ISCD OP-Adult-Traditional Chinese version- ZJ Sun and Paulo wu_revised

Transcription

1 2013 ISCD Current Positions (Adult) These are the Official Positions of the ISCD as updated in The Official Positions that are new or revised since 2007 are in bold type. Indications for Bone Mineral Density (BMD) Testing Women aged 65 and older For post-menopausal women younger than age 65 a bone density test is indicated if they have a risk factor for low bone mass such as; Low body weight Prior fracture High risk medication use Disease or condition associated with bone loss. Women during the menopausal transition with clinical risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use. Men aged 70 and older. For men < 70 years of age a bone density test is indicated if they have a risk factor for low bone mass such as; Low body weight Prior fracture High risk medication use Disease or condition associated with bone loss. Adults with a fragility fracture. Adults with a disease or condition associated with low bone mass or bone loss 國際臨床骨密檢測學會目前立場 ( 成人 ) 以下是國際臨床骨密檢測學會在 2013 年更新的官方立場 新的或自 2007 年修正的官方立場標以粗體字 骨密度 (BMD) 檢測的適應症! 65 歲以上的婦女! 對於小於 65 歲的停經婦女, 骨密度檢測是必要的, 假使她有低骨量的危險因子, 例如 ; " 低體重 " 曾經骨折 " 使用高風險性藥物 " 與骨流失相關的疾病或情況! 正處於停經階段且具有骨折危險因子如低體重 曾經骨折或使用高風險性藥物之婦女! 70 歲以上男性! 對於小於 70 歲的男性, 骨密度檢測是必要的, 假使他有低骨量的危險因子, 例如 ; " 低體重 " 曾經骨折 " 使用高風險性藥物 " 與骨流失相關的疾病或情況! 脆弱性骨折者! 罹患可能導致低骨量或骨流失之相關疾病者 1

2 Adults taking medications associated with low bone mass or bone loss. Anyone being considered for pharmacologic therapy. Anyone being treated, to monitor treatment effect. Anyone not receiving therapy in whom evidence of bone loss would lead to treatment. Women discontinuing estrogen should be considered for bone density testing according to the indications listed above. Reference Database for T-Scores Use a uniform Caucasian (non-race adjusted) female normative database for women of all ethnic groups.* Use a uniform Caucasian (non-race adjusted) female reference for men of all ethnic groups * Manufacturers should continue to use NHANES III data as the reference standard for femoral neck and total hip T-scores. Manufacturers should continue to use their own databases for the lumbar spine as the reference standard for T-scores If local reference data are available they should be used to calculate only Z-scores but not T-scores. *Note: Application of recommendation may vary according to local requirements.! 所服用藥物和低骨量或骨流失有相關者! 任何被認為需要用藥物治療者! 任何接受治療中, 用以監測治療效果者! 未曾接受治療者卻有骨流失的證據足以導致接受治療者參照上列各項適應症, 停止使用雌激素的女性應考慮接受骨密度檢測 T 值的參考資料庫! 統一使用白種人 ( 未經種族校正 ) 女性的正常資料庫於所有種族的女性! 統一使用白種人 ( 未經種族校正 ) 女性的正常資料庫於所有種族的男性! 製造商應繼續使用第三次全國健康與營養檢驗調查 (NHANE III) 的資料作為女性股骨頸及全髖骨的 T 值參考標準! 製造商應繼續使用他們自己的腰椎資料庫作為 T 值參考標準! 假如可以得到當地的參考資料, 應該僅使用於計算 Z 值而非 T 值 * 備註 : 使用本建議仍需視當地的要求而異 Central DXA for Diagnosis The WHO international reference standard for osteoporosis diagnosis is a T-score of -2.5 or less at the femoral neck. The reference standard from which the T-score is calculated is the female, white, age years, NHANES III database Osteoporosis may be diagnosed in postmenopausal women and in men age 50 and older if the T-score of the lumbar spine, total 2 以中軸型雙能量 X 光吸收儀 (DXA) 作診斷! 世界衛生組織的國際參考標準為股骨頸 T 值等於或小於 -2.5 時可診 斷為骨質疏鬆症 " 此 T 值計算的參考標準為女性 白種人 年齡介於 歲之 NHANES III 資料庫! 當停經後婦女或 50 歲以上男性腰椎 全髖骨或股骨頸的 T 值等於或

3 hip, or femoral neck is -2.5 or less:* In certain circumstances the 33% radius (also called 1/3 radius) may be utilized 小於 -2.5 時可診斷為骨質疏鬆症 " 在某些情形可採用橈骨 33% 長度處 ( 亦稱為 1/3 橈骨 ) *Note: Other hip regions of interest, including Ward s area and the greater trochanter, should not be used for diagnosis. Application of recommendation may vary according to local requirements. Skeletal sites to measure Measure BMD at both the PA spine and hip in all patients Forearm BMD should be measured under the following circumstances: Hip and/or spine cannot be measured or interpreted. Hyperparathyroidism Very obese patients (over the weight limit for DXA table) Spine Region of Interest (ROI) Use PA L1-L4 for spine BMD measurement Use all evaluable vertebrae and only exclude vertebrae that are affected by local structural change or artifact. Use three vertebrae if four cannot be used and two if three cannot be used BMD based diagnostic classification should not be made using a single vertebra. If only one evaluable vertebra remains after excluding other vertebrae, diagnosis should be based on a different valid skeletal site Anatomically abnormal vertebrae may be excluded from analysis if: They are clearly abnormal and non-assessable within the resolution of the system; or There is more than a 1.0 T-score difference between the vertebra in question and adjacent vertebrae 3 * 備註 : 髖骨其他判讀區間如華德氏區 (Ward s area) 及大轉子 (greater trochanter) 不應用來作為診斷依據 使用本建議仍需視當地的要求而異! 骨骼測量位置 " 所有的病人應同時檢測後前位脊椎及髖骨的骨密度 " 當以下情形時應測量前臂骨密度 # 當無法測量或判讀髖骨和 / 或脊椎時 # 副甲狀腺機能亢進 # 體重過重者 ( 超過 DXA 檢查台體重限制 )! 脊椎判讀區間 " 應採用後前位第一至第四腰椎作為脊椎骨密度測量 " 應計算所有可評估的腰椎, 僅排除受到局部結構變化或假影影 響之脊椎 如果不能四節全用, 就用三節 ; 不能使用三節, 就用 兩節 " 決不用單一節脊椎骨密度來作診斷分類 " 僅剩一節可評估的腰椎時, 應考慮其他可用骨骼部位作診斷 " 當出現下列之解剖異常腰椎, 判讀時可能被排除 : # 在系統解析度下有明確異常或無法評估者 ; 或 # 有問題和相鄰椎體的 T 值差距超過 1.0 時 " 當某節脊椎被排除後, 應以剩餘節數之脊椎骨密度來計算 T 值

