Age-Specific Values and Cutoff Levels for the Diagnosis of Osteoporosis in Quantitative Ultrasound Measurements at the Calcaneus with SAHARA in Healthy Japanese Women: Japanese Population-Based Osteoporosis (JPOS) Study
Age-Specific Values and Cutoff Levels for the Diagnosis of Osteoporosis in Quantitative Ultrasound Measurements at the Calcaneus with SAHARA in Healthy Japanese Women: Japanese Population-Based Osteoporosis (JPOS) Study
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DOI：
10.1007/s00223-001-2079-6
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发表时间：
2002-06
影响因子：
4.2
通讯作者：
Y. Ikeda;M. Iki;A. Morita;H. Aihara;S. Kagamimori;Y. Kagawa;T. Matsuzaki;H. Yoneshima;F. Marumo
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文献类型：
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作者：
Y. Ikeda;M. Iki;A. Morita;H. Aihara;S. Kagamimori;Y. Kagawa;T. Matsuzaki;H. Yoneshima;F. Marumo
为了建立定量超声(QUS)指数在日本健康女性中的参考值，并通过QUS指数提出骨质疏松的诊断标准，从一项更大的队列研究(JPOS研究)中招募了659名年龄在20-79岁的健康女性，用QUS检查了跟骨(撒哈拉，霍洛奇公司，美国)的骨量，并在脊柱、髋部和前臂远端用双能X射线骨密度仪进行了检查。我们给出了QUS指数的10年特定年龄的平均值和T分数。在QUS指数和总髋部骨密度中，T-Score的下降模式似乎是线性的，但在脊柱处的BMD则不是。70岁以上受试者QUS各指标的T-值显著高于脊柱骨密度。QUS诊断50岁及以上人群骨质疏松的患病率(SOS为8.7%，BUA为10.7%)与髋部骨密度(11.5%)相近，但明显低于按WHO标准诊断的脊柱骨密度(36.1%)。我们进行了受试者操作特征分析，以设定诊断骨质疏松的QUS指数的截止水平，以准确地识别由脊柱或全髋骨密度诊断的受试者。SOS和BUA的最大似然比分别为1,517.7 m/s(T分：-1.58)，灵敏度为0.65，特异度为0.65和59.5分贝/MHz(T分：-1.52)，分别为0.66和0.69。QUS指标对骨质疏松症的诊断准确性并不优于年龄。然而，在Logistic回归分析建立的多变量诊断模型中，QUS指数对形成独立于年龄和体型的骨质疏松症诊断有显著贡献。因此，在根据骨折风险设定QUS指数的截断值之前，本研究中提出的截断值可以作为一个暂定的标准。
To establish the reference values of the quantitative ultrasound (QUS) indices in healthy Japanese women and to propose a diagnostic criterion for osteoporosis by means of the QUS indices, 659 healthy women aged 20–79 years recruited from a larger cohort study (JPOS study), were examined for bone mass measurements by QUS at the calcaneus (SAHARA, Hologic Inc., USA) and by dual-energy X-ray absorptiometry at the spine, hip, and distal forearm. We presented 10-year age-specific mean values and T-scores of the QUS indices. The pattern of decrease in the T-score appeared to be linear in the QUS indices and total hip BMD but not in BMD at the spine. The T-score of the QUS of indices of the subjects in their 70s were significantly higher than that of BMD at the spine. The prevalence rates of osteoporosis in the subjects aged 50 and older diagnosed by QUS (8.7% for SOS, 10.7% for BUA) were similar to that diagnosed by total hip BMD (11.5%) and significantly lower than that by the spine BMD (36.1%) when the WHO criteria were applied. We performed receiver-operating characteristic analysis to set a cutoff level of the QUS indices for the diagnosis of osteoporosis to accurately identify the subjects diagnosed by either the spine or total hip BMD. The highest likelihood ratios for SOS and BUA were obtained at the cutoff levels of 1,517.7 m/sec (T-score:-1.58) with the sensitivity of 0.65 and the specificity of 0.65 and 59.5 dB/MHz (T-score:-1.52) with 0.66 and 0.69, respectively. The diagnostic accuracy of QUS indices for osteoporosis was not superior to that of age. However, the QUS indices showed a significant contribution to forming the diagnosis of osteoporosis independently of age and body size in multivariate diagnostic models developed by the logistic regression analysis. Therefore, the cutoff values presented in this study may be used as a tentative criterion until the cutoff levels for the QUS indices are set according to the fracture risk.