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。     

兰州市城关区中老年人群骨质疏松症三种诊断标准的检出率比较

目的比较骨质疏松症的国际卫生组织(WHO)诊断标准、中国老年学学会骨质疏松委员会(OCCGS)标准差诊断标准及骨量丢失百分率诊断标准在兰州市城关区中老年人群中应用的异同。方法采取多阶段整群分层随机抽样方法抽取城关区年龄在50岁以上的社区人员2500人进行问卷调查,分别应用WHO标准、OCCGS(标准差)标准与OCCGS(百分率)标准,比较原发性骨质疏松症(POP)的检出率及诊断的一致性。结果 WHO标准、OCCGS(标准差)标准和OCCGS(百分率)标准的POP检出率分别为13.89%、25.65%和45.32%。WHO标准与OCCGS(标准差)标准、WHO标准与OCCGS(百分率)标准以及OCCGS(标准差)标准与OCCGS(百分率)标准的检出POP一致率分别为13.89%、13.69%和25.44%。WHO标准和OCCGS(标准差)标准呈高度一致,OCCGS(标准差)标准和OCCGS(百分率)标准呈中度一致,WHO标准和OCCGS(百分率)标准呈低度一致。结论三种诊断标准在诊断POP上存在差异,建议对兰州市人群骨质疏松症的诊断采用OCCGS诊断标准。     

绝经后妇女膝关节骨性关节炎骨密度的临床研究

目的 通过测量膝关节骨性关节炎患者桡骨远端和跟骨骨密度,探讨膝关节骨性关节炎患者骨密度的特征及膝关节骨性关节炎与骨质疏松症的关系.方法 对100例绝经后妇女膝关节骨性关节炎患者分别测量桡骨远端和跟骨的骨密度.所有患者均按kellgren分级标准对膝关节进行评分.结果 绝经后妇女膝关节骨性关节炎患者桡骨远端和跟骨的骨密度值随kellgren分级级数的增高差异无显著性.以低于同性别同部位峰值骨量的2.0 SD为骨质疏松诊断标准,桡骨远端和跟骨符合骨质疏松症诊断率分别为51%和46%.桡骨远端骨密度与体重指数的相关系数为0.3630(P<0.01).结论 绝经后妇女膝关节骨性关节炎患者伴发骨质疏松症的比例较高,且随年龄增高有不断增高的趋势.膝关节骨性关节炎患者的骨密度与体重指数呈正相关.     

中国人骨质疏松症诊断标准回顾性研究

目的　通过对既往国内文献复习 ,提出一种更方便、更科学的中国人骨质疏松症诊断标准。方法　检索国内期刊数据库中已发表的文献 ,摘录骨密度丢失率数据进行统计、计算、分析 ,得到不同年龄段、不同作者、使用不同型号仪器、不同部位的骨密度丢失百分率及相关曲线。结果　中国男性骨质疏松诊断标准推荐使用骨密度丢失百分率 2 5 %或 2SD ;中国女性骨质疏松诊断标准推荐使用骨密度丢失百分率 2 5 %或 2SD ;测量部位推荐使用如下顺序 :股骨颈 >前臂远端 1/ 3、1/ 10、1/ 6 >RA法手指骨 2 ,3,4中节 >股骨Troch区 ;不推荐使用股骨Ward区和腰椎侧位。结论　使用骨密度丢失百分率这个指标作为中国人骨质疏松症诊断标准非常有意义 ,值得进一步推广和深入研究。     

QCT椎体骨密度测定诊断骨质疏松症

目的 探讨定量CT(QCT)椎体骨密度(BMD)测定在诊断骨质疏松症中的临床价值和诊断标准.方法 对53例健康无症状中老年人和68例临床拟诊骨质疏松患者进行L1-L4椎体BMD测定.结果 健康中老年人BMD随年龄增长而明显降低,有显著性差异.以BMD≤x-2.0SD为诊断骨质疏松症标准有68例,且各年龄段的BMD值均明显低于骨量截断值;如以BMD≤x-2.5SD为诊断标准则有60例.结论 QCT诊断骨质疏松症敏感、准确、重复性强,易于推广应用.以BMD≤x-2.0SD为诊断标准,更符合临床实际病例,并能减少漏诊.     

