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  

A comparative study on using BMD and vBMD to diagnose osteoporosis at lumbar spine and femoral neck

作　　者：王文志[1] 罗丽霞[2] 徐健[1] 孙蕾[1] 王露[1] 杨定焯[1] 赵立强[1] WANG Wenzhi;LUO Lixia;XU Jian;SUN Lei;WANG Lu;YANG Dingzhuo;ZHAO Liqiang(Department of Osteoporosis,Fourth Hospital of Huaxi,Sichuan University,Chengdu 610041;Huaxi School of Public Health,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第四医院骨质疏松科,四川成都610041 [2]四川大学华西公共卫生学院,四川成都610041

出　　处：《中国骨质疏松杂志》2018年第10期1310-1316,共7页Chinese Journal of Osteoporosis

摘　　要：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。Objective When using areal bone mineral density(aBMD)to diagnose osteoporosis,the three-dimensional bone was standardized to two dimension,and in theory it would cause missed diagnosis in big bone and misdiagnosis in small bone.Thus,in this article,we investigated whether using aBMD in the diagnosis of osteoporosis could cause missed diagnosis or misdiagnosis and whether these could be avoided by using vBMD through epidemiological investigation.Methods Bone mineral density of lumbar spine and femoral neck was measured using the GE-Lunar DPX dual-energy X-ray absorptiometry bone densitometer.Bone volume and vBMD(vBMD=BMC/bone volume)were obtained using the cube digital mode(lumbar spine)and the cylinder number(femoral neck)of the instrument’s projection area(area,cm 2).The standard deviation of aBMD and vBMD of people aged 20 to 39 years as recommended by the WHO was used to generate the T-score reference for normal,low bone density and osteoporosis(OP),and the WHO established T-score diagnosis method was used for the diagnosis of OP.Results Compared with using aBMD,the diagnosis of OP at lumbar spine and femoral neck using vBMD avoided small bone misdiagnosis by 16%and 11.6%,and big bone missed diagnosis by 7%and 18%,respectively.For lumbar bone volume every 10 cm 3 less than the average,the rate of misdiagnosis using aBMD increased by 1%;for 10 cm 3 more than the average,the rate of missed diagnosis increased by 0.44%.For femoral neck bone volume every 1 cm 3 less than the average,the rate of misdiagnosis using aBMD increased by 2.6%;for every 1 cm 3 more than average,the rate of missed diagnosis increased by 4%.Conclusion Using vBMD to diagnose osteoporosis could avoid missed diagnosis in big bone and misdiagnosis in small bone caused by using aBMD.

关 键 词：骨体积标准化 骨密度 骨质疏松 

分 类 号：R681[医药卫生—骨科学] R589.5[医药卫生—外科学]