4 When vertebrae are excluded, the BMD of the remaining vertebrae is used to derive the T-score The lateral spine should not be used for diagnosis, but may have a role in monitoring Hip ROI Use femoral neck, or total proximal femur whichever is lowest. BMD may be measured at either hip There are insufficient data to determine whether mean T-scores for bilateral hip BMD can be used for diagnosis The mean hip BMD can be used for monitoring, with total hip being preferred Forearm ROI Use 33% radius (sometimes called one-third radius) of the non-dominant forearm for diagnosis. Other forearm ROI are not recommended Fracture Risk Assessment " 側位脊椎影像不應作為診斷使用, 但可作為監測使用! 髖骨判讀區間 " 採用股骨頸或全髖骨兩者任一最低值 " 可以測量任何一側髖骨之骨密度 " 尚未有足夠證據來決定雙側髖骨骨密度平均 T 值可否作為診斷依據 " 髖骨骨密度平均值可用來監測骨密變化, 但仍建議採用全髖骨值為佳! 前臂判讀區間 " 使用非慣用手的橈骨 33% 長度處 ( 有時候稱為 1/3 橈骨 ) 作為診斷, 其他前臂區間均不建議使用 A distinction is made between diagnostic classification and the use of BMD for fracture risk assessment. For fracture risk assessment, any well-validated technique can be used, including measurements of more than one site where this has been shown to improve the assessment of risk. Use of the Term Osteopenia The term osteopenia is retained, but low bone mass or low bone density is preferred. People with low bone mass or density are not necessarily at high fracture risk. BMD Reporting in Postmenopausal Women and in Men Age 50 and Older 4 骨折風險評估! 診斷分類與以骨密度進行骨折風險評估明顯不同! 任何被驗證過的技術都可以用來作為骨折風險評估, 包含測量一個 部位以上也有助於改善風險評估 骨缺乏的用詞! 骨缺乏 (osteopenia) 一詞仍保留使用, 但是建議改用低骨量 (low bone mass) 或低骨密度 (low bone density)! 低骨量或低骨密度患者非必然具有高骨折風險 停經後婦女和 50 歲以上男性之骨密度報告

5 T-scores are preferred. The WHO densitometric classification is applicable. BMD Reporting in Females Prior to Menopause and in Males Younger Than Age 50 Z-scores, not T-scores, are preferred. This is particularly important in children. A Z-score of -2.0 or lower is defined as below the expected range for age, and a Z-score above -2.0 is within the expected range for age. Osteoporosis cannot be diagnosed in men under age 50 on the basis of BMD alone. The WHO diagnostic criteria may be applied to women in the menopausal transition. Z-Score Reference Database Z-scores should be population specific where adequate reference data exist. For the purpose of Z-score calculation, the patient s self-reported ethnicity should be used.! 建議採用 T 值! 使用世界衛生組織的分類標準停經前婦女和 50 歲以下男性之骨密度報告! 建議採用 Z 值, 而非 T 值 ; 尤其在兒童特別重要! 當 Z 值等於或小於 -2.0 時稱之為低於同齡的預期值 (below the expected range for age), 當 Z 值大於 -2.0 時稱之為介於同齡的預期值 (within the expected range for age)! 50 歲以下男性僅靠骨密度不可診斷為骨質疏鬆症! WHO 的診斷標準可以用於停經過渡期的女性 Z 值參考資料庫! Z 值應該以有適當參考資料存在的特定族群為參考值 為了 Z 值的計算, 病患自述種族資料應被採用 Serial BMD Measurements Serial BMD testing can be used to determine whether treatment should be started on untreated patients, because significant loss may be an indication for treatment. Serial BMD testing can monitor response to therapy by finding an increase or stability of bone density. Serial BMD testing can evaluate individuals for non-response by finding loss of bone density, suggesting the need for reevaluation of treatment and evaluation for secondary causes of osteoporosis. Follow-up BMD testing should be done when the expected change in BMD equals or exceeds the least significant change 5 系列骨密度測量! 系列骨密度檢測可以使用來決定未治療的病患是否應該開始治療, 因 為顯著的流失是治療的適應症! 系列骨密度檢測可以藉由發覺骨密度的增加或穩定來追蹤治療的反 應! 系列骨密度檢測可藉由發現骨密度的流失以評估無反應者, 給予再次 評估治療與評估骨質疏鬆症續發性原因的需求建議

6 (LSC). Intervals between BMD testing should be determined according to each patient s clinical status: typically one year after initiation or change of therapy is appropriate, with longer intervals once therapeutic effect is established. In conditions associated with rapid bone loss, such as glucocorticoid therapy, testing more frequently is appropriate. Phantom Scanning and Calibration The Quality Control (QC) program at a DXA facility should include adherence to manufacturer guidelines for system maintenance. In addition, if not recommended in the manufacturer protocol, the following QC procedures are advised: Perform periodic (at least once per week) phantom scans for any DXA system as an independent assessment of system calibration. Plot and review data from calibration and phantom scans. Verify the phantom mean BMD after any service performed on the densitometer. Establish and enforce corrective action thresholds that trigger a call for service. Maintain service logs. Comply with government inspections, radiation surveys and regulatory requirements.! 當骨密度的變化預期會等於或超過最小顯著變化值 (least significant change,lsc), 則應作追蹤骨密度檢測! 骨密度檢測的時間間隔應該根據每個病人的臨床狀況而定 : 通常為開始治療或改變治療後一年較適當, 一旦治療效果確立, 可以有較長的時間間隔! 在與快速骨質流失, 如類固醇治療相關的情況下, 較頻繁的檢測是適當的 假體掃描和校準雙能量 X 光吸收儀設備的品質管制程序應包括遵循製造商系統維護的指引 此外, 若製造商的指引未有建議, 則建議採以下品質管制程序 :! 對任何雙能量 X 光吸收儀系統執行週期性 ( 每週至少一次 ) 的假體掃描, 作為系統校準的獨立評估! 繪製及回顧校準和假體掃描的資料! 在執行任何骨密儀檢查後, 驗證假體平均骨密度! 建立和執行會觸發呼叫服務的校正措施之閾值! 維護服務紀錄! 遵守政府審查, 輻射檢測和法規要求 Precision Assessment Each DXA facility should determine its precision error and calculate the LSC. The precision error supplied by the manufacturer should not be used. If a DXA facility has more than one technologist, an average precision error combining data from all technologists should be 6 精確度評估! 每台雙能量 X 光吸收儀設備應確定其精確度誤差和計算最小顯著變化值! 不應使用製造商提供的精確度誤差! 假使雙能量 X 光吸收儀設備具有一個以上的技術員, 應該使用來自

