中国骨质疏松杂志

DXA 髋结构分析参数预测髋部脆性骨折的价值

Prediction of the hip osteoporotic fractures from the hip structure analysis using dual energy X-ray absorptiometry

投稿时间：2013-04-09

DOI：

英文关键词:Dual energy X-ray absorptiometry Hip structure analysis Osteoporosis Bone mineral density

基金项目:国家自然科学基金资助（81202809）

作者	单位	E-mail
徐铮	上海市闵行区社区卫生服务中心,上海,201199
孙君雷	上海市闵行区社区卫生服务中心,上海,201199	yy2097@163.com
许忠	上海市闵行区社区卫生服务中心,上海,201199
顾昊	上海市闵行区社区卫生服务中心,上海,201199
夏芳	上海市闵行区社区卫生服务中心,上海,201199
李冠武	上海中医药大学附属岳阳中西医结合医院医学影像科,上海,200437
常时新	上海中医药大学附属岳阳中西医结合医院医学影像科,上海,200437
周蕾	上海中医药大学附属岳阳中西医结合医院医学影像科,上海,200437

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中文摘要:

目的：探讨双能X线吸收测量法（ DXA）髋几何力学参数在预测髋部脆性骨折风险中的应用价值。方法髋部骨折女性患者41例（年龄52.3～89.4岁）及正常对照组259例（年龄28.2～88.3岁）行DXA扫描获取股骨颈骨密度（ femur neck BMD，FN＿BMD）及髋几何力学分析参数，包括股骨颈横截面惯性矩（CSMI）、股骨颈横截面面积（CSA）、截面模数（SM）、曲率比率（BR）、颈宽度（FNW）、髋轴长（HAL）、股骨颈干角（NSA），并计算股骨近端强度指数（FSI）。利用受试者工作特征曲线（ ROC）分析相关变量判定髋部骨折的效能。结果校正年龄、身高、体重、BMI混杂因素，髋部骨折组与非骨折组间FN＿BMD差异有显著性意义（P＜0.01），髋部骨折组FSI、SM、CSMI、CSA较非骨折组低（P均＜0.05），而BR、FNW、NSA、HAL较非骨折组高（P均＜0.05）；当校正FN＿BMD时，只有FSI、NSA及HAL在两组间差异仍有统计学意义（P均＜0.05）。控制混杂因素， FN＿BMD与FSI（r＝0.339）、BR（r＝-0.291）、SM（r＝0.644）、CSMI（r＝0.425）、NSA（r＝-0.291）呈轻-中度相关性，FN＿BMD与CSA相关密切性最好（r＝0.908，P＜0.001）。 FN＿BMD、FSI、HAL、NSA判定髋部骨折的ROC曲线下面积（AUC）分别为0.794±0.031、0.790±0.032、0.652±0.049、0.684±0.049。 FN＿BMD及FSI判定髋部骨折的效能相仿（ P＝0.9128）。 FN＿BMD联合FSI判定髋部骨折的AUC为0.844±0.039，较FN＿BMD大（P＜0.05）。结论 FSI独立于FN＿BMD起作用，可作为判断骨质疏松性髋部骨折的有用因子。 FN＿BMD联合FSI可以提高预测髋部骨折风险的能力。

英文摘要:

Objective To investigate the predictive value of the hip osteoporotic fractures from the hip structure analysis using dual energy X-ray absorptiometry ( DXA) .Methods Forty-one women with hip fractures ( aging from 52.3 to 89.4 years old) and 259 health controls ( aging from 28.2 to 88.3 years old) were selected.The femoral neck bone mineral density ( FN_BMD) was detected using DXA.The geometry parameters of the proximal femur, including cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (SM), buckling ratio (BR), the femur neck width (FNW), the hip axis length ( HAL) , and the neck shaft angle ( NSA) were also obtained.The femur strength index ( FSI) was calculated.The predictive value of the correlated variables was analyzed using ROC curve areas ( AUCs) .Results After adjusting for the confounding factors, including age, height, weight, and BMI, the significant difference of FN_BMD betweem fracture group and non-fracture group was observed (P<0.01).The hip structural parameters such as FSI, SM, CSMI, and CSA in the hip fracture group were lower than those in non-fracture group, while BR, FNW, NSA, and HAL were higher ( P <0.05 ) .After adjusting for FN_BMD, the remaining significant difference of FSI, NSA, and HAL was observed between the two groups (P<0.05).After controlling for the confounding factors, FN_BMD showed a low-moderate correlation with FSI (r=0.339), BR (r=-0.291), SM (r=0.644), CSMI (r=0.425), and NSA (r=-0.291), and the relationship between FN_BMD and CSA was the strongest (r=0.908, P <0.001).AUC for the hip fracture prediction from FN_BMD, FSI, HAL, and NSA was 0.794 ±0.031, 0.790 ±0.032, 0.652 ± 0.049, and 0.684 ±0.049, respectively.FSI best predicted the risk for each fracture and did not differ significantly from FN_BMD.AUC for FN_BMD combining with FSI was 0.844 ±0.039, which was significantly higher than that of conventional FN_BMD alone (P<0.05).Conclusion FSI, functioning independently from FN_BMD, may be valuable in the assessment of the hip osteoporotic fractures.A combination of FN_BMD and FSI is considered to have the potential to improve the value of risk assessment for the hip fractures.

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