A Comparison Study of the Reference Curves of Bone Mineral Density at Different Skeletal Sites in Native Chinese,Japanese, and American Caucasian Women

To understand the differences among reference curves for bone mineral density (BMD) for Chinese, Japanese, and American Caucasian women, we measured the BMD at the anteroposterior (AP) lumbar spine (L1–L4), lateral lumbar spine (L2–L4), hip (including the femoral neck, trochanter, intertrochanter, Wards triangle, and total hip), and ultradistal forearm by the dual-energy X-ray absorptiometry (DXA) in a total of 2728 healthy Chinese women, aged 5–96 years. Documented BMD data for Japanese women and device manufacturers BMD new reference databases (including the NHANES III dataset) for American Caucasian women were also used in this study. The cubic regression model was found to fit best in analyzing the age-associated variations of BMD at various sites in Chinese women, i.e., the equations had the largest coefficient of determination (R ²). At the AP/Lat spine, trochanter, intertrochanter, and Wards triangle, BMD reference curves for Chinese women were lower than those for Japanese or Caucasian women, while at the femoral neck, total hip, and ultradistal forearm, the reference curves for Chinese women were higher than those for Japanese women, with overlaps and crossing of the curves for some age spans in comparing the Chinese and Caucasian women. There were significant differences in the peak BMD (PBMD) at various sites among the Chinese, Japanese, and Caucasian women (P = 0.000). The PBMDs for Chinese women at the lumbar spine and various sites of the hip were 5.7% ± 2.1% (mean ± SD, range, 2.7–7.9%) lower than those for Japanese women and 5.1% ± 2.7% (range, 0.5–7.2%) lower than those for Caucasian women; however, the PBMDs for Chinese women were 26.2% higher than those for Japanese women and 10% higher than those for Caucasian women at the ultradistal forearm. After the PBMD, average T-scores of Chinese women for losses at the AP lumbar spine with increasing age were nearly identical to those for Japanese women, but both were greater than those for Caucasian women. The average T-scores for BMD loss at various sites in Chinese women were higher than those for both Japanese and Caucasian women except at the femoral neck, where the T-scores of Chinese women were exceeded by those of both Japanese and Caucasian women. Estimated from the T-score curve of BMD loss, the age of osteoporosis occurrence at the femoral neck in Chinese women was about 10 years later than that in Japanese or Caucasian women; at the AP spine, Chinese women were similar to Japanese women; at the other sites, the age for occurrence of osteoporosis in Chinese women was about 5–15 years earlier than that in either Japanese or Caucasian women. There are differences in prevalence or odds ratio (OR) of osteoporosis at the same skeletal region for Chinese, Japanese, and Caucasian women aged 50 years or at different skeletal regions in women of the same race. The prevalences of osteoporosis at various regions of the hip in Chinese women are 10.1–19.8% and ORs are 22.0–32.3, of which prevalence at the femoral neck is the lowest (10.1%); the prevalences of osteoporosis in Japanese women are 11.6–16.8% and ORs are 21.1–26.3, of which prevalence at the femoral neck is the lowest (11.6%); and the prevalences of osteoporosis in Caucasian women are 13.0–20.0% and ORs are 19.4–48.9, of which prevalence at the femoral neck is the highest (20%). In conclusion, racial differences in BMD reference curves, prevalences, and risks of osteoporosis at various skeletal sites exist among native Chinese, Japanese, and American Caucasian women.     

Relationship of body surface area with bone density and its risk of osteoporosis at various skeletal regions in women of mainland China

