Maini M, Brignoli E, Felicetti G, Bozzi M
Divisione RRF, Centro Medico Riabilitazione-Montescano (Pavia).
Minerva Med. 1996 Sep;87(9):385-99.
The recent development of highly accurate and precise osseous mass quantitative evaluation methodology, permits the conduction, in the sphere of osteoporosis, of epidemiologic investigations no longer limited solely to fracture complications but also based on the definition of osseous mass. Fractures being only complications, possible but not certain, of the advanced stages of the diseases, the studies based on their incidence allow one to underestimate the global entity of prevalence and incidence, besides building only a partially useful reference in view of primary and secondary prevention. The main points of our study are the following: 1) evaluation of the incidence of the primary risk factors for osteoporosis as they appear in the literature, on the bone mass values of examined subjects, utilizing tatic mineralometric data as a reference standard; 2) study of biohumoral data relative to phospho-calcium metabolism and to sexual function, to show the possibility of their use as early identifying markers of subjects at risk; references values represented by dynamic mineralometric data. The principal conclusions that emerged int he course of the study are the following. In regard to the evaluation of the principal risk factors, they prove to be correlated to the osseous mass values registered at the first control: physical activity (highly positive action). Favorable levels of correlation were also discovered for the variables of increased body weight (positive action) and increased age (negative action). In multivariate analysis, the R-square value (index of the variation fraction of osseous mass values due to the risk factors) has reached a total value of 0.65 (physical) activity: 0.46; physical activity + dietary calcium: 0.55; history + increased age: 0.58; history + smoking: 0.62; history + increased weight: 0.64; history + pre- or post-menopausal: (0.65). Such analysis furnishes useful indications on the modalities to employ in the anamnestic framing of the patients at risk for osteoporosis, and on the importance attributable to single risk factors.
高精度和高精准度的骨量定量评估方法的最新发展，使得在骨质疏松领域能够开展流行病学调查，这种调查不再仅仅局限于骨折并发症，而是基于骨量的定义。骨折只是该疾病晚期可能出现但并非必然出现的并发症，基于骨折发生率的研究不仅会低估患病率和发病率的总体情况，而且鉴于一级和二级预防，其提供的参考价值也仅部分有用。我们研究的要点如下：1）利用静态骨矿物质测量数据作为参考标准，评估文献中出现的骨质疏松主要危险因素对受试对象骨量值的影响；2）研究与磷钙代谢和性功能相关的生物体液数据，以表明其作为高危受试者早期识别标志物的可能性；以动态骨矿物质测量数据作为参考值。研究过程中得出的主要结论如下。关于主要危险因素的评估，结果表明它们与首次检查时记录的骨量值相关：身体活动（具有高度正向作用）。还发现体重增加（正向作用）和年龄增长（负向作用）等变量具有良好的相关性。在多变量分析中，R平方值（因危险因素导致的骨量值变化分数指数）的总值达到了0.65（身体活动：0.46；身体活动+膳食钙：0.55；绝经史+年龄增长：0.58；绝经史+吸烟：0.62；绝经史+体重增加：0.64；绝经史+绝经前或绝经后：0.65）。这种分析为骨质疏松高危患者问诊框架中应采用的方式以及单个危险因素的重要性提供了有用的指示。