7 used to establish precision error and LSC for the facility, provided the precision error for each technologist is within a pre-established range of acceptable performance. Every technologist should perform an in vivo precision assessment using patients representative of the clinic s patient population. Each technologist should do one complete precision assessment after basic scanning skills have been learned (e.g., manufacturer training) and after having performed approximately 100 patient-scans. A repeat precision assessment should be done if a new DXA system is installed. A repeat precision assessment should be done if a technologist s skill level has changed. To perform a precision analysis: Measure 15 patients 3 times, or 30 patients 2 times, repositioning the patient after each scan Calculate the root mean square standard deviation (RMS-SD) for the group Calculate LSC for the group at 95% confidence interval The minimum acceptable precision for an individual technologist is: Lumbar Spine: 1.9% (LSC=5.3%) Total Hip: 1.8% (LSC=5.0%) Femoral Neck: 2.5% (LSC=6.9%) Retraining is required if a technologist s precision is worse than these values Precision assessment should be standard clinical practice. Precision assessment is not research and may potentially benefit patients. It should not require approval of an institutional review board. Adherence to local radiologic safety regulations is necessary. Performance of a precision assessment requires the consent of participating patients. 所有技術人員的平均精確度誤差的合併數據, 去建立設備的精確度誤差和最小顯著變化值, 每個技術員提供的精確度誤差是在一個預先建立可接受的技能範圍內! 每個技術員應使用可代表診所病患族群的患者進行活體精確度評估! 每個技術員在學到基本掃描技能 ( 例如, 製造商培訓 ), 並已完成約 100 例患者掃描後, 都應該做一個完整的精確度評估! 如果安裝了新的雙能量 X 光吸收儀系統, 應該重複作精確度評估! 如果技術員的技術水準有變, 應該做重複的精確度評估! 執行精確度分析 " 測量 15 個病患 3 次或 30 個病患 2 次, 每次掃描後須重新定位病患 " 計算群體平方根標準差 (RMS-SD) " 計算群體在 95% 的信賴區間之最小顯著變化值! 個別技術員的最低可接受精確度為 :! 腰椎 :1.9% (LSC=5.3%)! 全髖骨 :1.8% (LSC= 5.0%)! 股骨頸 :2.5% (LSC=6.9%)! 如果一個技術員的精確度比這些值還差的話, 則需要再培訓! 精確度評估應該是標準的臨床工作 精確度評估不是研究, 且對患者可能有益 它不應該需要人體試驗委員會的核准 遵守當地的輻射安全法規是必要的 執行精確度評估需要參與患者的同意 Cross-Calibration of DXA Systems 7

8 When changing hardware, but not the entire system, or when replacing a system with the same technology (manufacturer and model), cross-calibration should be performed by having one technologist do 10 phantom scans, with repositioning, before and after hardware change. If a greater than 1% difference in mean BMD is observed, contact the manufacturer for service/correction When changing an entire system to one made by the same manufacturer using a different technology, or when changing to a system made by a different manufacturer, one approach to cross-calibration is: Scan 30 patients representative of the facility s patient population once on the initial system and then twice on the new system within 60 days Measure those anatomic sites commonly measured in clinical practice, typically spine and proximal femur Facilities must comply with locally applicable regulations regarding DXA Calculate the average BMD relationship and LSC between the initial and new machine using the ISCD DXA Machine Cross-Calibration Tool ( Use this LSC for comparison between the previous and new system. Inter-system quantitative comparisons can only be made if cross-calibration is performed on each skeletal site commonly measured Once a new precision assessment has been performed on the new system, all future scans should be compared to scans performed on the new system using the newly established intra-system LSC If a cross-calibration assessment is not performed, no quantitative comparison to the prior machine can be made. Consequently, a new baseline BMD and intra-system LSC should be established. 雙能量 X 光吸收儀系統的交叉校準! 當更換硬體, 而不是整個系統, 或用相同技術 ( 製造商和型號 ) 更換系統時, 交叉校準應當由一位技術員在硬體變化前後執行做 10 次有重新定位的假體掃描 " 如果在平均骨密度有大於 1% 的差異, 應聯繫製造商維修 / 校正! 當變動使用不同技術但相同製造商的整個系統, 或由不同製造商的系統時, 一種交叉校準的方法是 : " 在 60 天內掃描代表該設備的病患族群的 30 例患者, 一次在最初系統, 然後兩次在新系統上 " 測量臨床工作常用的測量解剖部位, 一般是脊椎和近端股骨 " 設備必須按照當地有關雙能量 X 光吸收儀的適用法規 " 使用 ISCD DXA 交叉校準工具計算初始和新機之間的平均骨密度關係和最小顯著變化值 ( " 使用此最小顯著變化值以前的和新系統的比較 如果每個常用的骨骼測量部位可以進行交叉校準, 則系統間的定量比較就可以進行 " 一旦新的精確度評估已在新系統上執行, 今後所有掃描應與使用新建立的系統內的最小顯著變化值所作的新系統掃描比較! 如果不進行交叉校準評估, 就無法與過去機器作定量比較 因此應該建立一個新的基準骨密度和系統內最小顯著變化值 8

9 BMD Comparison Between Facilities It is not possible to quantitatively compare BMD or to calculate a LSC between facilities without cross-calibration. Vertebral Fracture Assessment Nomenclature Vertebral Fracture Assessment (VFA) is the correct term to denote densitometric spine imaging performed for the purpose of detecting vertebral fractures. Indications for VFA Lateral Spine imaging with Standard Radiography or Densitometric VFA is indicated when T-score is < -1.0 and of one or more of the following is present; Women age 70 years or men age 80 years Historical height loss > 4 cm (>1.5 inches) Self-reported but undocumented prior vertebral fracture Glucocorticoid therapy equivalent to 5 mg of prednisone or equivalent per day for 3 months 設備間的骨密度比較! 在無交叉校準的設備間定量比較骨密度或計算最小顯著變化值是不可能的 脊椎骨折評估的命名! 脊椎骨折評估 (VFA) 是正確的用詞, 用來表示以檢測脊椎骨折的目的進所進行的密度測量脊椎影像 脊椎骨折評估的適應症! 使用標準放射影像技術的側面脊椎影像或密度測量脊椎骨折評估的適應症應在於當 T 值小於 -1.0 和有下述一項或多項情況時 ; " 70 歲以上的女性或 80 歲以上的男性 " 歷史身高減少大於 4 公分 ( 大於 1.5 英吋 ) " 自我報告, 但未證實的過去脊椎骨折 " 糖皮質激素治療, 持續 3 個月以上每天 5 毫克以上的醋酸去氫副腎皮質素 (prednisolone) 或相等效價者 Methods for Defining and Reporting Fractures on VFA The methodology utilized for vertebral fracture identification should be similar to standard radiological approaches and be provided in the report. Fracture diagnosis should be based on visual evaluation and include assessment of grade/severity. Morphometry alone is not recommended because it is unreliable for diagnosis. The Genant visual semi-quantitative method is the current 9 定義和報告在脊椎骨折評估有骨折之方法! 用於脊椎骨折鑑別的方法應該是類似於標準的放射學方法, 並在報告 中提供! 骨折的診斷應根據視覺評估, 包括級別 / 嚴重程度的評估 不建議單 獨的形態測定法, 因為它是不可靠的診斷