The aim of this study was to investigate the relationship between body surface area (BS) and bone mineral density (BMD) and the associated osteoporosis risk at various skeletal regions in women from mainland China. BMD was measured at the posteroanterior (PA) spine (L1–L4), supine lateral spine (L2–L4) including volumetric BMD (vBMD), hip including femoral neck, trochanter and total hip, and forearm, including radius+ulna ultradistal (R+UUD), 1/3 site (R+U1/3) and total region (R+UT) using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) in 3418 females aged from 18 to 75 years. Data analysis revealed a positive correlation between BS and BMD at the various skeletal regions (r=0.114–0.373, all P=0.000), but no correlation with vBMD (r=0.000, P=0.934). Using the stepwise regression model, BMDs at various skeletal regions were dependent variables while height, weight, body mass index (BMI), BS and projective bone area (BA) were independent variables; BS was determined to be the most important variable that affected the PA spine, hip and forearm BMDs. Subjects were divided into three groups according to size: large BS group (LBSG), intermediate BS group (IBSG) and small BS group (SBSG). The BMD at different skeletal regions of subjects between groups exhibited a significant gradient difference, with LBSG>IBSG>SBSG, but this was not seen for vBMD. On the fitting curves where BMD varied with age at the PA spine, femoral neck, total hip and R+UUD, BMDs of LBSG were 6.93–9.29% higher than those of IBSG and 12.1–16.9 % higher than those of SBSG, whereas those of SBSG were 6.12–9.59% lower than those of IBSG at various skeletal regions, respectively. The prevalence rates and risks of osteoporosis of LBSG were significantly lower than those of SBSG and IBSG, whereas those of IBSG were obviously lower than those of SBSG at various skeletal regions, respectively, presenting a gradient difference among the three study groups, LBSG<IBSG<SBSG. Our study shows that the relationship between BS and BMD exceeds that between BMD and height or weight in women in mainland China. When areal BMD is employed, those with a larger BS have higher areal BMD and lower risks of osteoporosis while, conversely, those with a smaller BS have lower areal BMD, and therefore higher risk for osteoporosis. However, when vBMD is used, these differences diminish or even disappear.     

中国健康男性腰椎和股骨近端的骨密度(英文)

目的:建立中国健康汉族男性的骨密度(BMD)参考数据库,以评价群体中骨质疏松的患病率。方法:对上海市1385例20-89岁健康汉族男性使用双能 X 线吸收仪测定腰椎1-4(L1-4)和股骨近端的 BMD。结果:年龄与股骨近端各部位 BMD 值呈显著负相关,但与腰椎 BMD 值之间无相关性。以20-39岁年龄段的男性腰椎和股骨近端各部位 BMD 均值作为峰值,根据 WHO 制定的骨质疏松诊断标准,中国男性 L1-4、全髋部、股骨颈、大转子和转子间部位 BMD 的骨质疏松诊断值分别为0.719、0.638、0.575、0.437、0.725 g/cm~2;使用本参考数据库,在1084例50岁以上男性中 L1-4、全髋部、股骨颈、大转子和转子间部位骨质疏松检出率分别为5.4%、3.8%、6.3%、1.8%和2.8%,而使用美国非西班牙裔白种男性参考数据库(NHANES Ⅲ),髋部各部位骨质疏松和骨量减少的检出率均显著高于使用本研究中的中国参考数据库。结论:中国健康汉族男性 BMD 参考数据库的建立,将有利于中国男性骨质疏松的正确诊断。     

Establishment of peak bone mineral density in Southern Chinese males and its comparisons with other males from different regions of China

Peak bone mineral density (PBMD) is an important determinant of osteoporotic fracture and a precondition for correct diagnosis of osteoporosis. The objective of this study was to establish the reference data of PBMD at the lumber spine and hip in Southern Chinese males. Bone mineral density (BMD) was measured at the lumbar spine and hip (femoral neck, trochanter, intertrochanter, and total) in 1155 Chinese men aged 15–39 years, using dual-energy X-ray absorptiometry (DXA). We utilized a fit curve method to determine the best age range over which to calculate PBMD. Our results indicated that the PBMD was observed at the age range of 18–25 years at the various sites. The mean value and standard deviation of PBMD was 0.753 ± 0.117, 1.156 ± 0.148, 0.896 ± 0.120, 0.989 ± 0.122, and 0.980 ± 0.116 g/cm² at the trochanter, intertrochanter, femoral neck, total hip, and spine, respectively. When the present PBMD reference was compared with the documented PBMD reference of males from other regions of China, we found great difference in standardized PBMD between Changsha males and those from other regions of China. The PBMD for Chinese males in Changsha at the various sites were 3.19%–11.33% lower than that for American Caucasian males. In conclusion, the PBMD at the spine and hip may be used as normal reference data for Southern Chinese males in Changsha instead of documented PBMD from other regions of China and the manufacturer's reference data.     

