骨质疏松症诊断标准的探讨

本文目的是再次讨论骨质疏松的诊断标准问题。骨质疏松症的诊断以骨密度DXA检测为金标准。1994年世界卫生组织(WHO)推荐的骨质疏松诊断标准为:患者骨密度低于同性别人群峰值骨量均值2.5个标准差以上,或减少30%以上。这个标准的T值是根据年轻白人妇女计算的,但是对于不同地区是不能固守这一标准的。有研究调查我国部分地区骨质疏松症总患病率为32.3%(2.0SD)和14.9%(2.5SD),2种骨密度诊断标准计算骨质疏松症患病率差异有显著性,若以2.5SD为标准很可能造成漏诊。该研究者还发现骨质疏松症的患病率在老年远高于年轻人。而WHO采用的是白人年轻女性的数据库,它是否适用就更值得推敲。另有研究者以骨密度低于-2.0SD标准,推算杭州市妇女骨质疏松的发病率为29.5%。认为以-2.0SD为标准可以相对早期发现骨质疏松。还有研究对于高原的藏族人群进行检测,也得出同样结论。有研究者推算我国各个DXA仪器之间的换算公式,发现上述换算公式基本上与日本推出的相同,但是与美国推出的换算公式有差异。这都证明WHO骨密度诊断标准是否适用于黄种人是有疑问的。国内有研究者以BMD-2.0SD为诊断标准,结合以骨代谢生化指标,认为能全面合理评价骨转换。还有研究者对目前国内使用骨密度检测方法进行统计分析,发现60岁骨量丢失率有18%左右,70岁阶段达到22%左右。这个患病百分率比较符合中国人的实际情况。按照世界上基本通用的换算方法,1.0SD约等于10%～12%的骨量丢失百分率,因此建议男性骨质疏松诊断标准为骨量丢失率达到25%或2.0SD,实际诊断年龄在70岁以上。如果采用2.5SD,中国人患病诊断时间会推迟到70岁以后,尤其是男性要推迟到90岁以后。骨质疏松症的研究关键是正确合理的诊断,不同种族、不同国家或地区有不同的诊断标准。1994年以前全世界都执行WHO1985年提出的峰值骨量丢失2.0个标准差诊断为骨质疏松症。1994年WHO提出了白人妇女小于-2.5SD为骨质疏松,但也明确指出该标准仅适用于欧美白人妇女。以Orimo为首的日本骨代谢学会制定了日本人群的骨质疏松诊断标准:骨密度在同性别青年人平均值30%以下为骨质疏松,丢失20%～30%为骨量减少。1999年中国老年学学会骨质疏松委员会诊断学组建议骨质疏松的诊断标准为骨量丢失百分率达到25%,或者说2.0SD。对于国外也有学者倾向于采用-2.0SD的标准来评价骨质疏松症。有研究发现不同国家间,和每国内部不同人群和人种的骨密度是明显不同的。非洲和拉丁美洲人种的骨密度高于白种人,而白种人的骨密度则高于黄种人。总结:1、国内外人群间骨密度的差异是公认的,我国人群骨密度是低于制定国际标准的白种人的,有倾向以T值低于-2.0SD为骨密度诊断标准。但是大规模的流行病学调查比较研究还很少,有必要进一步提供更确切的骨质疏松诊断更改的流行病学依据。2、以2.0SD为标准可以减少骨质疏松的漏诊,对于流行病学人群调查筛选病例,进行危险因素分析和对骨质疏松高危人群进行干预实验尤为有必要。3、如果加强国内和国际间多单位的联合研究,可以提高标准制定的科学性和权威性。     

