胸腰椎側面X光骨折評估於不同性別對老年骨質疏鬆症診斷的影響

Objective: The study aimed to compare the effect of lateral thoracolumbar spine X-ray on diagnosing osteoporosis in elderly men and women. Method: A township-wide screening for osteoporosis was performed for men and women over 65 years old living in Tianliao Township in southern Taiwan during 2009-2010. Each subject completed a structured questionnaire, received lateral spine X-ray in a ＂bone bus,＂ and had bone mineral density (BMD) measured by mobile dual energy X-ray absorptiometry (DXA). A total of 368 elderly women and 412 elderly men were enrolled and completed the questionnaire and screening. Diagnosis of osteoporosis was confirmed by either one of the criteria: (a) a bone mineral density T-score ≤ -2.5, (b) history of non-traumatic fracture, or (c) compression fracture identified by thoracolumbar X-ray. The discordant prevalence of osteoporosis diagnosed with and without compression fracture identified by lateral thoracolumbar spine X-ray was then assessed. Result: 4.1% of the elderly men and 11.4% of the elderly women were diagnosed of osteoporosis based on the history of low-energy fracture. The percentages changed to 13.1 % in males and 56.3% in females when BMD was used as the criterion and to 53.9% and 50.5% when diagnosis of osteoporosis was based on compression fracture identified by lateral thoracolumbar spine X-ray. The prevalence of osteoporosis diagnosed by any one of the three criteria was 61.9% in males and 78.3% in females (p＜0.001). The diagnostic discordance due to compression fracture identified by thoracolumbar X-ray was higher in men (44.9% vs 17.4%, p＜0.01) with OR=4.572 (95% 3.215-6.500). Conclusion: In addition to BMD and history of non-traumatic fracture, lateral thoracolumbar spine X-ray is recommended for improving the diagnosis of osteoporosis, especially in elderly men.