10 clinical technique of choice for diagnosing vertebral fracture with VFA. Severity of deformity may be confirmed by morphometric measurement if desired. Indications for Following VFA With Another Imaging Modality The decision to perform additional imaging must be based on each patient s overall clinical picture, including the VFA result. Indications for follow-up imaging studies include: Two or more mild (grade 1) deformities without any moderate or severe (grade 2 or 3) deformities Lesions in vertebrae that cannot be attributed to benign causes Vertebral deformities in a patient with a known history of a relevant malignancy Equivocal fractures Unidentifiable vertebrae between T7-L4 Sclerotic or lytic changes, or findings suggestive of conditions other than osteoporosis Note: VFA is designed to detect vertebral fractures and not other abnormalities.! 該 Genant 視覺半定量方法是目前診斷脊椎骨折與脊椎骨折評估的臨床技術選擇! 如果需要的話, 變形的嚴重程度可以通過形態的測量作確認 使用額外影像方式作後續脊椎骨折評估的適應症! 執行額外影像的決定必須根據每個病人的整體臨床表現, 包括脊椎骨折評估結果! 後續影像檢查的適應症包括 : " 兩個或更多的輕度 (1 級 ) 變形沒有任何中度或重度 (2 或 3 級 ) 的變形 " 不能歸因於良性原因的脊椎損害 " 脊椎變形出現在有惡性腫瘤相關病史的病人 " 不確定性骨折 " 第 7 胸椎至第 4 腰椎有無法辨識的脊椎 " 硬化性或溶骨性變化, 或除骨質疏鬆症外的情況備註 : 脊椎骨折評估是用來檢測脊椎骨折而非其他異常 Baseline DXA Report: Minimum Requirements Demographics (name, medical record identifying number, date of birth, sex). Requesting provider. Indications for the test. Manufacturer and model of instrument used Technical quality and limitations of the study, stating why a specific site or ROI is invalid or not included. BMD in g/cm2 for each site. The skeletal sites, ROI, and, if appropriate, the side, that were 10 基本的雙能量 X 光吸收儀報告 : 最低要求! 人口統計資料 ( 姓名 病歷號碼 出生日期 性別 )! 需求提供者! 檢測的適應症! 製造商和使用的儀器型號! 技術品質和檢查限制, 說明為什麼一個特定部位或判讀區間是無效或 不包括在內

11 scanned. The T-score and/or Z-score where appropriate. WHO criteria for diagnosis in postmenopausal females and in men age 50 and over. Risk factors including information regarding previous non traumatic fractures. A statement about fracture risk. Any use of relative fracture risk must specify the population of comparison (e.g., young- adult or age-matched). The ISCD favors the use of absolute fracture risk prediction when such methodologies are established. A general statement that a medical evaluation for secondary causes of low BMD may be appropriate. Recommendations for the necessity and timing of the next BMD study. Follow-Up DXA Report Statement regarding which previous or baseline study and ROI is being used for comparison. Statement about the LSC at your facility and the statistical significance of the comparison. Report significant change, if any, between the current and previous study or studies in g/cm2 and percentage. Comments on any outside study including manufacturer and model on which previous studies were performed and the appropriateness of the comparison. Recommendations for the necessity and timing of the next BMD study.! 每個部位骨密度 g/cm 2! 骨骼部位 判讀區間, 如果適當的話, 加註被掃描側! 適當的 T 值和 / 或 Z 值! 世界衛生組織對停經後女性和 50 歲及以上男性的診斷標準! 危險因子, 包括關於先前非創傷性骨折的資訊! 關於骨折風險的說明 任何使用相對骨折風險必須指定比較 ( 例如, 年輕成人或年齡匹配者 ) 的族群 當這些方法都建立後, 國際臨床骨密檢測學會傾向使用絕對骨折風險預測! 對低骨密度的續發性原因作適當醫療評估的一般性說明! 下一次骨密度檢查的必要性和時機的建議 追蹤雙能量 X 光吸收儀報告! 關於哪次過去或基本檢查和判讀區間被用以比較的說明! 關於你的設備的最小顯著變化和比較的統計顯著性之說明! 如果可以的話, 以 g/cm 2 和百分比方式報告目前和過去的檢查之間的顯著變化! 對任何外面檢查的意見, 包括過去執行檢查的製造商及型號和比較的適當性! 下一次骨密度檢查的必要性和時機的建議 DXA Report: Optional Items Recommendation for further non-bmd testing, such as X-ray, magnetic resonance imaging, computed tomography, etc. Recommendations for pharmacological and non pharmacological interventions. 11 雙能量 X 光吸收儀報告 : 選擇性項目! 建議進一步的非骨密度檢測, 如 X 光 磁振造影 電腦斷層掃描等