Establishment of BMD reference databases for the diagnosis and evaluation of osteoporosis in central southern Chinese men

Osteoporosis in men is an increasingly important public health problem. This study was designed to establish bone mineral density (BMD) reference databases for central southern Chinese men at multiple skeletal sites. We recruited 2433 native Chinese males for BMD assessment. Of these, 1537 were healthy volunteers (age range, 15–85 years), and 896 were suspected to have osteoporosis. BMD values were measured at the posteroanterior (PA) and lateral spine, hip, and distal forearm using a Delphi A absorptiometer. The quadratic regression model provided the best fit for age-related changes in BMD in the spine and hip. The cubic regression model was the best for describing age-related BMD changes in the distal forearm. Peak BMD in the lumbar spine, femoral neck, and total hip occurred at 15–19 years. Peak BMD at the distal forearm occurred at 40–44 years. The prevalence of primary osteoporosis in subjects ranging from 50–85 years was 4.3%–27.7% at various skeletal sites. Compared to the databases established here, the Hologic databases led to significantly higher osteoporosis detection rates. The BMD reference databases established for central southern Chinese men provide the most reliable diagnostic standards for osteoporosis detection in men of central south China.     

我国中老年脆性髋部骨折及桡骨远端骨折骨质疏松诊断标准与WHO诊断标准的比较分析

目的评估我国中老年髋部骨折及桡骨远端骨折骨质疏松诊断标准与世界卫生组织(World Health Organization,WHO)诊断标准的不同所产生的骨质疏松人群的数量差异,更加精确地指导临床对适宜骨质疏松人群的筛查及治疗。方法收集2016年8月至2018年2月我院骨科年龄在60～80岁的脆性髋部骨折女性患者110例及桡骨远端骨折女性患者100例及与年龄相仿的正常人女性312名,使用双能X线骨密度仪测量腰1～4、股骨颈、股骨大粗隆骨密度,分别计算骨质疏松率;再按照我国骨质疏松诊断标准及WHO诊断标准进行比较分析。结果脆性髋部骨折女性患者腰1～4、股骨颈、股骨大粗隆骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。脆性桡骨远端骨折女性患者腰1～4、股骨颈骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。股骨大粗隆骨密度低于对照组,骨质疏松率高于对照组,但差异不具有统计学意义(P0.05)。按照我国骨质疏松诊断标准与WHO诊断标准进行比较,我国脆性髋部骨折及桡骨远端骨折骨质疏松人数多于WHO骨质疏松人数,差异具有统计学意义(P0.05)。结论据本文分析,我国脆性髋部骨折及桡骨远端骨折骨质疏松率明显高于正常人,我国骨质疏松诊断标准扩大了骨质疏松人数。呼吁更多研究评估我国骨质疏松骨折,特别是脆性桡骨远端骨折的诊断及治疗,适时调整我国骨质疏松诊断标准。     

Bone Mineral Density of the Spine, Hip and Distal Forearm in Representative Samples of the Japanese Female Population: Japanese Population-Based Osteoporosis (JPOS) Study

Low bone mineral density (BMD) is one of the most important elements for the diagnosis of osteoporosis and screening people with higher risk of fractures. To establish the criterion value of BMD for the diagnosis of osteoporosis and to estimate the prevalence rate of osteoporosis in Japanese women, we performed a Japanese population-based osteoporosis (JPOS) study. The subjects were 4550 women aged 15 through 79 years randomly selected from seven municipalities throughout Japan. The sample size was determined to ensure that the observed mean BMD would remain within 2.5% from the real value with a probability of 0.95 in each of the 5-year age groups. The study comprised bone mass measurements by dual-energy X-ray absorptiometry at the spine (L2–4), hip and distal forearm, body size measurements and detailed interviews on medical and gynecologic history. After excluding those subjects with apparent or suggested abnormalities affecting bone mass from 3985 women (87.6%) who completed the study, 3465 women remained and served as the subjects. We present 5-year age-specific mean values of BMD and cut-off values for the diagnosis of osteoporosis according to World Health Organization (WHO) and the Japanese Society of Bone and Mineral Research (JSBMR) criteria. The cut-off levels at the spine and the distal radius proposed in this study were similar to those proposed by the JSBMR but the cut-off level at the femoral neck in this study was 4.7% higher than that of the JSBMR. The prevalence rates of osteoporosis according to WHO criteria in the present subjects aged 50 through 79 years were calculated as 38.0% at the spine, 11.6% at the femoral neck and 56.8% at the distal one-third site of the radius, and those in the Japanese female population of the same age were estimated to be 35.1%, 9.4% and 51.2%, respectively. A fivefold difference was observed among the prevalence rates at different skeletal sites, which suggests that the different definitions of osteoporosis should be established for the different skeletal sites. The prevalence rate diagnosed at the femoral neck seemed to be lower in the present study than those reported for Caucasians. This might account for a lower incidence rate of hip fracture in Japanese women. Received: 6 June 2000 / Accepted: 5 January 2001     

