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

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.