椎体骨折评估在绝经后女性骨质疏松诊断中的应用价值

Investigation on the practical value of vertebral fracture assessment for the diagnosis of osteoporosis in postmenopausal women

目的研究利用双能X线骨密度仪扫描的脊柱影像进行椎体骨折评估在绝经后女性骨质疏松诊断中的应用价值。方法回顾499名年龄≥50岁的绝经后女性行骨密度检测同时行椎体侧位扫描,分析骨密度及椎体骨折评估(vertebral fracture assessment,VFA)的检测结果,收集研究对象的一般资料。结果对499名绝经后女性进行VFA检测结果分析:(1)椎体骨折诊断率提高了41.1%,骨质疏松诊断率提高了6.3%,严重骨质疏松诊断率提高了29.1%(P<0.05);(2)当骨密度达到骨质疏松阈值时,椎体骨折率明显升高,较骨密度未达到骨质疏松阈值的椎体骨折发生率提高了29.2%(P<0.05);(3)年龄增加、绝经年限延长的女性椎体骨折、骨质疏松、严重骨质疏松的患病率显著增加,骨量显著减少(P<0.05);此外,体质量指数(body mass index,BMI)降低的绝经后女性骨量显著减少,骨质疏松的患病率显著增加(P<0.05)。结论骨密度检测联合椎体骨折评估可以显著提高椎体骨折、骨质疏松、严重骨质疏松的诊断率;骨密度越低,年龄越大,绝经年限越长,椎体骨折的风险就越高;随年龄增长、绝经年限增加、BMI降低,骨密度减少,骨质疏松患病率增加。

Objective The practical value of vertebral fracture assessment for the diagnosis of osteoporosis in postmenopausal women was investigated through using spinal images derived from dual energy X-ray absorptiometry. Methods Bone mineral density(BMD) measurements and lateral vertebral scans were retrospectively studied in 499 postmenopausal women aged over 50 years to analyze the test result of BMD and vertebral fracture assessment(VFA). General information on these study subjects were collected. Results The result of VFA in the 499 postmenopausal women were analyzed and shown as below:(1) The rate of diagnosis for vertebral fracture, osteoporosis and severe osteoporosis increased by 41.1%, 6.3% and 29.1%(P<0.05), respectively;(2) When BMD reached the osteoporosis threshold, the rate of vertebral fracture significantly increased, 29.2%(P<0.05) higher than the incidence of vertebral fractures in subjects whose BMD did not reach the osteoporosis threshold;(3) There was a significant increase in the incidence of vertebral fractures, osteoporosis and severe osteoporosis in women with increasing age and years since menopause, while bone mass declined significantly(P<0.05). In addition, the bone mass of postmenopausal women with lower BMI was significantly decreased while the incidence of osteoporosis significantly increased(P<0.05). Conclusion BMD measurement combined with vertebral fracture assessment could significantly improve the diagnosis rate of vertebral fracture, osteoporosis and severe osteoporosis. Risk for vertebral fractures increased with decrease in bone density and increase in age and years since menopause. Bone density decreased and incidence of osteoporosis increased with increase in age and years since menopause as well as decrease in BMI.