中国人骨质疏松症诊断标准专家共识（第三稿• 2014版）

中国老年学学会骨质疏松委员会组织专家在2000年第二稿的基础上,复习了近年来国际国内在骨质疏松症诊断方面的研究进展,结合中国人群特点和中国骨质疏松症防治实际情况,制定本共识为各级医疗机构开展骨质疏松症诊疗工作提供参考。骨密度测量在骨质疏松症诊断中有重要作用,可以参照WHO-2.5 SD的标准,也可以根据中国人群的实际情况采用中国老年学学会骨质疏松委员会(OCCGS)建议的-2.0SD或者骨量下降25%作为诊断标准。并提出了在使用DXA骨密度诊断时需要注意DXA的局限性,避免漏诊。根据近年来定量CT研究的成果,首次在共识中建议采用国际临床骨密度学会(ISCD)和美国放射学院(ACR)推荐的腰椎QCT骨密度低于80 mg/cm3作为骨质疏松的诊断标准。首次建议在骨质疏松诊断中的FRAX应用。脆性骨折作为骨质疏松症诊断标准的重要性,并推荐综合影像检查诊断脆性骨折和鉴别诊断。强调了骨生化检查的作用。     

骨量丢失率在骨质疏松症诊断中的价值

在原发性骨质疏松症的诊断中，骨密度测量占有重要地位，WHO提出的骨密度与同性别健康人的峰值骨密度相比，低于2，5个标准差就可诊断为骨质疏松症的诊断标准已被广泛应用。刘忠厚则结合国人的特点推荐2．0个标准差作为诊断标准。由于不同种族、不同地域、不同方法(仪器、测量部位)骨密度测量结果有很大差异，各实验室都需建立自己的正常值。在     

《WHO人类精液检查与处理实验室手册》第5版与第4版精子形态评估标准的比较研究

目的:比较《WHO人类精液检查与处理实验室手册》第5版与第4版(以下称《WHO5》、《WHO4》)精子形态评估标准的差异,了解《WHO5》对精子形态评估标准的变化。方法:由浙江省人类精子库9名工作人员分别用《WHO5》与《WHO4》精子形态评估标准,对96张精子形态照片共计1 000个精子进行形态评估。结果:用《WHO5》标准评估的形态正常精子百分率[(26.50±5.06)%]高于用《WHO4》标准的评估[(11.39±3.17)%],差异有显著性(P<0.05);用《WHO5》标准评估的头部异常率[(64.26±7.66)%]及尾部异常率[(10.92±2.03)%]较《WHO4》[(76.11±8.13)%、(39.89±3.85)%]更低,差异有显著性(P<0.05),颈和中段异常率及过量残留胞质差异无显著性[分别为(16.46±3.08)%vs(15.22±3.51)%、(4.24±1.66)%vs(3.87±1.68)%,P>0.05]。结论:《WHO5》精子形态总体评估标准不如《WHO4》的评估标准严格,形态正常精子百分率更高。     

中国人群定量CT（QCT）脊柱骨密度正常参考值的建立和骨质疏松症QCT诊断标准的验证

目的本研究的目的是建立中国人群定量CT腰椎骨密度正常参考值和验证国际定量CT脊柱骨密度骨质疏松症诊断标准是否适合中国人群。方法本研究采用了3个人群:①全国多中心20～40岁正常青年人群1584例;②年龄40～83岁,总共3420例社区健康人群;③因骨质疏松性脊柱骨折而就诊的432例骨折人群。腰椎骨密度采用美国Mindways的定量CT系统,测量腰椎第1～2椎体骨密度(如果有骨折椎体则测量临近的一个椎体),取平均值。采用国际定量CT腰椎骨密度骨质疏松症诊断标准,即腰椎骨密度120 mg/cm~3为正常,80～120 mg/cm~3为低骨量,80 mg/cm~3为骨质疏松症。社区健康人群采用脊柱侧位定位像,由有经验的骨放射医师根据Genant椎体骨折半定量分析法对胸4～腰4每个椎体分别判断为正常(0),轻度(1),中度(2)和重度(3)骨折。每个个体只要有一个椎体≥1,判断为骨折,每个个体椎体骨折的最高值作为该个体的骨折严重程度。脊柱骨折人群均有X线,CT和/或MR检查至少有一个椎体明确骨折。采用SPSS 19.0进行统计分析。计量数据进行正态分布检验,如果符合正态分布,以均数标准差表示。结果 20～40岁正常青年人的腰椎骨密度男性为(163.26±28.82)mg/cm~3,比女性(174.45±29.24)mg/cm~3低,P0.001。50岁开始,一直到80岁,女性骨密度比男性低(P0.05)。40～83岁正常社区人群以国际骨质疏松症定量CT诊断标准,人群33.2%为骨密度正常(120 mg/cm~3),38.3%为低骨量(80～120 mg/cm~3),28.5%为骨质疏松(80 mg/cm~3)。其椎体骨折的患病率分别为7.14%,14.6%和30.63%,呈倍比关系。432例确诊的脊柱骨折患者,86%脊柱定量CT骨密度低于80 mg/cm~3,其余14%骨密度在低骨量范围。结论建立了中国人群定量CT腰椎骨密度正常参考值,为定量CT的临床应用提供依据;研究结果表明国际定量CT腰椎骨质疏松症诊断标准适合中国人群,可以用于中国人群的定量CT诊断。     

