Instant vertebral assessment - A noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis
Instant vertebral assessment - A noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis
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DOI：
10.1385/jcd:4:4:373
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发表时间：
2001-12-01
影响因子：
2.5
通讯作者：
Parker, RA
中科院分区：
文献类型：
--
作者：
Greenspan, SL;von Stetten, E;Parker, RA
椎骨骨折的存在显著增加了未来骨折的风险，将患者归类为“临床”骨质疏松症，通常导致骨质疏松症的治疗。然而，大多数椎骨骨折是无声的，侧位X线片（标准的识别方法）并不是常规获得的。即时椎骨评估（IVA）是一种利用双X线吸收测定法（DXA）的技术，可快速评估椎骨骨折，并与标准脊柱侧位X线片评估的椎骨骨折高度相关。为了评估IVA在患者管理中的作用，我们检查了482名参与者的标准骨矿物质密度（BMD），脊柱，全髋关节，股骨颈和脊柱IVA通过DXA筛选骨质疏松症研究，谁没有以前的知识椎骨骨折。根据世界卫生组织（WHO）指南，在脊柱、全髋关节、股骨颈或这些中心部位的任何组合使用BNID对受试者进行分类。此外，如果受试者有与低骨密度无关的椎骨骨折，我们认为他们是椎体骨折。我们发现，在本研究招募的无症状绝经后妇女中，18.3%存在IVA评估的椎骨骨折。BNID单独诊断骨质疏松症的敏感性为40%至74%，无论是基于椎骨骨折或低BMD使用WHO标准。这意味着26%至60%的阿尔茨海默病个体可能被遗漏。此外，仅根据BMD标准，11.0-18.7%的临床骨质疏松个体将被归类为正常。我们的结论是，IVA是一个有用的辅助临床鉴定骨质疏松症，并可能防止管理不善的骨质疏松症患者。
The presence of a vertebral fracture significantly increases the risk of future fracture, classifies a patient with "clinical" osteoporosis, and usually results in treatment for osteoporosis. However, the majority of vertebral fractures are silent, and lateral X-rays (the standard method for identification) are not routinely obtained. Instant vertebral assessment (IVA), a technology that utilizes dual X-ray absorptiometry (DXA), provides rapid assessment of vertebral fractures and is highly correlated with vertebral fractures, as assessed on standard lateral spine X-rays. To assess the role of IVA in patient management, we examined standard bone mineral density, (BMD) of the spine, total hip, and femoral neck and spine IVA by DXA in 482 participants screened for an osteoporosis study, who had no previous knowledge of vertebral fractures. Using World Health Organization (WHO) guidelines, subjects were classified using BNID at the spine, total hip, femoral neck, or any combination of these central sites. In addition, we considered subjects as osteoporotic if they had vertebral fractures independent of low bone density. We found that vertebral fractures assessed by IVA were present in 18.3% of asymptomatic postmenopausal women recruited for this study. The sensitivity of BNID alone to diagnose osteoporosis based on either a vertebral fracture or low BMD using WHO criteria ranged from 40 to 74%. This means that between 26 and 60% of osteoporotic individuals could have potentially been missed. Furthermore, 11.0-18.7% of clinically osteoporotic individuals would have been classified as normal by BMD criteria alone. We conclude that IVA is a useful adjunct in the clinical identification of osteoporosis and may prevent mismanagement of osteoporotic patients.