Scheidt-Nave C, Felsenberg D, Kragi G, Bruckner T, Leidig-Bruckner G, Wüster C, Ziegler R
Abteilung Innere Medizin I, Endokrinologie und Stoffwechsel, Universität Heidelberg.
Med Klin (Munich). 1998 Mar 15;93 Suppl 2:46-55. doi: 10.1007/BF03041999.
In order to test the validity of vertebral morphometry for the assessment of prevalent vertebral osteoporotic fractures, we examined the association between vertebral deformities and bone mineral density (BMD).
The study population consisted of 595 postmenopausal women and 581 men aged 50 to 82 years who participated in the baseline survey of the European Vertebral Osteoporosis Study (EVOS) in Germany and received BMD measurements by dual-X-ray-absorptiometry (DXA) at the femur and the lumbar spine.
In both sexes only vertebral deformities defined by more stringent morphometric criteria (McCloskey; Eastell 4 SD criterion) were significantly and inversely related to BMD (odds ratios 1.42 to 3.21 for a 1 SD [standard deviation] reduction in BMD; p < 0.05). The strength of the association depended on the stringency of the morphometric algorithm applied, and on the site of BMD measurement. The strongest associations were observed with femoral neck BMD in women and with BMD at the lumbar spine in men. In contingency analyses between vertebral deformities and osteoporosis (WHO criteria; European young female BMD reference values), vertebral deformities proved to be highly specific by all methods, even slightly more so in men (87.8 to 97.5%) than in women (86.3 to 96.7%). The predictive value of a positive test with respect to vertebral osteoporosis reached a maximum value of about 50% in both sexes. It further increased up to 72%, when the definition of osteoporosis was based on low BMD values at either the spine or the femoral neck, but only in women.
In conclusion, for both men and women the likelihood of vertebral deformities to be related to osteoporosis increases with the stringency of the morphometric method, with a similar probability of major deformities to represent vertebral osteoporotic fractures in men as in women. Nevertheless, even the most stringent morphometric criteria are not sufficiently valid instruments for the assessment of the prevalence of vertebral osteoporotic fractures in epidemiological studies.
为了检验椎体形态测量法在评估椎体骨质疏松性骨折患病率方面的有效性，我们研究了椎体畸形与骨密度（BMD）之间的关联。
研究人群包括595名绝经后女性和581名年龄在50至82岁之间的男性，他们参与了德国欧洲椎体骨质疏松研究（EVOS）的基线调查，并通过双能X线吸收法（DXA）测量了股骨和腰椎的骨密度。
在男性和女性中，只有采用更严格的形态测量标准（麦克洛斯基；伊斯特尔4标准差标准）定义的椎体畸形与骨密度显著负相关（骨密度每降低1个标准差[标准差]，比值比为1.42至3.21；p<0.05）。关联强度取决于所应用的形态测量算法的严格程度以及骨密度测量部位。在女性中，与股骨颈骨密度的关联最强；在男性中，与腰椎骨密度的关联最强。在椎体畸形与骨质疏松症（世界卫生组织标准；欧洲年轻女性骨密度参考值）的列联分析中，所有方法都显示椎体畸形具有高度特异性，男性（87.8%至97.5%）甚至比女性（86.3%至96.7%）略高。两性中椎体骨质疏松症阳性检测的预测价值最高约为50%。当骨质疏松症的定义基于脊柱或股骨颈的低骨密度值时，预测价值进一步提高至72%，但仅在女性中如此。
总之，对于男性和女性而言，椎体畸形与骨质疏松症相关的可能性随着形态测量方法的严格程度而增加，男性和女性中主要畸形代表椎体骨质疏松性骨折的概率相似。然而，即使是最严格的形态测量标准，在流行病学研究中也不足以有效评估椎体骨质疏松性骨折的患病率。
