Kleerekoper M, Nelson D A
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Trans Am Clin Climatol Assoc. 1998;109:62-70; discussion 70-2.
The earliest assessments of bone "mass" involved metacarpal morphometry that provided insight into age-related changes, the effects of low habitual dietary calcium intake, and the effects of estrogen deficiency and replacement. Single photon absorptiometry (SPA) made quantitative mass measurement possible but this was intellectually unsatisfactory since osteoporotic fractures are more of a concern at the spine and hip than at the wrist. Necessity forced the development of axial bone mass measurement (dual photon absorptiometry--DPA, dual energy xray absorptiometry--DXA, quantitative computed tomography--QCT). Hip measurements provide a better prediction of hip fracture risk than measurements at any other skeletal site. For every standard deviation decrement of bone mass at the hip, relative risk of fracture is 3.0. At non-hip sites the relative risk is only 2.0 for each standard deviation decrement in bone mass. However measurement at non-hip sites provide a fracture risk prediction that is at least the equal of blood pressure measurement for predicting risk of CVA, and substantially better than the risk assessment of acute MI afforded by cholesterol measurement. An important caveat of the superiority of hip measurement is that the data are derived from short-term studies in older women (> 70 years). The relative risk data from phalangeal, forearm, and heel measurements have all been obtained from longer-term studies in younger women. From a community health perspective, bone density measurements, no matter how accurate, precise, and meaningful, have limited value if access to the technology is limited. Peripheral measurements can be obtained on existing radiographic equipment (phalanges), or small, portable, inexpensive dedicated equipment (forearm, heel). This technology is more likely to make it to the office of the primary care physician than the larger, more expensive, dedicated equipment needed for hip measurements. The peripheral measurement technology is also suitable for high traffic areas, just as blood pressure and cholesterol measurements are widely available. This presentation reviewed the scientific validity of peripheral bone mass measurement and explored the potential for making this technology available at non-traditional facilities such as pharmacies, shopping malls, health clubs, etc.
对骨“量”的最早评估涉及掌骨形态测量，它能洞察与年龄相关的变化、习惯性低钙饮食的影响以及雌激素缺乏和替代的影响。单光子吸收测定法（SPA）使定量骨量测量成为可能，但这在理论上并不令人满意，因为骨质疏松性骨折在脊柱和髋部比在腕部更受关注。需求促使轴向骨量测量技术的发展（双光子吸收测定法——DPA、双能X线吸收测定法——DXA、定量计算机断层扫描——QCT）。髋部测量比在任何其他骨骼部位的测量能更好地预测髋部骨折风险。髋部骨量每降低一个标准差，骨折的相对风险为3.0。在非髋部部位，骨量每降低一个标准差，相对风险仅为2.0。然而，非髋部部位的测量提供的骨折风险预测至少与测量血压预测中风风险相当，并且比通过胆固醇测量评估急性心肌梗死风险要好得多。髋部测量优越性的一个重要警告是，这些数据来自对老年女性（>70岁）的短期研究。来自指骨、前臂和足跟测量的相对风险数据均来自对年轻女性的长期研究。从社区健康的角度来看，如果获取该技术的机会有限，那么无论骨密度测量多么准确、精确和有意义，其价值都有限。外周测量可以在现有的放射设备上进行（指骨），或者使用小型、便携、廉价的专用设备（前臂、足跟）。与髋部测量所需的更大、更昂贵的专用设备相比，这项技术更有可能进入初级保健医生的办公室。外周测量技术也适用于人流量大的区域，就像血压和胆固醇测量一样广泛可用。本报告回顾了外周骨量测量的科学有效性，并探讨了在药店、购物中心、健身俱乐部等非传统场所提供这项技术的可能性。