骨密度与体积骨密度诊断腰椎、股骨颈骨质疏松效果比较研究

目的通过流行病学调查比较面积骨密度(areal bone mineral density,aBMD)和体积骨密度(volumetric BMD,vBMD)对骨质疏松的检出率,从而探索出针对大骨骼和小骨骼人群骨质疏松诊断的校正诊断方法。方法采用GE-Lunar DPX双能X线吸收法骨密度测量仪测量腰椎和股骨颈骨密度,将仪器给的投影面积(cm~2)通过正方体数学模式(腰椎)和圆柱体数学模式(股骨颈)分别获得骨体积和vBMD(vBMD=骨矿物含量/骨体积),按世界卫生组织推荐20～39岁的aBMD和vBMD的标准差生成的T值定义正常、骨量减低和骨质疏松,骨质疏松诊断用世界卫生组织确立的T值诊断法。结果腰椎和股骨颈vBMD诊断骨质疏松症避免了aBMD引起的小骨误诊两部位分别为16%和11.6%,大骨漏诊在两部位分别为7%和18%。腰椎骨体积每小于均值10 cm~3,其aBMD的误诊率为1%;每大于均值10 cm~3,漏诊率为0.44%。股骨颈骨体积每小于均值1.0 cm~3,aBMD的误诊率为2.6%;每大于均值1.0 cm~3,漏诊率为4%。结论诊断骨质疏松用vBMD可以避免aBMD引起的大骨漏诊和小骨误诊的弊病。     

不同峰值骨量对诊断青岛地区成年女性骨质疏松敏感性的比较

目的 比较青岛地区正常汉族成年女性峰值骨密度(PBMD)数据库与骨密度仪自身所应用数据库差异,以及对骨质疏松症(OP)诊断的影响.方法 应用法国DMS公司CHALLENGER型双能X线骨密度仪(DXA)对青岛地区汉族人868例25～83岁女性居民进行腰椎(L_2-L_4)部位和左侧髋部(股骨颈、大转子、Wards三角区)6个骨骼区域的BMD.统计分析获得本地区正常汉族人女性骨密度(BMD)数据库,将其PBMD及标准差与法国CHALLENGER型DXA骨密度仪所应用数据库的PBMD及标准差进行比较分析,并分别用两组数据库对191例脆性骨折患者进行诊断,观察两者诊断阳性率的差异.结果 青岛地区汉族人群6个骨骼区域BMD随年龄变化,不同部位骨峰值出现的时间不同,腰椎在25～29岁,髋部在40～44岁,其骨密度峰值骨量高于法国DMS公司CHALLENGER型DXA的峰值骨量,两个数据库的标准差无明显差异.应用本地区正常汉族人女性BMD数据库可提高对脆性骨折患者骨质疏松的诊断率约50%.结论 通过建立青岛地区汉族人群女性的骨密度数据库,确立青岛地区PBMD标准,与仪器PBMD比较显著提高了本地区汉族人群女性的骨质疏松症诊断准确率.     

