青年人群腰椎骨密度及标准差对骨质疏松检出率的影响:多中心、大样本分析
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中国组织工程研究与临床康复 』2眷 D 2008—12—09出版 Journal ofClinical Rehabilitative Tissue Engineering Research December 2008 Vo1.12,No.50 Basic Medicine
Influence of young people’s bone mineral densities and their standard deviations on detective rate of osteoporosis: Multicenter and large sample analyses★o
Wang Wen-zhi’,Yang Ding—zhuo’,Jiang Jian-jun’,Wu Tao ,Cheng Xiao—guang。,Zhou Qi ,Zhuo
Tie-jun ,Zhang Hua-chou。,Xiang Jing ,Wang Hong—fu。,Ou Pin—zhong。,Liu Jian-li’。,Xu Ling’’,Huang Gong-yi ,Huang Qi-ren坦,HS Barden ,LS Weynand ,KG Fqukner4,Meng Xun-wu
Abstract BACKGR0UND:Peak bone mass and standard deviation(SD)in different regions are varied,which have great influence on diagnosis of osteoporosis.To establish a complete database can provide accurate evidence for osteoporosis diagnosis. OBJECTIVE:To investigate the influence of bone minera1 densities(BMD)and their SD of young people on the detective rate of osteoporosis in gener ̄population. DESIGN,TIME AND SETTING:Investigation analysis was performed at Beijing,Shanghai,Guangzhou,Nanjing, Jiaxing and Chengdu between January 1997 and December 1999. PARTICⅡ'ANTS:1 1 418 sunects from related 6 centers of BMD reference database in China were investigated and analyzed using prospective and retrospective methods.including 3 666 males.and 7 752 females aged 20—9O years.Of them,2 385 were from Be0ing,1 178 from Guangzhou,1 404 from Shanghai,2 938 from Nanjing,1 425 from Chengdu, and 2 088 from Jiaxing.The sunects were selected from community investigation,physical examination volunteers. METHODS:BMD ofthe1umbar spine(L2-4)andthehipin 11.418 sunectsfromthe related 6 centersinChinawas measured with GE—Lunar dual energy X—ray absorptiometry(DXA)and the BMD reference database was established.The accuracy rate of the inner machine was 0.3%一0.7%.and the accuracy of different machines averaged 1.1%. MAIN oUTC0ME MEASURES:Lumbar BMD distribution of different age groups from 6 centers;influence of young people’s BMD and its SD on detective rate of osteoporosis. RESULTS:Different BMD and SD were found in the individual subject from 6 centers.and the maximum differences were 0.098 g/cm and 0.027 g/cm .With mean BMD and SD of the individuals from 6 centers as references.different T—scores and the detective rates of osteoporosis derived from the T—scores were found in the same group.The detective rate increased by 1.6%when BMD of the young people increased by 0.01 g/cm ̄(positive correlation),but the detective rate
decreased bv 4%when SD increased bv 0.O1g/cm‘(negative correlation). CoNCLUSIoN:Changes in BMD and SD of the young people can influence the detective rate of osteoporosis.To achieve comparability for the detective rate of osteoporosis in different centers.the specific reference database should be established for the same race,the same area,and the sarne bone densitometry machine.The T—score should be determined with the normal BMD and SD ofthe young people as the reference database.
1NTR0DUCTl0N Before 1 994.osteoporosis was diagnosed according to a decrease in BMD and fragile fracture.In 1986。RiggsL tried to use only BMD to diagnose osteoporosis.BMD+2 SD was used as a standard reference for the osteoporosis diagnosis among the people aged above 20 years, with every 10 years as a group.If BMD was lowered by 2 SD,then osteoporosis could be diagnosed.He observed 11 l patients with vertebral fracture and found the cOnventiOna1 standard reference group used in the gener ̄medical statistics was not suitable to the osteoporosis diagnosis.With a great effort of many medical experts,the peak bone mass was accepted as a standard reference for the osteoporosis diagnosis. Wasnich reported that a change in a person’s bone mass in one’s life should be considered as a whole,and the basic requirement for the maintenance of the whole depended on the body’s stress load.The studies by Garn and others showed that the bone mass of an adolescent aged above 20 years had a close correlation to his or her original bone mass fr=0.93).so the peak bone ISsN i673.8225 CN 21.1539,R CoDEN:zLXHAH mass should be regarded as a main standard for the loss of the bone mass in the old people.As the subjects for the investigation are USUally from different centers,the differences in the T-score and the SD of the young people have made a poor compatibility of the prevalence or the detective rate of osteoporosis.The report from the World Health Organization(WHO in 1 994 showed that the T-score±1 standard deviation fSD1 would be different when the patients were repeatedly measured and the error occurrence in the accuracy of the instrument would be greater than 10% . The error in the accuracy occurring in the lumbar spine(PA1 examination would be 4%一10% J.So. the error in the accuracy resulting from the instrumental examination could also affect the BMD and SD of the young people.To avoid the discrepancies in BMD values of the young people. we selected multiple areas,large enough samples, and relatively ideal experimental protocols to determine the influence of BMD and SD of young people on the detective rate of osteoporosis.