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この女性は骨粗鬆症ですか?
Amanda D Green1, Cathleen S Colón-Emeric, Lori Bastian
1Ambulatory Care Service, Durham Veterans Affairs Medical Center, Durham, NC, USA.
JAMA
|December 16, 2004
まとめ
低体重などの身体検査の結果は,骨粗鬆症のリスクのある女性を特定するのに役立ち,早期スクリーニングを提案します. 壁-頭距離などの特定の兆候は,隠された脊椎骨折を示唆する可能性があります.
科学分野:
- 骨粗鬆症のスクリーニング
- 診断の精度 診断の精度
- 身体検査をする.
背景:
- 現在のガイドラインでは,65歳以上の女性に対して骨密度測定を推奨しています.
- 骨粗鬆症や隠された脊椎骨折のリスクのある若い女性を特定することは,依然として課題です.
研究 の 目的:
- オステオペニア,骨粗鬆症,または脊椎骨折の診断のための身体検査の結果の正確性と精度を評価する.
主な方法:
- 総合的なMEDLINE検索 (1966-2004) を実施し,資料集をレビューし,教科書を閲覧し,専門家と連絡を取った.
- 骨粗鬆症や脊髄骨折の診断のための身体検査の正確性に関するオリジナルデータを含む研究.
- 審査された191件の論文のうち14件が,スクリーニング後,掲載基準を満たした.
主要な成果:
- 骨粗鬆症や脊髄骨折を断定的に診断できる物理的な操作は,一つでもありません.
- 陽性確率比 (LR+) は,体重<51kg (LR+,7.3),壁-頭距離>0cm (LR+,4.6),肋骨-骨盤距離<2指幅 (LR+,3.8) の場合が最も高かった.
- 他の重要な発見には,歯の数 <20 (LR+,3.4) と,自己報告した背中がひっくり返った (LR+,3.0) が含まれていた.
結論:
- いくつかの身体検査の操作,特に低体重は,現在のスクリーニング基準を満たしていない患者の骨粗鬆症のプレテストの確率を増やすことができます.
- 壁から頭までの距離が0cm以上,肋骨から骨盤までの距離が2指幅未満であれば,隠された脊椎骨折の存在が示唆される.
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