重庆市人类精子库捐精志愿者精液质量分析

目的:了解重庆市人类精子库捐精志愿者精液质量,探讨年龄对精液质量的影响。方法:收集重庆市人类精子库899例捐精志愿者精液样本,根据年龄分为5组:22~25岁、26~30岁、31~35岁、36~40岁、40岁,使用Makler板人工计数,分别进行精液体积(ml)、前向运动(PR)精子百分率(PR%)、精子总活力[(PR+NP)%]、精子浓度、精子总数及正常形态精子百分率检测,并与世界卫生组织《人类精液检查与处理实验室手册》第5版(以下简称WHO第5版)的参考值进行比较;各年龄段的精液参数指标采用中位数表示,比较精液质量差异。结果:899例捐精志愿者精液参数第5百分位数精液体积(1.8 ml)、精子浓度(25.0×10~6/ml)、精子总数(100.7×106)和正常形态精子百分率(4.3%)均高于WHO第5版第5百分位数参考值,PR%(31.0%)、(PR+NP)%(38.0%)低于WHO第5版第5百分位数参考值;精液参数中位数精液体积(4.0 ml)、精子浓度(88.0×10~6/ml)、精子总数(333.7×106)高于WHO第5版中位数参考值,正常形态精子百分率(11.6%)低于WHO第5版中位数参考值,PR%(55.0%)和(PR+NP)%(61.0%)与WHO第5版中位数参考值一致。精子浓度在22~25岁、26~30岁、31~35岁、36~40岁、40岁年龄组分别为88.0(1.0~270.0)×10~6/ml、96.0(5.0~335.0)×10~6/ml、100.0(3.0~200.0)×10~6/ml、105.0(15.0~225.0)×10~6/ml、90.0(22.0~159.0)×10~6/ml,在各年龄组间有显著性差异(P0.05),精液体积、PR%、(PR+NP)%、精子总数和正常形态精子百分率在各年龄组间无显著性差异(P0.05)。结论:重庆市人类精子库捐精志愿者精液质量普遍较好。随着年龄的增长,精子浓度呈显著性升高,但40岁以后精子浓度呈显著性下降。     

女性腰椎投影骨面积对骨密度及骨质疏松诊断的影响

目的观察健康女性腰椎投影骨面积(projective bone area,BA)对面积骨密度(areal bonemineral density,aBMD)和骨质疏松(osteoporosis,OP)诊断的影响。方法 1.成都地区健康女性824例,年龄20～80岁,用GE LUNAR公司生产的EXPERT-XL双能X线骨密度仪,测定腰椎正位1-4投射骨面积(BA)、骨矿物含量(bone mineral content,BMC)、面积骨密度(aBMD)。按照WHO推荐的诊断标准:aBMD低于峰值骨2.5个标准差为OP。2.按年龄分为20～39岁、40～59岁、60～80岁3个年龄组。各年龄组按BA大小分成大(large BA group,LBAG)、中(intermediate BA group,IBAG)、小(small BA group,SBAG)3组。3.统计学处理:用SPSS13.0统计软件,BA与BMC和aBMD的相关性用pearson相关分析;不同年龄组不同BA组腰椎BMC、aBMD比较用方差分析,OP检出率差异比较用卡方检验。结果 1.BA与BMC(r=0.768P0.01)和aBMD呈正相关(r=0.171P0.01);2.20～39岁、40～59岁、60～80岁不同BA组BMC、BMD比较均为:LBAGIBAGSBAG,差异有统计学意义(P0.05)。3.20～39岁不同BA组均无OP检出;40～59岁LBAG、IBAG、SBAG组OP检出率分别为:5.0%、13.5%、18.9%,BA越大,OP检出率越低,差异有统计学意义(P0.05);60～80岁LBAG、IBAG、SBAG组OP检出率分别为:45.2%、55.8%、64.3%,BA越大,OP检出率越低,差异有统计学意义(P0.05)。结论成都地区健康女性腰椎BA大者aBMD、BMC较高,OP检出率较低;反之腰椎BA小者,aBMD、BMC较低,OP检出率高。女性40岁后应注意骨质疏松防治。     

