老年骨质疏松性骨折主要部位的骨折阈值测定研究  

Study on the bone mineral density of elderly patients

作　　者：邱贵兴[1] 陈宾[1] 翁习生[1] 王志义[2] 孙天胜 张保中[1] 徐苓[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院骨科,100730 [2]北京友谊医院骨科 [3]北京军区医院骨科

出　　处：《中华医学杂志》2005年第16期1113-1116,共4页National Medical Journal of China

基　　金：国家十五攻关课题基金(2001BA702B03)

摘　　要：目的　统计北京地区老年骨质疏松性骨折患者的骨密度(BMD)值,探讨国人骨质疏松性骨折危险阈值。方法　研究组选择50岁以上髋部、肩部、腕部骨折的男女病人共300名,对照组选择50岁以上腰部疾患男女患者共150名,以双能X线骨密度仪测定BMD,进行统计学处理,对研究组和对照组BMD值进行t检验;以受试者工作特性曲线(ROC曲线)对BMD进行分析得出骨折危险阈值。结果　BMD与年龄呈负相关。研究组L2 4的r值为-0 .267,股骨颈的r值为-0 .284,Ward三角的r值为-0. 368,大粗隆的r值为-0 .314(均P<0 .01);对照组股骨颈的r值为-0 .383,Ward三角的r值为-0 .476,大粗隆的r值为-0 .305(均P<0. 01);研究组与对照组相比,BMD值差异有统计学意义(P<0. 01);男性Ward三角的BMD诊断界定值为0 .732g/cm2,此时敏感度为91 0%,特异度为56 1%,漏诊率为9%,误诊率为43. 9%;女性Ward三角的BMD诊断界定值为0. 577g/cm2,此时敏感度为72. 6%,特异度为64 5%,漏诊率为27 .4%,误诊率为35 .5%。结论　以Ward三角处BMD测定作为男、女骨质疏松性骨折危险阈值更科学。Objective To analyze bone mineral density (BMD) of elderly patients in Beijing suffering from osteoporotic fracture, and discuss Chinese population BMD threshold of osteoporosis complicated by fracture. Methods Randomly selected three hundred male and female patients over the age of fifty years old with hip, shoulder or wrist fracture forming a research group. And randomly selected one hundred and fifty male and female patients over fifty years old with lumbar diseases forming a comparison group. Hip and spine BMD values of both groups were measured by dual energy X-ray absorptiometry and statistically analyzed by t-test; The BMD values were analyzed using a receiver operating characteristic (ROC) curve to determine the optimal cutoff point as the fracture thresholds.Results BMD values relate negatively to age (research group, L2-L4 r value:-0.267, femur neck r value:-0.284, Ward triangle r value:-0.368, great trochanter r value: -0.314, all P <0.01; comparison group, femur neck r value:-0.383, Ward triangle r value: -0.476, great trochanter r value:-0.305, all P <0.01); There is evident difference between statistical comparisons of experimental and control group ( P <0.01); The cutoff point of the Ward triangle BMD at 0.732 g/cm 2( 91.0% sensitivity,56.1% specificity,9% missed diagnosis,43.9% misdiagnosis) yields the likelihood of osteoporotic fracture for male;and it is at 0.577 g/cm 2 (72.6% sensitivity,64.5% specificity,27.4% missed diagnosis,35.5% misdiagnosis) for female. Conclusion It is reasonable to take the cutoff point values as thresholds of fracture risk of osteoporosis.

关 键 词：骨质疏松性骨折 测定 骨折阈值 老年 受试者工作特性曲线 双能X线骨密度仪 50岁以上 危险阈值 BMD 统计学处理 ROC曲线 对照组 骨折患者 北京地区 腕部骨折 腰部疾患 股骨颈 大粗隆 界定值 敏感度 特异度 漏诊率 误诊率 

分 类 号：R683[医药卫生—骨科学] R681[医药卫生—外科学]