(English)
\nBetween May 1990 and February 1991 we enrolled 212 patients of 410 referred to our clinic for bone mass evaluation according to different diagnosis or therapeutic procedures. These patients were divided into 7 groups. The question had to be answered, which method of measurement and which skeletal site would give better information about the influence of the diseases of therapeutic procedures. We measured the areal mineral density of the lumbar spine with dual x-ray absorptiometry (DEXA) and the mineral content of the total and trabecular bone mass of a crossectional slice at the distal radius with periperal quantitative computed tomography (pQCT). The results were statistically analysed. We calculated the percentage deviation from young normals. Trabecular mineral content showed the greatest difference (18% to 44%), compared to the healthy reference group, corresponding to the known higher turnover of this bone compartement. In contrast, the difference of the areal density of the lumbar spine was found to be lowest (4% to 27%). In order to compare the methods objectively, we additionally catculated a ROC-analysis of two postmenopausal groups (51 healthy, 46 osteoporotic) to demonstrate the diagnostic validity. The validity proved to be substantially better when purely trabecular bone at the distal radius was measured. The ROC-curves showed a sensitivity of 84% for radial trabecular bone on a specificity level of 90%, whereas the lumbar spine values presented with a sensitivity of only 68%.<\/p>\n
(Deutsch)
\nVon 410 Patienten, die von Mai 1990 bis Februar 1991 zur Bestimmung des oss\u00e4ren Mineralgehaltes an unsere Klinik \u00fcberwiesen wurden, konnten 212 entsprechend der Diagnose und des Verlaufs in 7 Krankheitsgruppen eingeordnet werden. In der vorliegenden Studie soll die Frage beantwortet, welcher Me\u00dfort am Skelett (LWS oder distaler Radius) mit den uns zur Verf\u00fcgung stehenden Methoden den Einflu\u00df der Erkrankung und ihre therapeutischen Auswirkungen am besten erkennen l\u00e4\u00dft und welche St\u00f6rfaktoren und Fehlerquellen zu ber\u00fccksichtigen sind. Gemessen wurde die Mineral-Fl\u00e4chenbelegung der Lendenwirbels\u00e4ule mittels der Zweienergie-R\u00f6ntgenabsorptiometrie (DEXA) und der volumenbezogene Mineralgehalt der Spongiosa und des Gesamtquerschnittes am distalen Radius mittels der peripheren quantitativen Computertomographie (pQCT). Die Ergebnisse wurden einer statistischen Analyse unterzogen. Berechnet wurde die Abweichung der Knochendichteparameter von einem normalen knochengesunden Referenzkollektiv (n = 601 f\u00fcr pQCT, n=1240 f\u00fcr DEXA). Es zeigte sich, da\u00df in allen Gruppen jeweils der Spongiosamineralgehalt, gemessen mit der pQCT am Radius den gr\u00f6\u00dften Unterschied zum gesunden Vergleichskollektiv aufwies (zwischen 18% und 44%), entsprechend dem bekannterma\u00dfen h\u00f6heren Turnover in der Spongiosa. Demgegen\u00fcber fand sich der geringste Unterschied (zwischen 4% und 27%) bei der Mineralfl\u00e4chendichte der Lendenwirbels\u00e4ule. Zum objektiven Methodenvergleich wurde in einer ROC-Analyse zweier Gruppen von postmenopausalen Patientinnen (51 knochengesunde, 46 osteoporotische Patientinnen) die diagnostische Validit\u00e4t der Methoden in Bezug auf die Erkennung einer manifesten Osteoporose gepr\u00fcft. Die Validit\u00e4t war beim Nachweis einer manifesten Osteoporose mittels Messung reiner Spongiosa am Radius deutlich besser. Die ROC-Kurven zeigten bei einer Spezifit\u00e4t von 90% eine Sensitivit\u00e4t von 84%, wenn am Radius reine Spongiosa gemessen wurde, an der Lendenwirbels\u00e4ule dagegen nur 68%.<\/p>\n","protected":false},"excerpt":{"rendered":"
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