CTR基因多态性与老年男性骨质疏松的相关性研究

目的探讨降钙素受体基因(calcitonin receptor,CTR)C1377T基因多态性与老年男性人群骨质疏松的相关性。方法前瞻性收集2014年8月至2015年8月在河北医科大学第三医院门诊就诊及住院患者中无亲缘关系且符合纳入及排除标准的老年男性220例,按照骨质疏松诊断标准分为骨质疏松症组(n=116)和非骨质疏松症组(n=104)。用聚合酶链反应限制性片段长度多态性技术检测其CTR基因多态性,并测量骨质疏松症组患者的跟骨定量超声参数:超声振幅衰减(broadband ultrasound attenuation,BUA)、超声声速(speed of sound,SOS)及刚度(systems technologies inc,STI)。通过比较两组人群中CTR基因型频率,并分析CTR基因型与跟骨定量超声参数之间的关系,探讨CTR基因多态性与老年男性骨质疏松症的相互关系。结果骨质疏松症组CTR基因型CC型占81.00%,CT型占19.00%;非骨质疏松症组C C型占7 2.1 0%,C T型占27.90%,两组比较差异无统计学意义(χ~2=2.450,P=0.118);骨质疏松症组C等位基因占90.52%,T等位基因占9.48%;非骨质疏松症组C等位基因占86.06%,T等位基因占13.94%,两组比较差异无统计学意义(χ~2=2.128,P=0.145)。但骨质疏松症患者CT基因型组的BUA、SOS和STI均明显高于CC基因型组,差异有统计学意义(P0.05)。结论 CTR基因多态性不是影响骨质疏松发病的重要因素,但CTR基因型和定量超声参数所反映的骨密度、骨强度和骨的结构等指标均有一定相关性。     

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。     

Determination of age-specific bone mineral density and comparison of diagnosis and prevalence of primary osteoporosis in Chinese women based on both Chinese and World Health Organization criteria

The aim of this study was to determine age-specific bone mineral density (BMD) at various skeletal regions in a native Chinese reference population, and to explore the differences in the diagnosis of primary osteoporosis and estimated prevalence of osteoporosis based on both Chinese criteria (BMD of subjects, 25% lower than the peak BMD) and WHO criteria (BMD of subjects, 2.5 SD [T-score –2.5] lower than the young adult mean [YAM]). There were 3406 subjects in our female reference population, ranging in age from 10 to 90 years. A dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) was used to measure the BMD in subjects at the posteroanterior (PA) spine (L1–L4), supine lateral spine (L2–L4 including areal BMD [aBMD] and volumetric BMD [vBMD]), hip (including femoral neck and total hip), and radius + ulna ultradistal (R + UUD) of the forearm. Cross-sectional data analysis in stratified 5-year age intervals revealed that the peak BMD (PBMD) at various skeletal regions occurred within the age range of 30–44 years, with PBMD at the lateral spine and femoral neck occurring at 30–34 years, posteroanterior spine and total hip at 35–39 years, and ultradistal forearm at 35–44 years. The reference values of BMD (PBMD) calculated using Chinese criteria for the diagnosis of primary osteoporosis were significantly higher than the young adult mean (YAM) using WHO criteria for all skeletal regions except for the total hip, at a range of 0.9%–3.8% higher. The BMD cutoff values using Chinese criteria for the diagnosis of osteoporosis were 3.7%–10.9% higher than those using WHO criteria for various skeletal regions. The prevalence rate of primary osteoporosis according to Chinese criteria in subjects ranging from 50 to 90 years was 41.5% at the PA spine, 53.9% at the lateral spine, 34.2% at the femoral neck, 30.7% for total hip, and 51.4% at R + UUD; while according to WHO criteria, this rate was 32.1% at the PA spine, 34.9% at the lateral spine, 16.3% at the femoral neck, 18.9% for total hip, and 45.2% at R + UUD. The prevalence of primary osteoporosis according to both criteria varied with the age and skeletal region of the subjects. The prevalence of primary osteoporosis using Chinese criteria, compared with WHO criteria was 31% higher at the lumbar spine, 109% higher at the femoral neck, and 14% higher at the ultradistal forearm. In conclusion, PBMD occurs in the age range of 30–44 years in native Chinese females. The BMD reference values, BMD cutoff values, and prevalence of primary osteoporosis determined by Chinese criteria are all higher than those determined by the WHO criteria; thus, the application of Chinese criteria may overestimate the number of patients with primary osteoporosis.     

