身高縮減測量可改善骨質疏鬆診斷的敏感性


  May 5, 2008(華盛頓特區) — 一篇新的研究顯示,使用脊椎骨折評估作為骨質密度(bone mineral density,BMD)的輔助測量,可以改善骨質疏鬆診斷的敏感性。
  
  在美國老年醫學會2008年會中,此一研究探索老年病患的身高縮減量,代表脊椎骨折頻率,可以用於單獨使用BMD評估無法分類的骨質疏鬆病患。
  
  大部分的臨床檢查使用雙能量x光吸收儀(Dual energy X-ray Absorptiometry,DXA)檢測BMD以評估老年病患的骨質疏鬆;世界衛生組織根據「年輕正常健康30歲成人尖峰骨密度」之骨密度標準差定義骨質疏鬆;T-分數在 +1到 -1是正常的;分數在 -1到-2.5 表示骨質缺乏,分數在-2.5 以下表示骨質疏鬆。
  
  發表人、匹茲堡大學醫學院醫學系的 Wan Wan Xu指出,出現脊椎骨折表示病患有臨床的骨質疏鬆,更多脊椎骨折的風險也增加4倍;診斷的挑戰之一在於四分之三的VFs是無症狀的。
  
  Xu小姐向Medscape Internal Medicine表示,我不確定為什麼有些人會有脊椎骨折卻無症狀,但是有些人有背痛症狀,也許是因為運動、或者是突然的發生脊椎骨折,也可能是突然的疼痛。
  
  該研究納入109名男性和88名女性、年紀在65歲以上 (平均年紀 ~75歲),所有參與者接受DXA檢測,以確認其脊椎和髖骨的BMD、評估脊椎骨折以及身高;T分數在 -2.5以下者分類為骨質疏鬆;這些人也完成問卷,以測定之前的最高身高、維他命D攝取、抽菸和喝酒的情況,所有參與者的平均身高損失為1.88 ± 1.23 英吋。
  
  統計分析建立身高損失與有一次或多次脊椎骨折風險之間的明顯關係 (P = .0098),損失0.5英吋增加18%一次或多次脊椎骨折風險,1.0 英吋增加38%的風險,1.5 英吋增加63%的風險,2.0英吋增加91%的風險;BMD和脊椎骨折之間沒有明顯關係。
  
  發生至少一次脊椎骨折者,骨質疏鬆病患(T-score, -1到-2.5)有37%,正常BMD (T-score, +1到-1)者有43%;整體來說,34%的參與者因為只有使用BMD規範而被錯誤分類。
  
  Medscape Internal Medicine 也訪談了主持該段會議的康乃迪克大學健康中心老年中心老年醫學客座教授George A. Kuchel醫師。
  
  Kuchel醫師表示,有許多種類的脊椎骨折,有時候只有一部分、有時候相當完整;就疼痛來說,一定可以癒合,大多數案例可以自己癒合,疼痛漸漸消失,有些人一開始看來並無太多疼痛,因此,在表徵上有相當大的範圍。
  
  Kuchel醫師指出,最大的挑戰是,如果醫師只有進行X光而沒有檢查症狀,你得要找到許多骨折;你必須相當小心而不要歸因於症狀,那個人有脊椎骨折,因為這不見得會引起疼痛。
  
  Xu小姐觀察發現,問題仍然是哪種方式對於診斷骨質疏鬆是最好的,BMD仍是相當好的,它便宜且方便,且它在判定骨質疏鬆上也有好的效果;這項研究顯示有些人應被視為骨質疏鬆,但是未被BMD檢出;脊椎骨折評估將是有用的輔助方式。
  
  Xu小姐和 Kuchel醫師宣稱沒有相關資金往來。
  
  美國老年醫學會2008年會: 摘要P37。發表於2008年5月3日。

Height Loss Measurement Improv

By Jacquelyn K. Beals, PhD, PhD
Medscape Medical News

May 5, 2008 (Washington, DC) — A new study shows that using vertebral fracture assessment as an adjunct to measurement of bone mineral density (BMD) would improve sensitivity in osteoporosis diagnoses.