不同国家和地区各种族人群骨密度参考值及其相互比较

目的了解各种族之间骨密度(BMD)参考值的差异。方法收集科学引文索引(SCI)收录杂志发表的20多个国家和地区不同种族人群的BMD参考值,并进行分类整理和比较分析。结果BMD拟合参考曲线显示,各种族女性和男性人群不同骨骼部位的峰值BMD(PBMD),绝大多数发生在20~30岁,日本女性股骨颈达到PBMD的年龄最早(15岁),中国香港男性腰椎达到PBMD的年龄最晚(40岁)。中国人群的PBMD和BMD参考曲线显著低于其他种族,黑人BMD显著高于所有种族。在腰椎、股骨颈和总体髋部,中国女性的PBMD比美国白人女性分别低6.7%、4.9%和6.1%;美国黑人女性股骨颈和总体髋部的PBMD比中国长沙女性分别高13.9%和13.7%,比美国白人女性分别高10.4%和8.8%;墨西哥女性股骨颈的PBMD与北欧女性人群一致。美国黑人男性股骨颈的PBMD与中国香港男性人群的差异最大,为20.9%。结论不同国家和地区各种族人群之间的BMD参考值绝大多数存在种族或地域差异。     

Correlations of dual-energy X-ray absorptiometry,quantitative computed tomography,and single photon absorptiometry with spinal and non-spinal fractures

Controversy continues as to which method of measuring bone mineral density (BMD) best detects osteoporosis and best correlates with fractures of the spine, hip and elsewhere. To answer these questions the prevalence of fractures was carefully determined among 90 subjects (70 with osteoporosis, 6 with mild primary hyperparathyroidism, 1 with osteomalacia and 13 normals) and simultaneous measurements were made using spinal computed tomography (QCT), spinal anteroposterior (AP) and supine lateral dual X-ray absorptiometry (DXA), femoral neck and total hip DXA, and distal third radial DXA and single photon absorptiometry (SPA). The DXA measurements which had the greatest sensitivity in detecting osteoporosis (defined as a BMD lower than –2.5 SD of peak bone mass at age 30 years) were the supine lateral spine DXA (84%) and femoral neck DXA (75%); less sensitive were the DXA measurements of the distal third of the radius (61%) and AP spine (51%). DXA measurements of the femoral neck and distal third of the radius were more useful than spinal measurements in detecting the osteopenia of mild primary hyperparathyroidism. Vertebral compression fractures (VCF) correlated well with spinal QCT (r=–0.38) and lateral spine DXA (r=–0.41), but poorly with AP spine DXA (r=–0.17) and distal third radial DXA (r=–0.02). Non-spinal fractures correlated best with the distal third radial DXA (r=–0.42). In conclusion, spinal QCT, supine lateral spine DXA and femoral neck DXA are the best BMD methods to screen for osteoporosis, whereas AP spine DXA is a poor screening method in women over 60 years of age. Spinal QCT and lateral spine DXA correlate well with VCFs, whereas correlations of VCFs with AP spine DXA, femoral neck DXA and distal third radial DXA are poor.     

Can the WHO definition of osteoporosis be applied to multi-site axial transmission quantitative ultrasound?