63例QCT腰椎骨骨密度测量与DTX-200双能X前臂骨骨密度测量对比分析

目的 对比同一组检测者,使用DTX-200双能x线骨密度仪测量前臂骨骨密度(hone mineral density,BMD)与QCT测量腰椎骨骨密度的测定结果,发现不同设备,不同部位骨密度测量的差异性和相关性.方法 选取志愿者63例(男性19例,女性43例),分别用DTX-200双能X线骨密度仪测量前臂骨BMD值和T值(n=63),再用QCT测量腰椎骨的BMD值和T值(n=63).分别以QCT测量腰椎骨T值、DTX-200双能X线测量前臂骨T值,进行骨质疏松症诊断(诊断标准1994年WHO制定,T值≥-1.0SD为骨量正常,-2.5SD＜T值＜-1.0SD为骨量减低,T值≤-2.5SD为骨质疏松).用SPSS13.0软件对DTX-200和QCT测量的BMD值和T值,年龄进行相关性分析,对两组骨质疏松诊断结果分别进行一致性分析.结果 两种设备的检测结果BMD均与年龄呈负相关性,相同年龄段QCT测得的BMD较DTX-200测得的BMD要低,40岁以后更为明显,DTX-200与QCT测量的BMD值的相关系数=0.554(P＜0.01),二者骨质疏松症总体诊断符合率为52.4%.结论 DTX-200双能X线测量前臂骨BMD值与QCT测量腰椎骨BMD值密切相关,目前直接使用WHO制定的诊断标准,对QCT与DTX-200的测量结果进行骨质疏松症的诊断是否合适有待进一步探讨,不同的检测设备,不同的检查部位应有不同的诊断标准或换算系数.     

哈尔滨地区中老年人周围骨骨密度的测量状况分析

目的应用DEX200双能X线骨密度仪分析中老年人周围骨骨密度的测量结果。方法所选对象为哈尔滨地区及附近农村、郊区的中老年人,共3432例。年龄范围为40～79岁,每10岁为一个年龄段,分为4组。诊断标准:采用世界卫生组织(WHO)批准的诊断标准:T值≤-2.5标准差(SD)诊断为骨质疏松症;T值≥-1.0SD为骨量正常,-2.5SD相似文献   

建立原发性骨质疏松症诊断标准的原则和方法

建立骨质疏松症诊断标准的实质内容是建立骨密度正常参考值。１９６３年先进的高精度、无创伤的骨密度测量方法问世以来,国外经历了３０年制订一个诊断标准的艰辛历程,证明其难点是认识“把成人一生的骨量当成一个变量的问题”;在此基础上建立的诊断标准应遵守选择对象的同质性、骨密度正常参考值定界的合理性,建立骨密度诊断标准特殊性及流调峰值骨密度的问卷和方法等一系列要求。Ｋａｎｉｓ１９９４年的诊断标准是针对白人妇女的,本文为推动建立适合中国人的骨质疏松诊断标准而作。     

绝经妇女腰椎及髋关节定量cT骨密度测量诊断骨质疏松的初步研究

目的比较绝经后妇女L2-L4椎体及髋关节两个部位的定量CT骨密度（BMD )测量诊断骨 质疏松的效能。方法175例绝经妇女,年龄48-96岁,平均年龄为69 ±9岁。同时QCT测量L2-L4椎体的平均体积骨密度及髋关节类DXA的面积骨密度,右股骨颈和全髋二个感兴趣区（ROI )。 采用国际临床骨密度学会（ISCD )QCT骨质疏松诊断标准（<80 mg/cm3 )和WHO髋关节DXA骨密 度诊断标准即股骨颈或全髋感兴趣区的T值（-2.5 SD )进行骨质疏松诊断。比较二者诊断骨质疏 松的效能。结果175绝经后妇女中,QCT骨密度测量腰椎部位骨密度值骨质疏松的检出率是44%( 77/175 )。如果采用髋部检查股骨颈部位为11%.( 19/175 ),全髋部位为14%.( 24/175 ),或二者任一 部位为18%_( 31/175 )。如果只做腰椎,不做髋关节,有7人漏诊,而如果只做髋关节,不做腰椎会漏 诊44人。结论采用QCT骨密度测量,绝经妇女腰椎检查骨质疏松检出率为44%_,而髋部检查检出 率为18%_。采用QCT骨密度测量,测量腰椎一个部位就可以诊断骨质疏松。     