12 Addition of the percentage compared to a reference population. Specific recommendations for evaluation of secondary osteoporosis. DXA Report: Items That Should not be Included A statement that there is bone loss without knowledge of previous bone density. Mention of mild, moderate, or marked osteopenia or osteoporosis. Separate diagnoses for different ROI (e.g., osteopenia at the hip and osteoporosis at the spine). Expressions such as She has the bones of an 80-year-old, if the patient is not 80 years old. Results from skeletal sites that are not technically valid. The change in BMD if it is not a significant change based on the precision error and LSC. Components of a VFA Report Patient identification, referring physician, indication(s) for study, technical quality and interpretation. A follow-up VFA report should also include comparability of studies and clinical significance of changes, if any. VFA reports should comment on the following Unevaluable vertebrae Deformed vertebrae, and whether or not the deformities are consistent with vertebral fracture Unexplained vertebral and extra-vertebral pathology Optional components include fracture risk and recommendations for additional studies. General Recommendations for Non Central DXA Devices: QCT, pqct, QUS, and pdxa! 對藥物和非藥物介入的建議! 對比參考族群的增加比例! 對評估續發性骨質疏鬆症的特定建議 雙能量 X 光吸收儀報告 : 不應該包括的項目! 無過去骨密度的知識就說明有骨缺乏! 提及 輕度 中度 或 顯著 骨缺乏或骨質疏鬆症! 對不同的判讀區間作分別的診斷 ( 例如, 髖部的骨缺乏和脊椎的骨質疏鬆症 )! 假如病人不是 80 歲, 說明如 她有 80 歲的骨頭! 非技術上有效的骨骼部位之結果! 骨密度的變化, 如果依據精確度誤差和最小顯著變化下並不顯著時 脊椎骨折評估報告的組成! 患者身分 轉介醫師 檢查適應症 技術品質和判讀! 如果可以的話, 追蹤脊椎骨折評估報告也應包括檢查的比較和臨床變化的意義! 脊椎骨折評估報告應對以下作解說 " 無法評估的脊椎 " 變形的脊椎, 以及是否與脊椎骨折一致 " 不明原因的脊椎以及脊椎外病變! 選擇的部分包括骨折風險及進一步的檢查建議 對非中軸型雙能量 X 光吸收儀儀器的一般性建議 : 定量電腦斷層 (QCT) 周邊型定量電腦斷層(pQCT) 定量超音波(QUS) 及周邊型雙 12

13 The following general recommendations for QCT, pqct, QUS, and pdxa are analogous to those defined for central DXA technologies. Examples of technical differences amongst devices, fracture prediction ability for current manufacturers and equivalence study requirements are provided in the full text documents printed in the Journal of Clinical Densitometry. Bone density measurements from different devices cannot be directly compared. Different devices should be independently validated for fracture risk prediction by prospective trials, or by demonstration of equivalence to a clinically validated device. T-scores from measurements other than DXA at the femur neck, total femur, lumbar spine, or one-third (33%) radius cannot be used according to the WHO diagnostic classification because those T-scores are not equivalent to T-scores derived by DXA. Device-specific education and training should be provided to the operators and interpreters prior to clinical use. Quality control procedures should be performed regularly. 能量 X 光吸收儀 (pdxa) 對於定量電腦斷層 周邊型定量電腦斷層 定量超音波及周邊型雙能量 X 光吸收儀, 以下的一般建議是類似於中軸型雙能量 X 光吸收儀的技術定義 臨床骨密雜誌印有全文文檔, 提供設備間技術性差異的範例, 目前製造商骨折預測能力, 以及等效性研究的需求! 來自不同的設備骨密度測量不能直接比較! 不同的設備應藉前瞻性研究獨立驗證骨折風險預測, 或者通過示範等價的臨床驗證設備! 根據世界衛生組織的診斷分類, 不能使用來自於非雙能量 X 光吸收儀在股骨頸 全股骨 腰椎, 或三分之一 (33 %) 橈骨測量的 T 值, 因為這些 T 值並不等同於經雙能量 X 光吸收儀所得之 T 值! 在臨床應用前, 應提供給操作者和判讀者設備特定的教育和培訓! 品質控制程序應定期進行 Baseline Non Central DXA Devices (QCT, pqct, QUS, pdxa) Report: Minimum Requirements Date of test Demographics (name, date of birth or age, sex) Requesting provider Names of those receiving copy of report Indications for test Manufacturer, and model of instrument and software version Measurement value(s) Reference database Skeletal site/roi Quality of test Limitations of the test including a statement that the WHO diagnostic classification cannot be applied to T-scores obtained 13 基本非中軸性雙能量 X 光吸收儀儀器 ( 定量電腦斷層 周邊型定量電 腦斷層 定量超音波, 及周邊型雙能量 X 光吸收儀 ): 最低需求! 測試日期! 人口統計資料 ( 姓名 出生日期或年齡 性別 )! 需求提供者! 報告的接受副本名稱! 檢測適應症! 製造商, 以及儀器型號和軟體版本! 測量值! 參考數據庫

14 from QCT, pqct, QUS, and pdxa (other than one-third (33%) radius) measurements Clinical risk factors Fracture risk estimation A general statement that a medical evaluation for secondary causes of low BMD may be appropriate Recommendations for follow-up imaging Note: A list of appropriate technical items is provided in the QCT and pqct sections of the full text documents printed in the Journal of Clinical Densitometry. Non Central DXA Devices (QCT, pqct, QUS, pdxa) Report: Optional Items Report may include the following optional item: o Recommendations for pharmacological and non pharmacological interventions. QCT and pqct! 骨骼部位 / 判讀區間! 檢測的品質! 檢測的限制, 包括世界衛生組織診斷分類不能應用於從定量電腦斷層 周邊型定量電腦斷層 定量超音波, 及周邊型雙能量 X 光吸收儀 [ 非三分之一 (33%) 橈骨 ] 等獲得的 T 值之說明! 臨床危險因子! 骨折風險估計! 對低骨密度的續發性原因作適當醫療評估的一般性說明! 後續追蹤影像的建議備註 : 臨床骨密雜誌印有定量電腦斷層和周邊型定量電腦斷層章節中的全文文檔提供適當的技術項目的清單 非中軸行雙能量 X 光吸收儀 ( 定量電腦斷層 周邊型定量電腦斷層 定量超音波, 及周邊型雙能量 X 光吸收儀 ) 報告 : 選擇性項目! 報告可能包括下述選擇性項目 : " 藥物和非藥物介入的建議 Acquisition With single-slice QCT, L1-L3 should be scanned; with 3D QCT, L1-L2 should be scanned. Fracture Prediction Spinal trabecular BMD as measured by QCT has at least the same ability to predict vertebral fractures as AP spinal BMD measured by central DXA in postmenopausal women. There is lack of sufficient evidence to support this position for men. There is lack of sufficient evidence to recommend spine QCT for hip fracture prediction in either women or men. pqct of the forearm at the ultra-distal radius predicts hip, but not spine, fragility fractures in postmenopausal women. There is lack of sufficient evidence to support 14 定量電腦斷層和周邊型定量電腦斷層! 取像 " 使用單張切片定量電腦斷層, 第 1 腰椎至第 3 腰椎應該掃描 ; 使! 骨折預測 用 3 維定量電腦斷層, 第 1 腰椎至第 2 腰椎應該掃描 " 定量電腦斷層測量脊椎骨小樑骨密度與中軸型雙能量 X 光吸收 儀測量前後位脊椎骨密度有至少相同的能力預測停經後婦女脊 椎骨折 目前缺乏足夠的證據來支持男性立場 " 目前缺乏足夠的證據建議脊椎定量電腦斷層作為無論是女性或 男性髖部骨折的預測

