Jergas M, Glüer C C
Department of Radiology at St. Josef-Hospital, Ruhr University, Bochum, Germany.
Semin Nucl Med. 1997 Jul;27(3):261-75. doi: 10.1016/s0001-2998(97)80028-1.
Bone densitometry in its various applications has become an established tool for the diagnosis of osteoporosis. Bone density has been shown to be significantly associated with the risk of future fracture in many prospective studies. From long-term prospective studies, it can be concluded that peak bone density and bone loss are important predictors of subsequent fracture, and that fracture can be predicted over a longer period. Bone density predicts fracture even in elderly persons aged 80 years and older. However, in this population some fractures, such as the cervical hip fracture, may be more strongly influenced by other risk factors. The differences between the various densitometric techniques in predicting future osteoporotic fracture of any type is marginal. However, it seems that bone density measurements at the site of fracture do perform better than measurements at other sites. There is no evidence that measuring a second site improves the diagnostic capability of bone densitometry. The association between bone density and future fracture is partly independent of age and other significant predictors of fracture such as falls, cognizance, and mobility. Quantitative ultrasonic measures of bone quality have been shown to have a predictive capability that is comparable to that of bone density. From the perspective that bone densitometry and quantitative ultrasound independently predict fractures, these measures actually seem complementary rather than competitive. Simple geometric measures of the bones such as hip axis length and vertebral depth may be derived from images of bone densitometry scans and are also predictive of hip fracture or vertebral fracture independently of bone density. Using the current knowledge of the association between bone density, quantitative ultrasound, geometric properties, and fractures as well as clinical risk factors, new models for fracture prediction can be developed for future application in clinical practice for the benefit of the individual patient.
骨密度测定在其各种应用中已成为诊断骨质疏松症的既定工具。在许多前瞻性研究中，骨密度已被证明与未来骨折风险显著相关。从长期前瞻性研究可以得出结论，峰值骨密度和骨质流失是后续骨折的重要预测指标，并且骨折可以在更长时期内被预测。即使在80岁及以上的老年人中，骨密度也能预测骨折。然而，在这个人群中，一些骨折，如颈椎髋部骨折，可能受其他风险因素的影响更大。各种骨密度测量技术在预测任何类型的未来骨质疏松性骨折方面的差异很小。然而，似乎在骨折部位进行骨密度测量比在其他部位测量表现更好。没有证据表明测量第二个部位能提高骨密度测定的诊断能力。骨密度与未来骨折之间的关联部分独立于年龄以及其他重要的骨折预测指标，如跌倒、认知和活动能力。骨质量的定量超声测量已被证明具有与骨密度相当的预测能力。从骨密度测定和定量超声独立预测骨折的角度来看，这些测量实际上似乎是互补的，而非相互竞争的。骨骼的简单几何测量，如髋部轴长和椎体深度，可以从骨密度扫描图像中得出，并且也能独立于骨密度预测髋部骨折或椎体骨折。利用目前关于骨密度、定量超声、几何特性与骨折之间的关联以及临床风险因素的知识，可以开发新的骨折预测模型，以便未来在临床实践中应用，造福个体患者。