西藏拉萨地区藏族正常人群骨矿含量分布研究

目的 为了解正常藏族人群骨量分布，确定峰值骨量的年龄段，寻找骨丢失规律，为骨质疏松骨密度诊断标准提供参考依据。方法 选择5∽89岁健康藏族男女681人，20岁以前以5岁为一年龄段，其它以10岁为一年龄段，对男女分别进行分组。用DTX-200(美国OSTEOMETER公司提供)双能X线密度仪，对非优势手臂的远端进行测量，取结果的平均值，数据输入SPSS软件数据库进行统计分析。结果 峰值骨量男女都在30∽39年龄段，以后随年龄增加骨量逐渐减少。男性在60∽69年龄段骨量丢失达17．61％，70∽79年龄段骨量丢失达23．90％；女性在50．59年龄段13．91％。女性60∽69年龄段骨量丢失已达26．48％。结论 应依据不同地区正常人群骨量分布，建立诊断标准，用骨量丢失百分率诊断骨质疏松具有普遍意义。     

The Prevalence of Osteoporosis: Gender and Racial Comparison

Osteoporosis is common among the growing population of older men: almost 20% of men > or = 50 years old have osteoporosis of the hip, spine, or wrist. However, the exact estimate depends on the approach taken to normalize for bone size, the specific skeletal site assessed, and the diagnostic criteria used. Bone mineral density (BMD, g/cm2) by DXA is 12-25% greater in men than women, but bone mineral apparent density (g/cm3) is similar in the two sexes. This correction for skeletal size largely eliminates apparent differences in areal BMD between the races and also reduces the apparent effects on BMD of age. The particular skeletal site that is assessed has an important influence on the prevalence of osteoporosis (sex-specific BMD T-score less than -2.5) in men which varies from 0 to 36%, depending on the site, and from 2% to 45% in postmenopausal women. The discrepancies relate mainly to different patterns of bone loss at the various sites, but estimates are also affected by the specific young normal means and standard deviations (SD) used to calculate the T-scores. A greater mean and smaller SD among normal young men in Rochester, MN produced a higher prevalence of osteoporosis at the femoral neck (22% vs 7%) compared with estimates for white men from the Third National Health and Nutritional Examination Survey; use of female normal values further reduced osteoporosis prevalence at the hip in white, Hispanic, and African-American men to 4%, 2%, and 3%, respectively, compared with 20% for white women in the United States. By contrast, fracture risk is similar for men and women at any given level of BMD. These observations reinforce current efforts to move away from osteoporosis prevalence and toward absolute fracture risk as the main basis for clinical treatment decisions.     

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.     

A reference standard for the description of osteoporosis

In 1994, the World Health Organization published diagnostic criteria for osteoporosis. Since then, many new technologies have been developed for the measurement of bone mineral at multiple skeletal sites. The information provided by each assessment will describe the clinical characteristics, fracture risk and epidemiology of osteoporosis differently. Against this background, there is a need for a reference standard for describing osteoporosis. In the absence of a true gold standard, this paper proposes that the reference standard should be based on bone mineral density (BMD) measurement made at the femoral neck with dual-energy X-ray absorptiometry (DXA). This site has been the most extensively validated, and provides a gradient of fracture risk as high as or higher than that of many other techniques. The recommended reference range is the NHANES III reference database for femoral neck measurements in women aged 20-29 years. A similar cut-off value for femoral neck BMD that is used to define osteoporosis in women can be used for the diagnosis of osteoporosis in men - namely, a value for BMD 2.5 SD or more below the average for young adult women. The adoption of DXA as a reference standard provides a platform on which the performance characteristics of less well established and new methodologies can be compared.     

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.     

老年骨质疏松症诊断标准探讨

本文对老年骨质疏松症骨密度（ＢＭＤ）诊断标准进行深入探讨。以美国Ｌｕｎａｒ公司ＤＰＸ－Ｌ型双能Ｘ线ＢＭＤ测定仪，随机对北京市６０～９４岁７３４名老年人进行ＢＭＤ测定，并分别以同性别、同部位峰值减低２．０及２．５ＳＤ作为骨质疏松症诊断标准进行分析比较。结果：以减低２．５ＳＤ较减低２．５ＳＤ所得骨质疏松症患病率高１倍左右，如以Ｗａｒｄ’ｓ三角为例，男性６０～６９、７０～７９及８０岁以上组，以减低２．０ＳＤ为诊断标准，其患病率各为２５．５％、４７．６％及４８．２％；若以减低２．５ＳＤ为诊断标准其患病率则下降为１０．６％、１９．０％及２３．２％，两者相差１倍以上。结论：若以减低２．５ＳＤ为诊断标准很可能造成一部分骨质疏松症患者被误诊、漏诊。鉴于国人ＢＭＤ峰值较白人低０．５ＳＤ左右，应以峰值减低２．０ＳＤ作为诊断骨质疏松症的标准为宜。     

Misinterpretation of osteodensitometry with high bone density: BMD Z > or = + 2.5 is not "normal".