Osteoporosis is a highly prevalent but preventable disease and, as such, it is important that there are appropriate diagnostic criteria to identify those at risk of low trauma fracture. In 1994 the World Health Organization (WHO) introduced definitions of osteoporosis and osteopenia using T-scores, which identified 30% of all Caucasian post-menopausal women as having osteoporosis. However, the use of the WHO T-score thresholds of –2.5 for osteoporosis and –1.0 for osteopenia may be inappropriate at skeletal sites other than the spine, hip and forearm or when other modalities, such as quantitative ultrasound (QUS) are used. The aim of this study was to evaluate the age-dependence of T-scores for speed of sound (SOS) measurements at the radius, tibia, phalanx and metatarsal by use of the Sunlight Omnisense, to evaluate the prevalence of osteoporosis and osteopenia at these sites by use of the WHO criteria, and calculate appropriate equivalent T-score thresholds. The study population consisted of 278 healthy pre-menopausal women, 194 healthy post-menopausal women and 115 women with atraumatic vertebral fractures. All women had SOS measurements at the radius, tibia, phalanx and metatarsal and bone mineral density (BMD) measurements at the lumbar spine and hip. A group of healthy pre-menopausal women aged 20–40 years from the pre-menopausal group were used to estimate the population mean and SD for each of the SOS and BMD measurement sites. Healthy post-menopausal women were classified into normal, osteopenic or osteoporotic, based upon the standard WHO definition of osteoporosis and expressed as a percentage. We investigated the age-related decline in T-scores from 20–79 by stratifying the healthy subjects into 10-year age groups and calculating the mean T-score for each of these groups. Finally, we estimated appropriate T-score thresholds, using five different approaches. The prevalence of osteoporosis in the post-menopausal women aged 50 years and over ranged from 1.4 to 12.7% for SOS and 1.3 to 5.2% for BMD. The age-related decline in T-scores ranged from –0.92 to –1.80 for SOS measurements in the 60 to 69-year age group and –0.60 to –1.19 for BMD measurements in the same age group. The WHO definition was not suitable for use with SOS measurements, and revised T-score thresholds for the diagnosis of osteoporosis of –2.6, –3.0, –3.0 and –2.2 and for osteopenia of –1.4, –1.6, –2.3, and –1.4, for the radius, tibia, phalanx and metatarsal, respectively, were recommended.     

Prevalence of osteoporosis using bone mineral measurements at the calcaneus by dual X-ray and laser (DXL)

Using manufacturers reference data the prevalence of osteoporosis using a T-score threshold of –2.5 for heel measurements by DXL technology was compared to dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck, spine and forearm. The prevalence of osteoporosis for women aged 50 years or older was 28% for DXL measurements of the heel bone and 30, 22 and 32% for DXA measurements of the lumbar spine, femoral neck and forearm respectively. Bone mineral density (BMD) was also measured by DXL in the heel bone and by DXA in spine and femoral neck in 251 women (mean age 62±14.5 years) when attending an osteoporosis clinic. The sensitivity and specificity for osteoporosis and osteopenia for the DXL measurements were calculated assuming a low T-score at the spine or femoral neck as the criterion for a correct diagnosis. The sensitivity was found to be 80% for osteoporosis and 82% for osteopenia and the specificity was 82% for osteoporosis and 89% for osteopenia. We conclude that DXL measurement at the heel bone, using a T-score threshold of –2.5 for classification of osteoporosis, is in concordance with the World Health Organization (WHO) definition of osteoporosis.     

Establishment of BMD reference plots and determination of peak BMD at multiple skeletal regions in mainland Chinese women and the diagnosis of osteoporosis