Presented here at the American Geriatrics Society 2008 Annual Meeting, this study investigated the amount of height loss in older patients that indicates a vertebral fracture and the frequency with which osteoporotic patients are misclassified when using only BMD assessment.

Most clinical testing assesses osteoporosis in elderly patients using dual-energy X-ray absorptiometry (DXA) to determine BMD. The World Health Organization defines osteoporosis on the basis of standard deviations of bone density from that of a "young normal healthy 30-year-old adult with peak bone density." A T-score of +1 to −1 is normal; scores of −1 to −2.5 indicate osteopenia, and a score of −2.5 or less indicates osteoporosis.

Presenter Wan Wan Xu, MSII, from the Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, noted that "the presence of a [vertebral fracture] identifies a patient who has clinical osteoporosis" and also elevates the risk of more [vertebral fractures] as much as 4-fold; one of the diagnostic challenges is that two thirds to three quarters of VFs are asymptomatic.

"I'm not sure why...someone can have vertebral fracture and not be symptomatic, but the ones who do show signs [have] back pain, maybe with exercise, or the vertebral fracture could be sudden. It could [be] sudden pain," Ms. Xu told Medscape Internal Medicine.

The study enrolled 109 men and 88 women older than 65 years (average age, ~75 years). All participants underwent DXA to determine BMD of their spine and hip, vertebral fracture assessment, and height measurement. Patients with T-scores of −2.5 or less were classified as osteoporotic. Subjects also completed a questionnaire to determine previous maximum height, vitamin D intake, and tobacco and alcohol use. Average height loss of all participants was 1.88 ± 1.23 inches.

Statistical analysis established a significant association between height loss and the risk of having 1 or more vertebral fractures (P = .0098): A loss of 0.5 inches was associated with an 18% increase in the odds of having 1 or more vertebral fractures, 1.0 inch with a 38% increase, 1.5 inches with a 63% increase, and 2.0 inches with a 91% increase. There was no significant association between BMD and vertebral fracture.

At least 1 vertebral fracture was present in 37% of patients with osteopenia (T-score, −1 to −2.5) and 43% of patients with normal BMD (T-score, +1 to −1). In all, 34% of participants would have been misclassified by using only BMD criteria.

Medscape Internal Medicine also spoke with George A. Kuchel, MD, professor of medicine, Travelers Chair in Geriatrics and Gerontology, director of the University of Connecticut Center on Aging, chief of the Division of Geriatric Medicine, University of Connecticut Health Center, Farmington, who moderated the session.

"There are many different kinds of vertebral fractures," observed Dr. Kuchel. "Sometimes they're very partial, and sometimes they're more complete. But they certainly can heal in terms of pain.... In most cases they heal on their own, and the pain gradually goes away, and in some people there does not seem to be much pain in the first place. So there's a wide spectrum in how it presents."

Dr. Kuchel added, "The biggest challenge is, if a physician just does X-rays on lots of people without looking at the symptoms, you're going to find lots and lots of fractures. You have to be very careful not to attribute the symptoms: 'Ah, that person has a vertebral fracture,' because it may or may not be the cause of the pain."

Ms Xu observed, "The question remains as to what method is best for diagnosing osteoporosis. The BMD is still a great test. It's cheap and it's readily accessible, and it does do a good job of telling you who's osteoporotic. This study does show that there are some people who should be considered osteoporotic but are not picked up by BMD. A vertebral fracture assessment will be a helpful adjunct," Ms. Xu concluded.

Ms. Xu and. Dr. Kuchel have disclosed no relevant financial relationships.

American Geriatrics Society 2008 Annual Meeting: Abstract P37. Presented May 3, 2008.

    
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