15 this position for men. Therapeutic Decisions Central DXA measurements at the spine and femur are the preferred method for making therapeutic decisions and should be used if possible. However, if central DXA cannot be done, pharmacologic treatment can be initiated if the fracture probability, as assessed by QCT of the spine or pqct of the radius using device specific thresholds, and in conjunction with clinical risk factors, is sufficiently high. Monitoring Trabecular BMD of the lumbar spine measured by QCT can be used to monitor age-, disease-, and treatment-related BMD changes. Trabecular and total BMD of the ultra-distal radius measured by pqct can be used to monitor age-related BMD changes. Reporting For QCT using whole body CT scanners the following additional technical items should be reported: Tomographic acquisition and reconstruction parameters kv, mas Collimation during acquisition Table increment per rotation Table height Reconstructed slice thickness, reconstruction increment Reconstruction kernel For pqct using dedicated pqct scanners, the following additional technical items should be reported: Tomographic acquisition and reconstruction parameters 15 " 前臂橈骨最末端的周邊型定量電腦斷層可以預測停經後婦女髖 部而非脊椎的脆弱性骨折 目前缺乏足夠的證據可支持此立場用 於男性! 治療決策 " 中軸型雙能量 X 光吸收儀測量脊椎和股骨是作治療決策的首選! 監測 方法, 可能的話應該使用 但是, 如果中軸型雙能量 X 光吸收 儀不能做, 但脊椎定量電腦斷層及橈骨週邊型定量電腦斷層使用 特定的設備的閾值, 並結合臨床危險因子評估的骨折機率是夠高 時, 可以使用藥物治療 " 定量電腦斷層測量的腰椎骨小樑骨密度可以使用於監測年齡 疾 病 治療相關的骨密度變化 " 周邊型定量電腦斷層橈骨測量的最末端骨小樑及整體骨密度可! 報告 以使用於監測年齡相關的骨密度變化 " 對於使用全身電腦斷層掃描儀的定量電腦斷層, 以下額外的技術 項目應報告 : # 斷層取像和重建參數 # 千伏 (kv) 毫安培秒 (mas) # 取像過程的準直 # 每轉檯面增加量 # 檯面高度 # 重構切片厚度, 重建增加量 # 重建核心! 對於使用專用週邊型電腦斷層掃描儀的週邊型電腦斷層, 下列額外的 技術項目應報告 :

16 QUS Reconstructed slice thickness Single / multi-slice acquisition mode Length of scan range in multi-slice acquisition mode Acquisition The only validated skeletal site for the clinical use of QUS in osteoporosis management is the heel. Fracture Prediction Validated heel QUS devices predict fragility fracture in postmenopausal women (hip, vertebral, and global fracture risk) and men over the age of 65 (hip and all non-vertebral fractures), independently of central DXA BMD. Discordant results between heel QUS and central DXA are not infrequent and are not necessarily an indication of methodological error. Heel QUS in conjunction with clinical risk factors can be used to identify a population at very low fracture probability in which no further diagnostic evaluation may be necessary. (Examples of device-specific thresholds and case findings strategy are provided in the full text documents printed in the Journal of Clinical Densitometry.) Therapeutic Decisions Central DXA measurements at the spine and femur are preferred for making therapeutic decisions and should be used if possible. However, if central DXA cannot be done, pharmacologic treatment can be initiated if the fracture probability, as assessed by heel QUS, using device specific thresholds and in conjunction with clinical risk factors, is sufficiently high. (Examples of device-specific thresholds are provided in the full text documents printed in the Journal of Clinical 16 超音波 " 斷層取像和重建參數 " 重構的切片厚度 " 單 / 多切片取像模式 " 多片取像模式的掃描範圍長度! 取像 " 臨床使用定量超音波處理骨質疏鬆症的唯一驗證之骨骼部位是 足跟! 骨折預測 " 經過驗證的足跟定量超音波設備可預測停經後婦女 ( 髖部, 脊 椎, 和整體骨折風險 ) 和 65 歲以上男性 ( 髖部和所有非脊椎骨折 ) 的脆弱性骨折, 並獨立於中軸型雙能量 X 光吸收儀骨密度 " 足跟定量超音波和中軸型雙能量 X 光吸收儀間結果不一致的情 況並不少見, 不一定是方法錯誤 " 足跟定量超音波結合臨床危險因子可以辨識骨折機率很低的族! 治療決策 群, 而沒必要作進一步診斷評估 ( 臨床骨密雜誌印有全文文檔 提供設備特定閾值的範例和個案研究結果的策略 ) " 中軸型雙能量 X 光吸收儀測量脊椎和股骨是作治療決策的首選 方法, 可能的話應該使用 但是, 如果中軸型雙能量 X 光吸收 儀不能做, 但足跟定量超音波使用特定的設備的閾值, 並結合臨 床危險因子評估的骨折機率是夠高時, 可開始使用藥物治療 ( 臨 床骨密雜誌印有全文文檔提供設備特定閾值的範例 )

17 Densitometry.) Monitoring QUS cannot be used to monitor the skeletal effects of treatments for osteoporosis.! 監測 " 定量超音波不能使用於監測在骨骼的骨質疏鬆症之治療效果 pdxa Fracture Prediction Measurement by validated pdxa devices can be used to assess vertebral and global fragility fracture risk in postmenopausal women, however its vertebral fracture predictive ability is weaker than central DXA and heel QUS. There is lack of sufficient evidence to support this position for men. Radius pdxa in conjunction with clinical risk factors can be used to identify a population at very low fracture probability in which no further diagnostic evaluation may be necessary. (Examples of device-specific thresholds and case findings strategy are provided in the full text documents printed in the Journal of Clinical Densitometry.) Diagnosis The WHO diagnostic classification can only be applied to DXA at the femur neck, total femur, lumbar spine and the one-third (33%) radius ROI measured by DXA or pdxa devices utilizing a validated young-adult reference database. Therapeutic Decisions Central DXA measurements at the spine and femur are the preferred method for making therapeutic decisions and should be used if possible. However, if central DXA cannot be done, pharmacologic treatment can be initiated if the fracture probability, as assessed by radius pdxa (or DXA) using device specific thresholds and in conjunction with clinical risk factors, is sufficiently high. (Examples of 17 周邊型雙能量 X 光吸收儀! 骨折預測 " 通過驗證周邊型雙能量 X 光吸收儀設備的測量可用於評估停經 後婦女脊椎和的整體脆弱性骨折的風險, 但其脊椎骨折的預測能 力比中軸型雙能量 X 光吸收儀和足跟定量超音波弱 目前缺乏 足夠的證據可支持此立場用於男性 " 橈骨的周邊型雙能量 X 光吸收儀結合臨床危險因子可以辨識骨! 診斷 折機率很低的族群, 而沒必要作進一步診斷評估 ( 臨床骨密雜 誌印有全文文檔提供設備特定閾值的範例和個案研究結果的策 略 ) " 世界衛生組織診斷分類可以應用於雙能量 X 光吸收儀測量的股! 治療決策 骨頸 全股骨 腰椎, 以及利用驗證過的年輕成人資料庫的雙能 量 X 光吸收儀和周邊型雙能量 X 光吸收儀測量的三分之一 (33%) 橈骨判讀區間 " 中軸型雙能量 X 光吸收儀測量脊椎和股骨是作治療決策的首選 方法, 可能的話應該使用 但是, 如果中軸型雙能量 X 光吸收 儀不能做, 但周邊型雙能量 X 光吸收儀 ( 和雙能量吸收儀 ) 使用特