Osteoporosis is a major public health problem, particularly in women. Bone mineral density (BMD) reference plot is a basic, and the peak BMD (PBMD) an important, parameter in the diagnosis of osteoporosis. In order to establish reference plots of BMD at multiple skeletal sites in Chinese women and improve the diagnostic accuracy for osteoporosis, we measured BMDs at several skeletal regions in 3,378 Chinese women, aged 5–96 years, using a dual-energy X-ray absorptiometry fan-beam bone densitometer. After determining that the cubic regression model best fit all skeletal regions, we utilized the curve-fitting to establish BMD reference plots and utilized the curve-fitting equation to calculate the highest BMDs at all skeletal regions using three different methods of calculation—actual PBMD (method A), PBMD of each 5-year age group (method B), and a cross-section of age (method C). When the three methods were compared, we found significant differences among them at the majority of skeletal regions studied. When we utilized these three methods to determine the prevalence of osteoporosis in 2,120 women aged 40 years and older, except for the Wards triangle, we observed significant differences among them at all skeletal regions. In the present study, we established new BMD reference plots at multiple skeletal regions for women of mainland China. Our findings also indicate that curve-fitting equations can be employed to calculate actual PBMDs specific to individual regions, and that the use of different methods to calculate PBMD may have a significant impact on both PBMD and the diagnosis of osteoporosis. Therefore, we suggest that a standardized method be established to calculate site-specific PBMDs based on the peak values of best-fit reference curves in appropriate age groups.     

Classification of osteoporosis in the elderly is dependent on site-specific analysis

Vertebral osteoporosis accounts for over 500,000 spinal fractures annually, the majority of which occur in older women. Despite these statistics, data regarding the rate of spinal bone loss in this population are conflicting. Moreover, the site of skeletal evaluation may significantly alter classification of osteoporosis in this age group. To examine trabecular-rich spinal bone loss with a measurement less affected by age-related artifacts that the AP spine, we measured lateral lumbar spine bone density (BMD) using dual-energy X-ray absorptiometry in 120 healthy, ambulatory, community-dwelling women 65 years of age and older (mean 70±5 years, range 65–88). We also examined cortical-rich sites in the forearm and total body along with AP spine and femoral BMD to assess the impact of site specificity using the World Health Organization (WHO) classification of osteoporosis. Significant losses in BMD were observed at the lateral spine (−1.1%/year,P<0.01), forearm (−0.77%/year,P≤0.01), total hip (−0.75%/year,P≤0.01), femoral neck (−0.70%/year,P≤0.05), and trochanter (−0.78%/year,P≤0.01), but not the AP spine. Using the WHO criteria, lateral spine BMD determinations classified 66% of women with osteoporosis in contrast to 29% using the AP projection. Osteoporosis was diagnosed in 55% of women using measurements of the femoral neck, 43% using the total radius, and 19% using the total body. We conclude that elderly women lose bone at trabecular-and cortical-rich sites (lateral spine and total radius, respectively) in addition to sustaining significant age-related bone loss at mixed cortical/trabecular sites such as the hip. Classification of osteoporosis in this age group more than doubles using lateral versus AP spinal projections, supporting the necessity of developing more uniform agreement on site-specific analyses.     

Age-Related Bone Mineral Density, Accumulated Bone Loss Rate and Prevalence of Osteoporosis at Multiple Skeletal Sites in Chinese Women

We investigated the age-related bone mineral density (BMD), accumulated bone loss rate (ABLR) and the prevalence of osteoporosis at different skeletal sites in Chinese women. BMD was measured at the anteroposterior (AP) spine, supine lateral spine (areal BMD at the midarea [mLat] and the whole region [Lat], volumetric BMD at the middle region [MVD] and total region [TVD]), hip (femoral neck [FN], trochanter [Troc] and Ward’s triangle [Ward’s]) and forearm (radius + ulna ultradistal [RUUD], 1/3 region [RU1/3] and total region [RUT]) using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) in 2702 females aged from 5 to 96 years old. Data were analyzed by eight different regression models. We found that the cubic regression model was the best for describing age-related changes in BMD. The coefficients of determination (R ²) of the fitting curve were 0.398 to 0.612 (p= 0.000). The data were then analyzed by 5-year age groups. This showed that the earliest peak BMD was at the age of 20–24 years at Troc and Ward’s, and the latest at the age of 40–44 years at RU1/3 and RUT of the distal forearm. Compared with BMD, the ABLRs were highest at Ward’s (−66.2%) and the lowest at RU1/3 of the distal forearm (−31.3%) in subjects over 80 years old. The prevalence of osteoporosis at at least one site in these women was 0.5 ± 0.4% in those 30–39, 4.6 ± 4.4% in those 40–49, 23.9 ± 13.3% in those 50–59, 56.3 ± 20.3% in those 60–69, 71.8 ± 16.7% in those 70–79 and 83.2 ± 12.1% those over 80 years of age, respectively. The prevalence of osteoporosis in these women was 8.6–11.1% at the age of 40–49 and 36.5–40.6% at the age of 50–59 at the lateral spine regions (mLat, Lat, MVD and TVD), and 0.5–3.7% at the age of 40–49 and and 3.9–21.7% at the age of 50–59 years at the other skeletal sites (AP, FN, Troc, Ward’s, RUUD, RU1/3 and RUT). Significant differences were found in the prevalence of osteoporosis between the lateral spine regions and other skeletal sites (p<0.001) at the age of 40–59 years. In summary, we demonstrated significant age-related differences in peak BMD, ABLR and osteoporosis prevalence among various skeletal sites. Our data suggest that the supine lateral spine is the most sensitive site for the diagnosis of osteoporosis, especially in the early menopausal period, although the prevalence of osteoporosis varied with age and with different sites measured. Received: 20 November 2001 / Accepted: 13 February 2002     

