4) for BMD. After control for the femoral neck BMD, ultrasonographic variables remained predictive of hip fracture. The incidence of hip fracture among women with values above the median for both calcaneal ultrasound attenuation and femoral neck BMD was 2.7 per 1000 woman-years, compared with 19.6 per 1000 woman-years for those with values below the median for both measures.
Ultrasonographic measurements of the os calcis predict the risk of hip fracture in elderly women living at home as well as DPXA of the hip does, and the combination of both methods makes possible the identification of women at very high or very low risk of fracture.
迄今为止，超声测量鉴别髋部骨折患者与年龄匹配对照组的能力主要通过横断面研究进行了测试。我们报告一项前瞻性研究的结果，以评估超声测量在预测髋部骨折风险方面的价值。
5662名老年女性（平均年龄80.4岁）进行了跟骨超声基线测量和股骨X线摄影（双能X线吸收法，DPXA）以评估其骨质。每4个月的随访使我们能够识别新发骨折。在平均2年的随访期间记录了115例髋部骨折。
跟骨超声低变量值（通过测量骨宽带超声衰减和声速获得）能够预测髋部骨折风险增加，其准确性与DPXA获得的低股骨骨密度（BMD）相似。超声衰减每降低1个标准差，髋部骨折的相对风险为2.0（95%CI 1.6 - 2.4），声速为1.7（1.4 - 2.1），而BMD为1.9（1.6 - 2.4）。在控制股骨颈BMD后，超声变量仍可预测髋部骨折。跟骨超声衰减值和股骨颈BMD值均高于中位数的女性中，髋部骨折发生率为每1000女性年2.7例，而两项测量值均低于中位数的女性中为每1000女性年19.6例。
跟骨超声测量对居家老年女性髋部骨折风险的预测能力与髋部DPXA相当，两种方法结合能够识别骨折风险极高或极低的女性。