Classification of osteoporosis based on bone mineral densities.

In this article we examine the role of bone mineral density (BMD) in the diagnosis of osteoporosis. Using information from 7671 women in the Study of Osteoporotic Fractures (SOF) with BMD measurements at the proximal femur, lumbar spine, forearm, and calcaneus, we examine three models with differing criteria for the diagnosis of osteoporosis. Model 1 is based on the World Health Organization (WHO) criteria using a T score of -2.5 relative to the manufacturers' young normative data aged 20-29 years, with modifications using information from the Third National Health and Nutrition Examination Survey (NHANES). Model 2 uses a T score of -1 relative to women aged 65 years at the baseline of the SOF population. Model 3 classifies women as osteoporotic if their estimated osteoporotic fracture risk (spine and/or hip) based on age and BMD is above 14.6%. We compare the agreement in osteoporosis classification according to the different BMD measurements for the three models. We also consider whether reporting additional BMD parameters at the femur or forearm improves risk assessment for osteoporotic fractures. We observe that using the WHO criteria with the manufacturers' normative data results in very inconsistent diagnoses. Only 25% of subjects are consistently diagnosed by all of the eight BMD variables. Such inconsistency is reduced by using a common elderly normative population as in model 2, in which case 50% of the subjects are consistently diagnosed as osteoporotic by all of the eight diagnostic methods. Risk-based diagnostic criteria as in model 3 improve consistency substantially to 68%. Combining the results of BMD assessments at more than one region of interest (ROI) from a single scan significantly increases prediction of hip and/or spine fracture risk and elevates the relative risk with increasing number of low BMD subregions. We conclude that standardization of normative data, perhaps referenced to an older population, may be necessary when applying T scores as diagnostic criteria in patient management. A risk-based osteoporosis classification does not depend on the manufacturers' reference data and may be more consistent and efficient for patient diagnosis.     

Assessment of bone structure in renal transplant recipients: comparison of phalangeal qualitative ultrasound and dual x-ray absorptiometry

According to the WHO criteria many renal transplant patients display osteopenia or osteoporosis. Dual-energy X-ray absorptiometry (DXA), the standard method to assess bone mineral density (BMD), is not always available. Quantitative ultrasound (QUS) of the phalanx is an inexpensive, mobile, and radiation-free diagnostic alternative. Few data address the correlation of this method with DXA in renal transplant patients. This study assessed the value of QUS compared with DXA to detect changes in bone structure among renal transplant recipients. This cross-sectional study of 42 patients (22 women), of mean age 40.2 +/- 11.9 years, mean time since transplantation of 2.8 +/- 2.9 years, and mean dialysis time of 8.55 +/- 10.26 months, included. DXA for bone mineral densitometry of the hip (neck and total femur) and spine as well as QUS to measure the amplitude-dependent speed of sound (Ad-SOS) in the phalanx. Using DXA, osteoporosis was observed in 19% of all patients: 9.5% in femoral neck, 9.5% in total region of the femur, and 9.5% in the spinal region. The sensitivity of Ad-SOS for osteoporosis diagnosis in the above regions were 100%, 75%, and 25%, respectively; its specificity was 45%, 43%, and 37%, respectively. There was no significant relation between the two methods for diagnosis of osteoporosis in any region. QUS of phalanx can be recommended for osteoporosis screening in renal transplant patients. Those suspected of osteoporosis should be examined by additional DXA measurements in order to establish the diagnosis.     