Osteodensitometry is increasingly used to identify low bone density resulting from osteoporosis. The universally accepted World Health Organization (WHO) criteria for assessing bone mineral density (BMD) contrasts individual T-scores to peak BMD in healthy adult control populations. In this scheme, "osteoporosis" refers arbitrarily to T-values below -2.5, "osteopenia" to values between -1.0 and -2.5, and "normal" to values above -1.0. Although individually rare, numerous conditions cause supranormal BMD in children and adults. Increasingly, elevated BMD is detected by osteodensitometry, especially dual-energy X-ray absorptiometry. Illustrated here, the absence of upper limits for BMD in the WHO criteria jeopardizes recognition of high-BMD disease for all age groups. This oversight requires correction using Z-scores.     

Use of a Swedish T-score reference population for women causes a two-fold increase in the amount of postmenopausal Swedish patients that fulfill the WHO criteria for osteoporosis

The WHO criteria for osteoporosis are based on bone mineral density (BMD) values in comparison to a reference population of healthy young adults. The aim of this study was to create BMD references for ethnic Swedish women, and to investigate whether the use of these T-score measurements influence the amount of Swedish postmenopausal patients that are diagnosed as having osteoporosis. A bone density reference was created by measuring a population-based sample of 335 randomly selected Swedish women aged 20-39yr. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, proximal femur, and total body. These locally derived T-score values were subsequently used to diagnose a sample of 300 consecutive postmenopausal Swedish patients referred to the Uppsala Osteoporosis Unit. There was a slight age-dependent decrease in femoral neck BMD, whereas no age effect was seen at other sites such as total hip, lumbar spine, or total body. This suggests that the cohort represents the steady state BMD at the ages of expected peak bone mass in Swedish women. The correlation between BMD measures at different sites differed from r=0.55 (lumbar spine BMD vs femoral neck BMD [FNBMD]) to r=0.92 (total hip BMD vs FNBMD). Central DXA-generated T-scores were calculated from this cohort, and these were significantly higher (0.3-0.5 SD) as compared with manufacturers and NHANESIII reference populations. This indicates that young Swedish women have a higher peak bone mass than the subjects included in the reference populations currently used for clinical measurements. The T-score in total hip derived from the investigated cohort was subsequently used to diagnose 300 clinical patients (mean age 63yr) referred for a DXA scan by their physicians. The use of this locally established and ethnic representative, T-score reference increased the prevalence of osteoporosis in femoral neck and total hip with 53-106%. A Swedish female BMD reference representing peak bone mass has been established and the normative data are presented. Notably, this cohort has considerably higher BMD as compared to the NHANESIII and manufacturer's reference populations. The use of the present T-score reference therefore causes approximately a 2-fold increase in the amount of Swedish postmenopausal women that fulfill the WHO criteria for osteoporosis. This demonstrates the problems with using T-score as diagnostic threshold for osteoporosis and is an argument for future strategies to obtain standardized densitometric cut-offs, for example, mg/cm(2).     

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。     

The Prevalence of Osteoporosis in Nursing Home Residents

This study describes the prevalence of osteoporosis in a statewide sample of nursing home residents. Composite forearm bone mineral density (BMD) (including the distal radius and the distal ulna) of 1475 residents aged 65 years and older from 34 randomly selected, stratified nursing homes was assessed. BMD was expressed with reference to World Health Organization diagnostic criteria. Trends with age, gender and race were consistent with other populations. However, prevalence estimates were higher than community-based age-specific rates. The prevalence of osteoporosis for white female residents increased from 63.5% for women aged 65–74 years to 85.8% for women over 85 years of age. Only 3% had composite forearm BMD within 1 standard deviation of the young adult mean. The significance of the high prevalence of low BMD in nursing home residents is the increased fracture risk it may confer. In community cohorts of white women, the risk of hip fracture increases approximately 50% for every 1 standard deviation decrease in bone mass. However, the degree to which BMD contributes to fracture risk in this population has not been well established. Received: 26 February 1998 / Accepted: 22 May 1998