18 device-specific thresholds are provided in the full text documents printed in the Journal of Clinical Densitometry.) Monitoring pdxa devices are not clinically useful in monitoring the skeletal effects of presently available medical treatments for osteoporosis. Body Composition Indications DXA total body composition with regional analysis can be used in the following conditions: $ In patients living with HIV to assess fat distribution in those using anti-retroviral agents associated with a risk of lipoatrophy (currently stavudine [d4t] and zidovudine [ZDV, AZT]). $ In obese patients undergoing bariatric surgery (or medical, diet, or weight loss regimens with anticipated large weight loss) to assess fat and lean mass changes when weight loss exceeds approximately 10%. The impact on clinical outcomes is uncertain. $ In patients with muscle weakness or poor physical functioning to assess fat and lean mass. The impact on clinical outcomes is uncertain. 定的設備的閾值, 並結合臨床危險因子評估的骨折機率是夠高時, 可以使用藥物治療 ( 臨床骨密雜誌印有全文文檔提供設備特定閾值的範例 )! 監測 " 周邊型雙能量 X 光吸收儀設備在監測目前藥物治療有骨質疏鬆症的骨骼效果在臨床上仍未有用 人體組成! 適應症 " 雙能量 X 光吸收儀的全人體組成及區間分析可以在下述情況下使用 : # 在愛滋病病患, 評估使用抗反轉錄病毒藥物有脂肪萎縮相關風險的脂肪分布情形 ( 目前 stavudine [d4t] 和 zidovudine [ZDV, AZT]) # 在接受減重手術的肥胖病患 ( 或藥物 飲食 或減重療法有預期性大量體重減少 ), 當減重超過 10% 時, 評估脂肪和瘦體質量變化 對臨床結果的影響是不確定的 # 在肌肉無力或身體功能較差的患者, 評估脂肪和瘦體質量 對臨床結果的影響是不確定的 Pregnancy is a contraindication to DXA body composition. Limitations in the use of clinical DXA for total body composition or bone mineral density are 18 " 懷孕是雙能量 X 光吸收儀檢測人體組成的禁忌 在臨床上 使用雙能量 X 光吸收儀作全身組成分析和骨密度檢查的限

19 Acquisition weight over the table limit, recent administration of contrast material and/or artifact. Radiopharmaceutical agents may interfere with accuracy of results using systems from some DXA manufacturers. No phantom has been identified to remove systematic differences in body composition when comparing in-vivo results across manufacturers. An in-vivo cross-calibration study is necessary when comparing in-vivo results across manufacturers. Cross-calibrating systems of the same make and model can be performed with an appropriate whole body phantom. Changes in body composition measures can be evaluated between two different systems of the same make and model if the systems have been cross-calibrated with an appropriate total body phantom. When changing hardware, but not the entire system, or when replacing a system with the same technology (make and model), cross-calibration should be performed by having one technologist do 10 whole body phantom scans, with repositioning, before and after hardware change. If a greater than 2% difference in mean percent fat mass, fat mass or lean mass is observed, contact the manufacturer for service/correction. No total body phantoms are available at this time that 制是體重超過檢查檯限制, 最近服用顯影劑和 / 或假影 放射性藥物可能會干擾一些雙能量 X 光吸收儀製造商所使用的系統的結果準確性! 取像 " 沒有假體在跨廠牌比較活體結果時, 可以除去人體組成的系統差異 " 當比較跨廠牌的活體結果時, 活體交叉校準的研究是必要的 " 相同品牌和型號的交叉校準系統時, 可以使用適當的全身假體進行 " 如果系統已經用適當的全身假體交叉校準過, 則測量人體組成的變化, 可以在同一品牌和型號的兩種不同的系統之間進行評估 " 當變更硬體, 而不是整個系統, 或使用相同的技術 ( 品牌和型號 ) 更換系統時, 交叉校準應在硬體變更前後, 由一個技術員進行做 10 次有重新定位的全身假體掃描 如果觀察到 19

20 can be used as absolute reference standards for soft-tissue composition or bone mineral mass. The Quality Control (QC) program at a DXA body composition facility should include adherence to manufacturer guidelines for system maintenance. In addition, if not recommended in the manufacturer protocol, the following QC procedures are advised: $ Perform periodic (at least once per week) body composition phantom scans for any DXA system as an independent assessment of system calibration. $ Plot and review data from calibration and body composition phantom scans. $ Verify the body composition phantom mean percent fat mass and tissue mass after any service performed on the densitometer. $ Establish and enforce corrective action thresholds that trigger a call for service. $ Maintain service logs. $ Comply with radiation surveys and regulatory government inspections, radiation surveys and regulatory requirements. Consistent positioning and preparation (e.g. fasting state, clothing, time of day, physical activity, empty bladder) of the patient is important for accurate and precise measures. 平均百分比脂肪質量, 脂肪質量或瘦體質量大於 2% 的差異, 則與製造商聯繫維修 / 校正 " 目前沒有全身假體可以用來作為軟組織組成或骨礦物質量的絕對參考標準 " 在雙能量 X 光吸收儀人體組成設備的品質管制程序應包括遵循製造商系統維護的指引 此外, 若製造商的指引未有建議, 則建議採以下品質管制程序 : # 對任何雙能量 X 光吸收儀系統執行週期性 ( 每週至少一次 ) 的人體組成假體掃描, 作為系統校準的獨立評估 # 繪製及回顧校準和假體掃描的資料 # 在執行任何骨密儀檢查後, 驗證人體組成假體平均百分比脂肪質量和組織質量 # 建立和執行會觸發呼叫服務的校正措施之閾值 # 維護檢查紀錄 # 遵守政府審查, 輻射檢測和法規要求 Positioning of the arms, hands, legs and feet whenever possible should be the NHANES method 20 " 病患一致的定位和準備 ( 如空腹狀態 服裝 當日時間 體

