亚洲骨质疏松自我评价工具对成都地区部分中老年妇女筛检效果评价

Evaluation of screening ability of OSTA for middle age and old women in Chengdu

目的观察亚洲骨质疏松自我评价工具(OSTA)对成都地区部分中老年妇女骨质疏松(OP)、低骨量(osteopenia)的筛查效果及不同部位筛查结果的差异。方法采用双能X线骨密度仪(DXA)测定5293名年龄40～96岁的成都地区健康女性骨密度。测量部位包括腰椎1-4(L1-4)、左股骨颈、大转子、Wards区、股骨干和全髋的骨密度。根据公式计算亚洲骨质疏松自我评价工具(OSTA)得分,按OSTA≥0、-5<OSTA<0、OSTA≤-5将研究对象分为低、中、高危险性3个级别或按OSTA≥0、OSTA<0分为低、中高危险2级。与双能X线骨密度仪(DXA)测定的不同部位T-score进行对比,通过灵敏度、特异度、Kappa值、ROC曲线下面积等指标进行评价。采用SPSS17.0统计软件进行处理。结果腰椎、股骨颈、全髋OP检出率分别为:26.9%、16.6%、9.5%,低骨量检出率分别为33.6%、44.2%、34.9%。OSTA指数低、中、高危险者分别为:49.4%、43.0%、7.6%,低、中高危险者分别为49.4%和50.6%。腰椎+股骨检测OP、骨密度异常率分别为:31.1%和72.2%,高于腰椎或股骨检出率。OSTA对不同骨骼部位筛查(T-score<-1)灵敏度为61.9%～77.4%,特异度为70.9%～80.2%;对OP筛查(T-score≤-2.5)灵敏度为75.7%～95.6%,特异度为57.0%～62.6%。低、中、高危险性分类中OSTA与T-score一致性Kappa值为0.176～0.398(P<0.001)。低、中高危险分类OSTA与T-score一致性提高,Kappa值为0.323～0.488(P<0.001)。T-score<-1、≤-2.5不同部位筛查ROC曲线下面积为0.760～0.819和0.749～0.887(P<0.001)。结论 OSTA对筛查中老年妇女OP具有一定价值;不同部位、不同T-score截断值OSTA筛查效果存在差异。

Objective To evaluate the screening effect of OSTA for osteoporosis and osteoponia in women in Chengdu,to compare the difference effects of OSTA in various skeletal sites。Methods A total of 5293 heathy women aged 40 ～ 96 years were measured by dual energy X-ray absorptiometry （ DXA） ; OSTA index was calculated. All persons were classified into high,medium,low osteoporosis-group by OSTA≤ 5, 5 OSTA 0,OSTA≥0 or the low and the high risk-group by OSTA index OSTA≥0,OSTA 0. The results of OSTA were compared with T-scores of skeletal sites. The results were analyzed with SPSS version 17. 0. Results 1. The prevalence of osteoporosis in lumbar spine,femur neck,total femur were 26. 9% ,16. 6% ,9. 5% ,respectively; and the detection rate of osteoponia were 33. 6% ,44. 2% ,34. 9% ,respectively. The ratio of low-risk,medium-risk group,high-risk group according to OSTA index were 49. 4% ,43. 0% ,7. 6% ,respectively. 2. The detection rate of osteoporosis and osteoponia in combined detection of lumbar spine and proximal femur were 31. 1% ,72. 2% ,respectively,higher than those in lumbar spine or proximal femur alone. 3. The sensitivity,specificity of OSTA by T-score 1 were 61. 9% ～ 77. 4% ,70. 9% ～ 80. 2% ; and by T-score≤ 2. 5 were 75. 7% ～ 95. 6% ,57. 0% % ～ 62. 6% ,respectively. The consistency of diagnosis result between T-score and OSTA index according to three and two risk levels were （ Kappa = 0. 176 ～ 0. 398） ,（ Kappa = 0. 323 ～ 0. 488 ） （ P 0. 001 ） ,respectively. The area under ROC （ receiver operating characteristic,ROC） curve by T-score 1,T-score≤ 2. 5 were 0. 760 ～ 0. 819,0. 749 ～ 0. 887,respectively （ P 0. 001） . Conclusion The screening ability to OSTA had been found osteoporosis and low bone mass in middle age and old healthy women in Chengdu. Differences of screening effects on osteoporosis and osteoponia exsit between different T-score cutoffs and various skeletal sites.