骨定量超声测量及OSTA指数与绝经后妇女非椎骨骨折的关系  

The relationship between quantitative ultrasound and osteoporosis self-assessment tool for Asians (OSTA) score and non-vertebral fracture in postmenopausal Chinese women

作　　者：陶蓓[1] 刘建民[1] 李小英[1] 王继光[2] 王卫庆[1] 周怀发[2] 郭慧峰[2] 温燕[2] 周薇薇[1] 杜鹏飞[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢科上海市内分泌代谢病研究所上海市内分泌代谢病临床医学中心,200025 [2]上海市高血压研究所

出　　处：《中华内科杂志》2006年第12期988-991,共4页Chinese Journal of Internal Medicine

基　　金：上海市科学技术委员会科研计划项目课题(04DZ19502)

摘　　要：目的横断面社区研究分析绝经后妇女OSTA指数及多部位定量骨超声(quantitativeultrasound,QUS)[超声速率(speedofsound,SOS)],探讨该两个指标预测非椎骨骨折的价值。方法采用以色列SunlightOmnisense7000P型QUS仪测量513例女性受试者非优势侧桡骨远端1/3、中指近节指骨及胫骨中段SOS。测量受检者身高、体重,计算OSTA指数,上门问卷形式询问骨折史。结果(1)271例绝经后妇女桡骨、指骨、胫骨SOS显著低于242例绝经前妇女,P<0·001。(2)绝经后妇女非椎骨骨折组桡骨SOS低于无骨折组(P=0·044),发生于绝经后的非椎骨骨折妇女,指骨SOS低于无骨折组(P=0·003)。(3)以OSTA<-4、-4^-1、>-1将绝经后妇女分为骨质疏松高、中、低风险3组。随骨质疏松风险增加,发生于绝经后的非椎骨骨折率明显升高(χ2=6·370,P=0·041),且桡骨、指骨、胫骨SOS显著下降。(4)OSTA取-1及指骨SOSt值取-1·95反映绝经后非椎骨骨折的敏感性分别为75%和81%,特异性分别为48%和40%,受试者工作特征曲线下面积(AUC)分别为0·64和0·66。两者结合敏感性为83%,特异性提高至84%,AUC为0·64。结论OSTA和QUS尤其是指骨SOS具有反映绝经后妇女非椎骨骨折的能力。这两种非常简单、廉价、无创伤性的检查方法有助于筛查高危骨折风险的绝经后妇女。Objective To assess a simple and non-invasive scoring system, osteoporosis self-assessment tool for Asians （ OSTA ） and quantitative ultrasound （ QUS ） measurement to identify Chinese postmenopausal women with non-vertebral fracture. Methods Data came from 513 healthy women. Speed of sound （ SOS ） of the radius, phalanx and tibia was assessed using the instrument of Omnisense （ Sunlight Ltd. Israel）. Body height and weight were measured. Body mass index and OSTA were calculated. Self-reported fractures were identified using a structured questionnaire. Results SOS of radius was significantly lower in women with non-vertebral fracture than those without. SOS of phalanx was significantly lower in women with a history of postmenopausal non-vertebral fracture than those without. Using cut-offs of OSTA - 4 and - 1 to categorize osteoporosis risk, SOS of radius, phalanx and tibia decreased with increasing risk, while the prevalence of non-vertebral fracture increased. OSTA values of ≤ -1 had a sensitivity of 75% and specificity of 48% , with an area under curve （ AUC ） of 0.64 to discriminate women with and without a history of postmenopausal non-vertebral fracture. The optimal cut-off T-score of - 1.95 for phalanx yielded sensitivity and specificity of 81% and 40% , respectively, with an AUC of 0. 66. Combination of OSTA and phalanx QUS gave a sensitivity of 83% and specificity of 84% to identify postmenopausal women with a history of postmenopausal non-vertebral fracture, and an AUC of 0. 64. Conclusions It is concluded that OSTA and phalanx QUS are effective measures for identifying postmenopausal women at increased risk of non-vertebral fracture. The use of the both parameters could facilitate appropriate and more cost-effective use of bone densitometry to prevent osteoporotic fractures in developing countries.

关 键 词：骨密度 骨折 超声速率 定量骨超声 OSTA 

分 类 号：R580[医药卫生—内分泌]