Lunt M, Felsenberg D, Adams J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch J A, Johnell O, Khaw K T, Masaryk P, Pols H, Poor G, Reid D, Scheidt-Nave C, Weber K, Silman A J, Reeve J
University Institute of Public Health, Cambridge, UK.
Osteoporos Int. 1997;7(3):175-89. doi: 10.1007/BF01622286.
The purpose of this study was to investigate variations in bone density between 16 European populations, 13 of which were participants in the European Vertebral Osteoporosis Study (EVOS). Men and women aged 50-80 years were recruited randomly from local population registers, stratified in 5-year age bands. The other three centres recruited similarly. Random samples of 20-100% of EVOS subjects were invited for dual-energy X-ray absorptiometry (DXA) densitometry of the lumbar spine and/or proximal femur using Hologic, Lunar or Norland pencil beam machines or, in one centre, a Sopha fan-beam machine. Cross-calibration of the different machines was undertaken using the European Spine Phantom prototype (ESPp). Highly significant differences in mean bone density were demonstrated between centres, giving rise to between centre SDs in bone density that were about a quarter of a population SD. These differences persisted when centres using Hologic machines and centres using Lunar machines were considered separately. The centres were ranked differently according to whether male or female subjects were being considered and according to site of measurement (L2-4, femoral neck or femoral trochanter). As expected, bone mineral density (BMD) had a curvilinear relationship with age, and apparent rates of decrease slowed as age advanced past 50 years in both sexes. In the spine, not only did male BMD usually appear to increase with age, but there was a highly significant difference between centres in the age effect in both sexes, suggesting a variability in the impact of osteoarthritis between centres. Weight was consistently positively associated with BMD, but the effects of height and armspan were less consistent. Logarithmic transformation was needed to normalize the regressions of BMD on the independent variates, and after transformation, all sites except the femoral neck in females showed significant increases in SD with age. Interestingly, the effect of increasing weight was to decrease dispersion in proximal femur measurements in both sexes, further accentuating the tendency in women for low body mass index to be associated with osteoporosis as defined by densitometry. It is concluded that there are major differences between BMD values in European population samples which, with variations in anthropometric variables, have the potential to contribute substantially to variations in rates of osteoporotic fracture risk in Europe.
本研究的目的是调查16个欧洲人群之间的骨密度差异，其中13个是欧洲椎体骨质疏松症研究（EVOS）的参与者。年龄在50至80岁之间的男性和女性从当地人口登记册中随机招募，按5岁年龄组分层。其他三个中心也采用类似的招募方式。邀请20%至100%的EVOS受试者随机样本，使用Hologic、Lunar或Norland笔形束机器，或在一个中心使用Sopha扇形束机器，对腰椎和/或股骨近端进行双能X线吸收法（DXA）骨密度测定。使用欧洲脊柱体模原型（ESPp）对不同机器进行交叉校准。各中心之间的平均骨密度存在高度显著差异，导致骨密度的中心间标准差约为总体标准差的四分之一。当分别考虑使用Hologic机器的中心和使用Lunar机器的中心时，这些差异仍然存在。根据所考虑的是男性还是女性受试者以及测量部位（L2-4、股骨颈或股骨转子），各中心的排名有所不同。正如预期的那样，骨矿物质密度（BMD）与年龄呈曲线关系，并且在50岁之后，两性的表观下降速率随着年龄的增长而减缓。在脊柱方面，不仅男性BMD通常似乎随年龄增加，而且两性的年龄效应在各中心之间存在高度显著差异，这表明各中心之间骨关节炎的影响存在差异。体重始终与BMD呈正相关，但身高和臂展的影响不太一致。需要进行对数转换以使BMD对独立变量的回归标准化，转换后，除女性股骨颈外，所有部位的标准差均随年龄显著增加。有趣的是，体重增加的影响是减少两性股骨近端测量值的离散度，进一步加剧了女性中低体重指数与骨密度测定所定义的骨质疏松症相关的趋势。结论是，欧洲人群样本中的BMD值存在重大差异，这些差异以及人体测量变量的变化，有可能极大地导致欧洲骨质疏松性骨折风险率的差异。
