When Should Densitometry Be Repeated in Healthy Peri- and Postmenopausal Women: The Danish Osteoporosis Prevention Study
作者:B. Abrahamsen、N. Nissen、A. P. Hermann、B. Hansen、O. Bärenholdt、P. Vestergaard、C. L. Tofteng、S. Pors Nielsen
DOI:10.1359/jbmr.2002.17.11.2061
日期:——
Intervention should be considered in postmenopausal women with bone mineral density (BMD) ≥1 SD below the reference (T or Z score < −1). However, it is unclear when densitometry should be repeated. This study aimed at determining the need for repeat DXA within 5 years in untreated peri‐/postmenopausal women to detect declines of T or Z score to below −1 with 85% confidence. A cohort of 925 healthy women (aged 51.2 ± 2.9 years) were followed within the Danish Osteoporosis Prevention Study (DOPS) for 5 years without hormone‐replacement therapy (HRT). DXA of spine, hip, and forearm was done at 0,1, 2, 3, and 5 years (Hologic QDR‐1000/2000). The annual loss in SD units was 0.12 ± 0.10 at the spine (1.3%), 0.10 ± 0.09 at the femoral neck (1.2%), and 0.07 ± 0.09 at the ultradistal (UD) forearm (1.0%). Accordingly, T scores below −1 developed earlier at the spine. The need for a future DXA scan to predict declines of T and Z scores below −1 depended strongly on baseline BMD. In subjects with a positive T score, the risk of developing T < −1 remained at <15% for 5 years at all measured sites. A new scan was needed after 1 year if the T score was below −0.5, and after 3 years if the T score was between 0 and −0.5. Slightly longer intervals apply if Z scores are used. Follow‐up densitometry in untreated women should be individually targeted from baseline BMD rather than scheduled at fixed time intervals. An algorithm for planning repeat densitometry in perimenopausal women is provided.
对于骨矿物质密度 (BMD) 低于参考值≥1 SD(T 或 Z 评分 < -1)的绝经后妇女,应考虑进行干预。然而,尚不清楚何时应重复密度测定。本研究旨在确定未经治疗的围绝经期/绝经后妇女是否需要在 5 年内重复 DXA,以检测 T 或 Z 评分下降至低于 -1 的情况,置信度为 85%。丹麦骨质疏松症预防研究 (DOPS) 对 925 名健康女性(年龄 51.2 ± 2.9 岁)进行了为期 5 年的随访,未进行激素替代治疗 (HRT)。脊柱、髋部和前臂的 DXA 在第 0、1、2、3 和 5 年进行(Hologic QDR-1000/2000)。 SD 单位的年度损失在脊柱处为 0.12 ± 0.10 (1.3%),在股骨颈处为 0.10 ± 0.09 (1.2%),在超远端 (UD) 前臂处为 0.07 ± 0.09 (1.0%)。因此,低于-1的T分数在脊柱中较早出现。未来是否需要进行 DXA 扫描来预测 T 和 Z 分数下降至 -1 以下,很大程度上取决于基线 BMD。在 T 评分为阳性的受试者中,所有测量部位发生 T < -1 的风险在 5 年内保持在 <15%。如果 T 评分低于 -0.5,则需要在 1 年后进行新的扫描;如果 T 评分在 0 至 -0.5 之间,则需要在 3 年后进行新的扫描。如果使用 Z 分数,则适用稍长的间隔。未经治疗的女性的后续密度测定应根据基线 BMD 单独进行,而不是按固定时间间隔安排。提供了一种用于计划围绝经期妇女重复密度测定的算法。