Abrahamsen B, Hansen T B, Jensen L B, Hermann A P, Eiken P
Department of Endocrinology, Odense University Hospital, Denmark.
J Bone Miner Res. 1997 Sep;12(9):1471-9. doi: 10.1359/jbmr.1997.12.9.1471.
Because the bone mineral density (BMD) in different anatomic regions is heterogenous the number of women who fulfill the World Health Organization definition of osteopenia or osteoporosis increases with the number of regions examined. The purpose of this study was to investigate the agreement between measurements of the spine, femur, forearm, and whole body following menopause. Two thousand and five healthy, perimenopausal women, mean age 50.6 years, were studied using Hologic QDR-1000/W and QDR-2000 densitometers. Though the BMD of different anatomic regions were correlated (r = 0.40-0.77, p < 0.01), the variability in each patient regarding T and Z scores between regions was considerable. For example, despite a high correlation (r = 0.67, p < 0.01) and no systematic difference between the T scores for total femoral and lumbar BMD, the limits of agreement (mean difference +/- 2 SD) for the comparison were -1.89 to 1.87. Femoral neck T scores were 0.5 SD lower than those of the other regions, confirming reports that the young adult reference for this measurement is disproportionally high. The prevalence of osteoporosis was 1.2% when femur total BMD was considered alone and 5.9% when lumbar and ultradistal forearm results were included. However, as many as 7.9% showed osteoporosis of the femoral neck when the Hologic T score was used, compared with 0.7% using National Health and Nutrition Examination Survey (NHANES) values. The choice of anatomic region and availability of appropriate young adult reference data has considerable impact on the apparent prevalence of osteoporosis. Given the heterogeneity between regions, a combination of spinal and femoral densitometry should be used in diagnosing osteoporosis, though this increases the prevalence of osteoporosis by 50% or more in perimenopausal women.
由于不同解剖区域的骨矿物质密度（BMD）存在异质性，符合世界卫生组织骨质疏松症或骨质减少定义的女性数量会随着检查区域数量的增加而增多。本研究的目的是调查绝经后脊柱、股骨、前臂和全身测量结果之间的一致性。使用Hologic QDR - 1000/W和QDR - 2000骨密度仪对2005名健康的围绝经期女性（平均年龄50.6岁）进行了研究。尽管不同解剖区域的BMD具有相关性（r = 0.40 - 0.77，p < 0.01），但每位患者各区域之间T值和Z值的变异性相当大。例如，尽管全股骨和腰椎BMD的T值之间具有高度相关性（r = 0.67，p < 0.01）且无系统差异，但两者比较的一致性界限（平均差异±2SD）为 - 1.89至1.87。股骨颈T值比其他区域低0.5个标准差，这证实了有关该测量的年轻成人参考值过高的报道。单独考虑股骨全BMD时骨质疏松症的患病率为1.2%，纳入腰椎和前臂远端结果时为5.9%。然而，使用Hologic T值时，多达7.9%的女性显示股骨颈骨质疏松，而使用国家健康和营养检查调查（NHANES）值时为0.7%。解剖区域的选择以及合适的年轻成人参考数据的可用性对骨质疏松症的表观患病率有相当大的影响。鉴于各区域之间的异质性，在诊断骨质疏松症时应结合脊柱和股骨密度测量，尽管这会使围绝经期女性骨质疏松症的患病率增加50%或更多。