DXA椎体骨折评价在骨质疏松诊断中的意义

目的比较双能X线骨密度仪的椎体骨折评价(vertebral fracture assessment,VFA)中Genant半定量法和6点定量法对椎体压缩诊断的差异,探讨联合应用VFA在骨质疏松诊断中的意义。方法对85名主诉有腰背痛或身高变矮的患者行骨密度检查(男12例,女73例),平均年龄68.1±10.4岁;女性绝经年龄49.4±3.4岁。同时应用VFA软件分析椎体是否存在压缩,分别采用Genant半定量法和6点定量法进行分析。结果骨密度采用世界卫生组织(WHO)诊断标准,诊断骨质疏松66人,低骨量14人,5人骨量正常,骨质疏松诊断率为77.65%。采用Genant半定量法判断椎体Ⅰ~Ⅲ度压缩76人,6点定量法判断椎体压缩64人,两种方法的椎体压缩诊断率有差异(P0.01),两种方法的Ⅱ、Ⅲ度椎体压缩的诊断率无差异(P0.05)。6例通过骨密度T值诊断的非骨质疏松患者用VFA分析诊断有椎体骨折(压缩Ⅱ~Ⅲ度),应用T值联合VFA椎体压缩Ⅱ~Ⅲ度诊断的骨质疏松率为84.71%,与单独使用T值相比诊断率有差异(P0.05)。结论使用双能X线骨密度仪进行椎体骨折评价时,Genant半定量法和6点定量法对椎体压缩程度为Ⅱ、Ⅲ度的诊断率无差异、一致性好。骨密度检查时联合行VFA可增加骨质疏松的诊断率。     

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.     

Diagnosis of osteoporosis: visual assessment on conventional versus digital radiographs

In many radiological departments conventional radiography has been replaced by digital radiography. Therefore, the purpose of this study was to analyze the visual detection of osteopenia/osteoporosis with both digital and conventional radiographs. In 286 patients we retrospectively evaluated radiographs of the lumbar spine in two planes. One hundred twenty-eight patients had conventional and 158 patients had digital radiographs. Patients with pre-existing vertebral fractures were excluded. Four experienced musculoskeletal radiologists blinded to the values of DXA and to the patients ages assessed independently from each other whether the bone density of the lumbar spines was normal or decreased. The results of dual X-ray absorptiometry served as the standard of reference. The threshold value for the diagnosis of osteopenia was a T-score less than –1 SD according to the WHO classification of osteoporosis. Sensitivity/specificity was 86%/36% for conventional and 72%/47% for digital radiographs. The overall diagnostic accuracy was 68% for conventional and 64% for digital radiographs. Eighty percent of the patients with osteopenia and 96% of the patients with osteoporosis were correctly assessed as true positive on conventional radiographs and 65% (osteopenia) and 82% (osteoporosis) on digital radiographs. Interobserver agreement was markedly lower for digital (35%) than for conventional radiographs (73%). However, the differences were not statistically significant. There is no major difference in diagnostic accuracy in the assessment of osteopenia/osteoporosis using digital and conventional radiographs, respectively. However, the high interobserver variance on digital radiographs indicates that visual assessment of osteoporosis/osteopenia is problematic, which may be due to image processing and postprocessing algorithms that manipulate the visual aspect of bone density.     

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     

兰州地区成年人群骨密度调查

目的：通过测量兰州地区成年人骨密度（Bone mineral density,BMD),获得该地区成年人骨密度状况及骨质疏松（Osteoprosis,OP)患病率,为预防和诊断骨质疏松提供科学依据。方法：对长期居住在本地区20岁以上的人群进行随机抽样,抽取样本996人,准确记录其性别和年龄,使用德国Siemens公司Somatom,AR.C型CT机及相应QCT标准软件测量受试L1－L4的BMD,然后进行统计分析。结果：随年龄增加男女两性别BMD均逐渐下降,同龄男性BMD高于女性BMD。骨质疏松患病率随年龄增加而上升,尤以50岁组女性增加最明显。兰州地区骨质疏松患病率高于北京等地。结论：兰州地处西部高原,人群牛奶平均摄入量较低,骨质疏松知识缺乏,需加强营养（特别是牛奶的摄入量）和锻炼,增加户外活动以及普及骨质疏松知识。