Osteoporosis assessment by whole body region vs. site-specific DXA

The ability of regional data from whole body scans to provide an accurate assessment of site-specific BMD, osteoporosis prevalence and fracture risk has not been fully explored. To address these issues, we measured total body (TBBD) and site-specific BMD in an age-stratified population sample of 351 women (21–93 years) and 348 men (22–90 years). We found an excellent correlation between AP lumbar spine and total body lumbar spine subregion BMD (r ²=0.92), but weaker ones for total hip compared to pelvis region (r ²=0.72) or between total wrist and left arm subregion from the whole body scan (r ²=0.83). The error in estimating site-specific BMD from total body regions ranged from 4.3% (lumbar spine) to 11.2% (femoral neck) in women and from 4.9 to 11.1%, respectively, in men. Site-specific versus regional measurements at the lumbar spine and total hip/pelvis provided comparable overall estimates of osteoporosis prevalence, but disagreed on the status of individuals; measurements at whole body regions underestimated osteoporosis as assessed at the femoral neck or total wrist. All measurements were associated with a history of various fractures [age adjusted odds ratios (OR), 1.3 to 2.1 in women and 1.2 to 1.5 in men] and were generally interchangeable, but femoral neck BMD provided the best estimate of osteoporotic fracture risk in women (OR, 2.9; 95% CI, 1.7–5.0). Although there are strong correlations between BMD from dedicated scans of the hip, spine and distal forearm and corresponding regions on the whole body scan, the measurements provide somewhat different estimates of osteoporosis prevalence and fracture risk.     

南京地区成年女性衰老过程中各部位骨密度的变化

目的 探讨南京地区成年女性骨质疏松的患病情况,及衰老过程中各部位骨密度的变化。方法 对南京地区成年女性,20-29岁,共计388人,均排除继发性骨质疏松症,运用双能X线骨密度仪,对所有患者进行腰椎及髋部骨密度测定。结果 1.南京地区成年女性,骨量正常者占33.5%,骨量低下者占48.5%,骨质疏松者占18%;其中绝经前成年女性骨量正常者占52.7%,骨量低下者占47.3%,无骨质疏松患者;绝经后女性骨量正常者占12%,骨量低下者占49.7%,骨质疏松患者占38.3%;2. 20~39岁年轻女性,随年龄增加,各部位骨密度均无明显下降;但自40岁开始至49岁,股骨颈骨密度首先开始下降,而此时腰椎及总髋部骨密度无明显变化;到50岁开始,各部位骨密度均明显下降;其中50~69岁时,腰椎骨密度T值与股骨颈骨密度T值之间的差异消失,但均低于总髋部骨密度T值。结论 1.南京地区年轻女性骨量低下者患病率较高,随年龄增加,绝经后女性骨量低下者进一步增多,且骨质疏松患病率高达38.3%;2.在女性50岁前,股骨颈骨密度下降最早,诊断骨质疏松最敏感,而50岁后,腰椎骨密度与股骨颈骨密度均明显下降,诊断骨质疏松同样敏感。     

