骨质疏松症诊断标准的探讨

Osteoporosis diagnostic criteria

本文目的是再次讨论骨质疏松的诊断标准问题。骨质疏松症的诊断以骨密度DXA检测为金标准。1994年世界卫生组织(WHO)推荐的骨质疏松诊断标准为:患者骨密度低于同性别人群峰值骨量均值2.5个标准差以上,或减少30%以上。这个标准的T值是根据年轻白人妇女计算的,但是对于不同地区是不能固守这一标准的。有研究调查我国部分地区骨质疏松症总患病率为32.3%(2.0SD)和14.9%(2.5SD),2种骨密度诊断标准计算骨质疏松症患病率差异有显著性,若以2.5SD为标准很可能造成漏诊。该研究者还发现骨质疏松症的患病率在老年远高于年轻人。而WHO采用的是白人年轻女性的数据库,它是否适用就更值得推敲。另有研究者以骨密度低于-2.0SD标准,推算杭州市妇女骨质疏松的发病率为29.5%。认为以-2.0SD为标准可以相对早期发现骨质疏松。还有研究对于高原的藏族人群进行检测,也得出同样结论。有研究者推算我国各个DXA仪器之间的换算公式,发现上述换算公式基本上与日本推出的相同,但是与美国推出的换算公式有差异。这都证明WHO骨密度诊断标准是否适用于黄种人是有疑问的。国内有研究者以BMD<-2.0SD为诊断标准,结合以骨代谢生化指标,认为能全面合理评价骨转换。还有研究者对目前国内使用骨密度检测方法进行统计分析,发现60岁骨量丢失率有18%左右,70岁阶段达到22%左右。这个患病百分率比较符合中国人的实际情况。按照世界上基本通用的换算方法,1.0SD约等于10%～12%的骨量丢失百分率,因此建议男性骨质疏松诊断标准为骨量丢失率达到25%或2.0SD,实际诊断年龄在70岁以上。如果采用2.5SD,中国人患病诊断时间会推迟到70岁以后,尤其是男性要推迟到90岁以后。骨质疏松症的研究关键是正确合理的诊断,不同种族、不同国家或地区有不同的诊断标准。1994年以前全世界都执行WHO1985年提出的峰值骨量丢失2.0个标准差诊断为骨质疏松症。1994年WHO提出了白人妇女小于-2.5SD为骨质疏松,但也明确指出该标准仅适用于欧美白人妇女。以Orimo为首的日本骨代谢学会制定了日本人群的骨质疏松诊断标准:骨密度在同性别青年人平均值30%以下为骨质疏松,丢失20%～30%为骨量减少。1999年中国老年学学会骨质疏松委员会诊断学组建议骨质疏松的诊断标准为骨量丢失百分率达到25%,或者说2.0SD。对于国外也有学者倾向于采用-2.0SD的标准来评价骨质疏松症。有研究发现不同国家间,和每国内部不同人群和人种的骨密度是明显不同的。非洲和拉丁美洲人种的骨密度高于白种人,而白种人的骨密度则高于黄种人。总结:1、国内外人群间骨密度的差异是公认的,我国人群骨密度是低于制定国际标准的白种人的,有倾向以T值低于-2.0SD为骨密度诊断标准。但是大规模的流行病学调查比较研究还很少,有必要进一步提供更确切的骨质疏松诊断更改的流行病学依据。2、以2.0SD为标准可以减少骨质疏松的漏诊,对于流行病学人群调查筛选病例,进行危险因素分析和对骨质疏松高危人群进行干预实验尤为有必要。3、如果加强国内和国际间多单位的联合研究,可以提高标准制定的科学性和权威性。

The purpose is to discuss the diagnostic criteria for osteoporosis. The gold standard of osteoporosis diagnosis is DXA BMD test. In 1994, the world health organization （WHO） recommended diagnostic criteria for osteoporosis patients： lower than mean 2.5 standard peak bone mass of the same gender population, or reduced by 30%. The standard of value is calculated according to the young white women. But in different regions is not a standard entrenched. Some studies osteoporosis total prevalence for 32.3% （2.0 SD） and 14.9（2. 5 SD） , which means two BMD diagnosis standard for osteoporosis result in significantly different prevalence. The 2.5 S for standard is likely to miss the diagnosis. The researchers also found that the more prevalence of osteoporosis in aged than young people. And WHO USES is white young women, it is the database that is more doubtful. Otherwise, researchers in bone mineral density below -2.0 SD standards, calculate the incidence of Hangzhou City women＇s osteoporosis for 29. 5% ,and think with - 2.0 SD for the early detection of osteoporosis. There is research to the Tibetan plateau, which drew the same conclusion. Researchers calculated the conversion formulas between each DXA instruments in China, and found that with Japan conversion formulas basically the same, but the launch and the US have difference conversion formulas. It is proved problematic that the diagnostic criteria are suitable density of the yellow. Domestic researchers in BMD 〈 -2.0 SD for diagnostic criteria, combined with bone metabolism biochemical indexes can have comprehensively reasonable evaluation of bone. And researchers to use BMD test method by statistical analysis, found that 60 age have bone loss about 18% , stage of 70 to about 22%. This percentage is of Chinese practical situation of the illness. According to the world, the general method of conversion of basic 1 SD approximately equal to 10% - 12% bone loss percentage, therefore they advise men diagnostic criteria for bone osteoporosis actually reach 25% or 2 SD, actual diagnosis at the age of 70 years old. If using 2.5 SD, Chinese sicken time will be delayed until after the age of 70, especially men will be postponed to 90 years later. The correct diagnosis criteria of osteoporosis is a key research. Different times and different countries or regions have different diagnosis criteria. Before 1994, all over the world WHO 1985 executed before the peak bone loss in a 2. 0 standard deviation diagnosed osteoporosis. In 1994, WHO proposed white women less than -2.5 SD for osteoporosis, but also explicitly pointed out that this standard applies only to the Euro-American white women. With the Japanese Orimo led to formulate the bone metabolism of Japanese people diagnostic criteria： bone osteoporosis in sex below average young for osteoporosis 30%. 1999 China gerontology learn osteoporosis commission t diagnosis of osteoporosis diagnostic standard advice for bone loss percentage, or 25% 2 SD. For foreign scholars have also tended to use -2 SD standards for assessment of osteoporosis. Studies have found that between different countries, and each different populations and inland of bone is obviously different. Africa and Latin America＇s racial and white than white bone density is higher than the yellow race. Conclusion： 1 The differences between people bone density is lower, the Chinese people for the international standard of white, have the tendency to T below - 2.0 SD diagnostic criteria for bone density. But the scale of the epidemiology investigation is seldom comparative study, it is necessary to further provide more accurate diagnosis of osteoporosis epidemiology of the change. 2,2.0 SD for standard can reduce the diagnosis of osteoporosis, epidemiology investigation cases, the crowd screening and risk factors of osteoporosis high-risk intervention is necessary to experiment. 3 Combination of domestic and international joint research units, can better improve the standards and scientific authority.