Lochmüller E M, Eckstein F, Kaiser D, Zeller J B, Landgraf J, Putz R, Steldinger R
I. Frauenklinik, Ludwig-Maximilians-Universität München, Germany.
Bone. 1998 Nov;23(5):417-24. doi: 10.1016/s8756-3282(98)00127-6.
The objective of the current study was to determine the correlation of spinal and femoral dual-energy X-ray absorptiometry (DXA) and calcaneal ultrasound, measured in situ with intact soft tissues, with the in vitro failure loads of lumbar vertebral bodies. Forty-nine cadavers with intact skin and soft tissues (32 men aged 82.1 +/- 9.0 years, 17 women aged 83.1 +/- 10.1 years) were examined. The bone mineral content (BMC), the projectional area, and the bone mineral density (BMD) of the lumbar spine and proximal femur were determined with DXA, and the ultrasonic properties of the calcaneus with quantitative calcaneal ultrasound. The fourth lumbar vertebra was then excised with adjacent intervertebral disks and its mechanical failure load determined, using a materials testing machine. Absolute fracture loads were significantly higher in men than in women, but they were similar after adjusting for body weight and height. Spinal DXA was significantly associated with vertebral failure load (r = 0.62 combined; r = 0.54 men; r = 0.58 women). Femoral DXA (r = 0.46) and calcaneal ultrasound (r = 0.48) showed somewhat lower correlation coefficients, with the speed of sound (SOS) being able to add predictive information in a stepwise regression model. Normalizing the vertebral failure loads to body weight and height reduced the correlations, with only spinal DXA yielding a significant relationship. Our data suggest that previous in vitro studies may have overestimated the association between spinal DXA and vertebral failure loads, presumably because measurements were performed on excised bones, but not in situ in the presence of soft tissue inhomogeneity. The results indicate that, even in a population of old age and under in situ conditions, spinal DXA may still be somewhat better than femoral DXA and calcaneal ultrasound in predicting vertebral failure loads.
本研究的目的是确定在软组织完整的原位状态下测量的脊柱和股骨双能X线吸收法（DXA）以及跟骨超声与腰椎椎体体外破坏载荷之间的相关性。对49具皮肤和软组织完整的尸体（32名男性，年龄82.1±9.0岁；17名女性，年龄83.1±10.1岁）进行了检查。用DXA测定腰椎和股骨近端的骨矿物质含量（BMC）、投影面积和骨矿物质密度（BMD），用定量跟骨超声测定跟骨的超声特性。然后切除第四腰椎及其相邻椎间盘，并用材料试验机测定其机械破坏载荷。男性的绝对骨折载荷显著高于女性，但在根据体重和身高进行调整后两者相似。脊柱DXA与椎体破坏载荷显著相关（合并r = 0.62；男性r = 0.54；女性r = 0.58）。股骨DXA（r = 0.46）和跟骨超声（r = 0.48）的相关系数略低，声速（SOS）在逐步回归模型中能够增加预测信息。将椎体破坏载荷按体重和身高进行标准化后，相关性降低，只有脊柱DXA呈现显著关系。我们的数据表明，以往的体外研究可能高估了脊柱DXA与椎体破坏载荷之间的关联，推测是因为测量是在切除的骨头上进行的，而不是在存在软组织不均匀性的原位状态下进行的。结果表明，即使在老年人群和原位条件下，脊柱DXA在预测椎体破坏载荷方面可能仍略优于股骨DXA和跟骨超声。