Bone mineral density reference norms for Hong Kong Chinese

The aim of this study was to establish bone mineral density (BMD) reference norms for Hong Kong Chinese using Hologic QDR 2000 and 4500 densitometers, and to estimate the prevalence of osteoporosis in the population. Altogether, 4,274 subjects (2,415 females and 1,859 males), aged 9–94 years old, were recruited using a combination of private solicitation and public advertising from schools, community centers, nursing homes, housing estates, and the general community in Hong Kong. Among females, BMD increased by 20% at the total hip and 48% at the lumbar spine between ages 10 and 20 but remained essentially constant between ages 20 and 40. Between ages 40 and 70, BMD declined by 17% at the total hip and 23% at the spine. Total hip BMD continued to drop after age 70 but little change in spine BMD was observed. Among males, BMD increased by 45% at the total hip and 77% at the spine between age 10 and 30. Between ages 30 and 80, total hip BMD decreased by 20%. Lumbar spine BMD decrease was milder, showing a loss of 4% between ages 30 to 50 and remaining relatively constant afterwards. The prevalence of osteoporosis was consistently overestimated when using Hologic-supplied Caucasian cutoffs as compared with local Chinese cutoffs. The prevalence of osteoporosis among Chinese women 50 years or older was 37% and 16% at the spine and total hip, respectively, while that among Chinese men 50 years or older was 7% and 6% at the spine and total hip, respectively. Prior studies have been limited by size or restricted to women. This study represents the largest sample of Hong Kong Chinese amassed to date, provides continuous BMD reference values from ages 10 to 85 for both women and men, and yields more reliable estimates of the prevalence of osteoporosis for the population.     

Instant Vertebral Assessment: A Noninvasive Dual X-ray Absorptiometry Technique to Avoid Misclassification and Clinical Mismanagement of Osteoporosis

The presence of a vertebral fracture significantly increases the risk of future fracture, classifies a patient with "clinical" osteoporosis, and usually results in treatment for osteoporosis. However, the majority of vertebral fractures are silent, and lateral X-rays (the standard method for identification) are not routinely obtained. Instant vertebral assessment (IVA), a technology that utilizes dual X-ray absorptiometry (DXA), provides rapid assessment of vertebral fractures and is highly correlated with vertebral fractures, as assessed on standard lateral spine X-rays. To assess the role of IVA in patient management, we examined standard bone mineral density (BMD) of the spine, total hip, and femoral neck and spine IVA by DXA in 482 participants screened for an osteoporosis study, who had no previous knowledge of vertebral fractures. Using World Health Organization (WHO) guidelines, subjects were classified using BMD at the spine, total hip, femoral neck, or any combination of these central sites. In addition, we considered subjects as osteoporotic if they had vertebral fractures independent of low bone density. We found that vertebral fractures assessed by IVA were present in 18.3% of asymptomatic postmenopausal women recruited for this study. The sensitivity of BMD alone to diagnose osteoporosis based on either a vertebral fracture or low BMD using WHO criteria ranged from 40 to 74%. This means that between 26 and 60% of osteoporotic individuals could have potentially been missed. Furthermore, 11.0-18.7% of clinically osteoporotic individuals would have been classified as normal by BMD criteria alone. We conclude that IVA is a useful adjunct in the clinical identification of osteoporosis and may prevent mismanagement of osteoporotic patients.     

中国长沙地区女性多骨骼部位骨密度参考值横断面调查

目的 横断面调查中国长沙地区女性多骨骼部位骨密度（BMD）随年龄的变化，建立诊断骨质疏松症（OP）参考数据库。方法 用DXA QDR－4500A型扇形束骨密度仪测定2702例5－96岁女性腰椎前后位（AP）和仰卧侧位、髋部及前臂38个不同区域的BMD。结果 按每5岁年龄分组分析的结果显示，38个不同骨骼区域的峰值BMD分别出现在20－24岁至40－44岁之间，其中髋部（股骨颈除外）最早（20－24岁），前臂（超远端除外）最晚（40－44岁）。结论 不同骨骼区域峰值BMD出现的年龄各异。