Mele R, Masci G, Ventura V, de Aloysio D, Bicocchi M, Cadossi R
Department of Orthopaedic Surgery, Ospedale Civile, Pordenone, Italy.
Osteoporos Int. 1997;7(6):550-7. doi: 10.1007/BF02652561.
A longitudinal study was conducted to assess the value of quantitative ultrasound (QUS) measurement in predicting the risk of fracture and to evaluate how QUS parameters change with ageing and the climacteric. A group of 211 female subjects underwent assessment by QUS at the distal metaphysis of the first phalanx of the last four fingers of the hand on two occasions 3 years apart. The subjects were selected from outpatients attending the orthopaedic clinic, provided they were not affected by metabolic disease or under treatment with drugs known to interfere with bone metabolism. In vivo the coefficient of variation and the standardized coefficient of variation of the QUS device were respectively 0.5% and 3.5%. The correlation between the values of the amplitude-dependent speed of sound (AD-SoS) in the two measurements was r = 0.92. In 77.3% of the subjects during the observation period we recorded a reduction in AD-SoS. During the study 22 fractures were observed in peripheral sites, 8 of which were associated with 'low-energy trauma'. By multiple logistic regression analysis we found that the relative risk of fracture for a 1 SD reduction in AD-SoS was 1.5 (95% CI 1.1-1.7) (p < 0.03). The percentage of low-energy fractures significantly increased among those subjects with an AD-SoS value lower than 1850 m/s (T-score < -3.5) at the first examination (p <0.0001). QUS investigation proved to be especially sensitive to hormonal changes associated with the climacteric: we observed a mean decrease of 56 m/s in the AD-SoS for women who entered the menopause between the first and the second QUS test (average time since menopause 2 years), as against 10 m/s in subjects remaining premenopausal. In a group of 146 subjects with 'normal' Ad-SoS at the first examination, we observed a significant reduction in AD-SoS only after 40 years of age. This study demonstrates that measurement of the AD-SoS at the phalanx is reproducible, can be employed to assess the risk of fracture, and is able to detect age-related alterations in bone tissue.
进行了一项纵向研究，以评估定量超声（QUS）测量在预测骨折风险中的价值，并评估QUS参数如何随年龄和更年期而变化。一组211名女性受试者在相隔3年的两个时间点接受了手部最后四指第一指骨远端干骺端的QUS评估。这些受试者选自骨科门诊患者，前提是她们未患代谢性疾病或未接受已知会干扰骨代谢的药物治疗。在体内，QUS设备的变异系数和标准化变异系数分别为0.5%和3.5%。两次测量中振幅依赖声速（AD-SoS）值之间的相关性为r = 0.92。在77.3%的受试者观察期内，我们记录到AD-SoS降低。在研究期间，在外周部位观察到22例骨折，其中8例与“低能量创伤”有关。通过多因素逻辑回归分析，我们发现AD-SoS每降低1个标准差，骨折的相对风险为1.5（95%可信区间1.1 - 1.7）（p < 0.03）。在首次检查时AD-SoS值低于1850 m/s（T值< -3.5）的受试者中，低能量骨折的百分比显著增加（p < 0.0001）。QUS检查被证明对与更年期相关的激素变化特别敏感：我们观察到在第一次和第二次QUS检查之间进入更年期的女性（绝经后平均时间2年），其AD-SoS平均下降56 m/s，而仍处于绝经前的受试者下降10 m/s。在一组首次检查时Ad-SoS“正常”的146名受试者中，我们观察到仅在40岁以后AD-SoS才有显著降低。这项研究表明，指骨AD-SoS的测量具有可重复性，可用于评估骨折风险，并能够检测骨组织中与年龄相关的变化。
