骨密度影像学测量与椎体骨折率评估结合提高骨质疏松的诊断率

摘要

背景：临床上用于诊断骨质疏松症的通用指标：脆性骨折或骨密度 T ≤-2.5标准差，只要满足一个条件即可作出骨质疏松的诊断。在做骨密度检查时同时进行椎体骨折评估，可以避免单一因素的评判造成骨质疏松症的漏诊，有利于提高骨质疏松的诊断率。　　目的：评估骨密度结合椎体骨折对骨质疏松症临床诊断率的影响。　　方法：对217例年龄≥50岁的绝经后女性患者行髋部骨密度检测，同时进行椎体骨折评估，比较单纯依靠骨密度检查与骨密度结合椎体骨折评估对骨质疏松的诊断率的影响，同时探讨骨密度对椎体骨折率的影响。　　结果与结论：92例骨密度T ≤-2.5，达到骨质疏松诊断阈值，占42.4%；102例骨密度-1> T >-2.5，为低骨量，占47.0%；23例骨密度在正常范围，骨密度T>-1，占10.6%。158例无椎体骨折；59例(27.2%)椎体骨折，101个骨折椎。骨密度T>-2.5的患者椎体骨折率为21.6%，骨密度T ≤-2.5的患者椎体骨折率34.8%，两组骨折率比较差异有显著性意义(P <0.05)；骨密度结合椎体骨折评估的骨质疏松诊断率为54.8%，比单纯依靠骨密度检查，骨质疏松诊断率提高12.4%(P=0.01)。说明绝经后女性做骨密度检测的同时进行椎体骨折评估可以提高骨质疏松的诊断率。%BACKGROUND:The diagnosis of osteoporosis depends upon the bone mineral density T-score of ≤ -2.5 standard deviation or brittle fractures. Bone mineral density measurement combined with vertebral fracture assessment might prevent the missed diagnosis of osteoporosis due to bone mineral density evaluation alone, and improve the diagnosis rate of osteoporosis. OBJECTIVE:To evaluate the effect of bone mineral density measurements combined with vertebral fracture assessment for the diagnosis of osteoporosis. METHODS:Bone mineral density measurements of proximal femur and vertebral fracture assessment for lateral thoraco-lumbar images were consecutively done for 217 postmenopausal women who aged ≥ 50 years. The rate of osteoporosis diagnosed with bone mineral density T score was compared with that diagnosed with bone mineral density combined with vertebral fracture assessment. The effects of bone mineral density on the vertebral fracture were analyzed. RESULTS AND CONCLUSION:92 (42.4%) patients had bone mineral density T score ≤ -2.5, which met the threshold for diagnosis of osteoporosis. 102 (47.0%) patients had osteopanic (-1>T>-2.5) and 23 (10.6%) had normal range of bone mineral density. 158 patients had no vertebral fractures and 59 (27.2%) patients had 101 vertebral fractures. The vertebral fracture rate was 21.6%in the patients with bone mineral density T> -2.5 and 34.8%in the patients with bone mineral density T ≤ -2.5, with significant differences (P<0.05). Bone mineral density in combination with vertebral fracture assessment for the diagnosis rate of osteoporosis was up to 54.8%, which was significantly higher than the rate diagnosed with only bone mineral density (12.4%;P=0.01). Bone mineral density measurement combined with vertebral fracture assessment improves the diagnosis of osteoporosis for postmenopausal women.