Langton C M, Ballard P A, Langton D K, Purdie D W
Centre for Metabolic Bone Disease, Hull, UK.
Technol Health Care. 1997 Jul;5(3):235-41.
Bone mineral density (BMD) referral for dual energy X-ray absorptiometry (DXA) is generally based upon agreed clinical referral criteria (CRC). The aim of this study was to determine whether ultrasound measurements of Broadband UI-trasound Attenuation (BUA) and velocity (VOS) provide a superior selective pre-screen referral method for BMD assessment by DXA. 107 women aged 60-69 years (64.2 +/- 2.8) had BMD measurements at lumbar spine and right femoral neck along with ultrasound BUA and VOS measurements of the left calcaneus. Each subject completed an extensive clinical and social questionnaire to ascertain those who would have met one or more of the five general clinical referral criteria adopted by our Centre. Each subject was classified by DXA using the WHO criteria as normal, osteopenic or osteoporotic at lumbar spine or femoral neck. The cost per osteoporotic subject correctly identified was calculated. As a reference, based upon DXA measurements alone on all 107 subjects, the cost per osteoporotic subject identified would be Ponds 185. If subjects had been referred using the clinical referral criteria the cost is Ponds 171. For assessment of referral by BUA or VOS, an additional charge for ultrasound measurement of all subjects was incorporated. At a BUA of 60 dB MHz-1 the cost per osteoporotic subject is Ponds 107. Ultrasound velocity or a combination of BUA or VOS with clinical referral criteria did not provide a significantly reduced cost than the current clinical referral criteria alone. This study has demonstrated that BUA provides an improved referral procedure to that currently achieved with clinical referral criteria and supports the concept of BUA being used as a selective pre-screen for DXA in 7th decade subjects.
双能X线吸收法（DXA）的骨密度（BMD）转诊通常基于公认的临床转诊标准（CRC）。本研究的目的是确定宽带超声衰减（BUA）和速度（VOS）的超声测量是否能为DXA评估BMD提供一种更优的选择性预筛查转诊方法。107名年龄在60 - 69岁（64.2±2.8）的女性接受了腰椎和右股骨颈的BMD测量，以及左跟骨的超声BUA和VOS测量。每位受试者完成了一份详尽的临床和社会调查问卷，以确定哪些人符合本中心采用的五项一般临床转诊标准中的一项或多项。根据世界卫生组织标准，通过DXA将每位受试者在腰椎或股骨颈处分类为正常、骨量减少或骨质疏松。计算出正确识别的每例骨质疏松受试者的成本。作为参考，仅基于对所有107名受试者的DXA测量，识别出的每例骨质疏松受试者的成本为185英镑。如果根据临床转诊标准转诊受试者，成本为171英镑。对于通过BUA或VOS进行转诊评估，纳入了对所有受试者进行超声测量的额外费用。在BUA为60 dB MHz-1时，每例骨质疏松受试者的成本为107英镑。超声速度或BUA与VOS的组合加上临床转诊标准，并没有比仅使用当前临床转诊标准显著降低成本。本研究表明，与当前的临床转诊标准相比，BUA提供了一种改进的转诊程序，并支持将BUA用作70岁左右受试者DXA选择性预筛查的概念。