21 (palms down isolated from the body, feet neutral, ankles strapped, arms straight or slightly angled, face up with neutral chin). Offset-scanning should be used in patients who are too wide to fit within the scan boundaries, using a validated procedure for a specific scanner model. Every technologist should perform an in-vivo precision assessment for all body composition measures of interest using patients who are representative of the clinic s patient population. The minimum acceptable precision for an individual technologist is 3%, 2% and 2% for total fat mass, total lean mass, and percent fat mass, respectively. Consistently use manufacturer s recommendations for ROI placement. Consistently use manufacturer s recommendations for artifact removal. 能活動 排空膀胱 ) 對準確和精確的測量很重要 " 手臂, 手, 腿和腳應該盡可能按 NHANES 的方法擺放 ( 手心向下離開身體, 雙腳置中, 腳踝約束, 雙臂伸直或略有角度, 面朝上及下巴置中 ) " 偏移掃描 應使用在病人身材太寬, 以至於不在掃描範圍內, 其是使用特定掃描儀型號驗證過的程序 " 每個技術員應使用代表該診所病患族群所有感興趣的人體組成的量測, 執行活體精密度評估 " 個別技術員的總脂肪質量, 總瘦體質量和百分比脂肪質量之最小可接受精確度分別為 3% 2% 和 2% " 始終使用製造商的建議作判讀區間定位 " 始終使用製造商的建議去除假影 Analysis and Reporting For adults total body (with head) values of BMI, BMD, BMC, total mass, total lean mass, total fat mass, and percent fat mass should appear on all reports. Total Body BMC as represented in the NHANES reference data should be used when using DXA in 4-compartment models.! 分析和報告 " 對於成年人全身 ( 含頭 ) 的身體質量指數 骨密度 骨礦物含量 總質量 總瘦體質量 總脂肪質量和百分比脂肪質量的數值應該出現在所有的報告 DXA measures of adiposity and lean mass include visceral adipose tissue (VAT), appendicular lean mass index (ALMI: appendicular lean mass/ht 2 ), android/gynoid percent fat mass ratio, trunk to leg fat 21 " 當使用四組份模式時, 雙能量 X 光吸收儀的全身骨礦物含 量應該使用 NHANES 1999 年至 2004 年的參考資料作為代

22 Glossary mass ratio, lean mass index (LMI: total lean mass/ht 2 ), fat mass index (FMI: fat mass/ht 2 ) are optional. The clinical utility of these measures is currently uncertain. When comparing to the US population, the NHANES body composition data are most appropriate for different races, both sexes, and for ages from 8 to 85 years. [Note: Reference to a population does not imply health status.] Both Z-scores and percentiles are appropriate to report if derived using methods to adjust for non-normality. The use of DXA adiposity measures (percent fat mass or fat mass index) may be useful in risk-stratifying patients for cardio-metabolic outcomes. Specific thresholds to define obesity have not been established. Low lean mass could be defined using appendicular lean mass divided by height squared (ALM/height 2 ) with Z-scores derived from a young adult, race, and sex-matched population. Thresholds for low lean mass from consensus guidelines for sarcopenia await confirmation. ALMI appendicular lean mass index BMC bone mineral content 表 " 雙能量 X 光吸收儀量測之肥胖和瘦體質量包括內臟脂肪組織 (VAT) 四肢瘦體質量指數(ALMI: 四肢瘦體質量 / 身高 2 ) 雄型 / 雌型百分比脂肪質量比 軀幹比腿部脂肪質量比 瘦體質量指數 (LMI: 瘦體質量 / 身高 2 ) 脂肪質量指數(FMI: 脂肪質量 / 身高 2 ) 則是選擇性的測量值 這些測量值的臨床應用目前尚無定論 " 當比較美國族群,1999 至 2004 年 NHANES 的人體組成資料是最適合於不同的種族 性別, 及年齡從 8 至 85 歲 [ 備註 : 參照一個族群並不意味著健康狀況 ] " 如果要使用方法來調整非常態性, 用 Z 值和百分位數兩者來報告是適當的 " 使用雙能量 X 光吸收儀之肥胖測量 ( 百分比脂肪質量和脂肪質量指數 ) 可能在心臟代謝的結果風險分層的患者是有用的 用來定義肥胖的特定閾值尚未建立 " 低瘦體質量 可以用四肢瘦體質量除以身高的平方 (ALM/height 2 ) 與從一個年輕的成人 種族和性別匹配的族群衍生的 Z 值來的定義 來自肌少症的共識指引的低瘦體質量閾值仍有待進一步確立 22

23 BMD bone mineral density BMI - body mass index DXA dual-energy X-ray absorptiometry FMI fat mass index ISCD International Society for Clinical Densitometry LMI lean mass index LSC least significant change NHANES III National Health and Nutrition Examination Survey III PA posterior anterior pdxa peripheral dual-energy x-ray absorptiometry pqct peripheral quantitative computed tomography QC quality control QCT quantitative Computed Tomography 詞彙表 ALMI appendicular lean mass index( 四肢瘦體質量指數 ) BMC bone mineral content( 骨礦物含量 ) BMD bone mineral density( 骨密度 ) BMI - body mass index( 身體質量指數 ) DXA dual-energy X-ray absorptiometry( 雙能量 X 光吸收儀 ) FMI fat mass index( 脂肪質量指數 ) ISCD International Society for Clinical Densitometry( 國際臨床骨密檢 測學會 ) LMI lean mass index( 瘦體質量指數 ) LSC least significant change( 最小顯著變化 ) NHANES III National Health and Nutrition Examination Survey III( 第三次全國健康與營養檢驗調查 ) PA posterior anterior( 後前位 ) pdxa peripheral dual-energy x-ray absorptiometry( 週邊型雙能量 X 吸收儀 ) 23 pqct peripheral quantitative computed tomography( 週邊型定量電腦

24 QUS quantitative Ultrasound ROI region(s) of interest SSI - strain strength index TBLH total body less head VAT visceral adipose tissue VFA Vertebral Fracture Assessment vbmd volumetric BMD WHO World Health Organization Copyright ISCD, July Supersedes all prior Official Positions publications. - See more at: 斷層 ) QC quality control( 品質管控 ) QCT quantitative Computed Tomography( 定量電腦斷層 ) QUS quantitative Ultrasound( 定量超音波 ) ROI region(s) of interest( 判讀區間 ) SSI - strain strength index( 應變強度指數 ) TBLH total body less head( 去頭外全身 ) VAT visceral adipose tissue( 內臟脂肪組織 ) VFA Vertebral Fracture Assessment( 脊椎骨折評估 ) vbmd volumetric BMD( 體積骨密度 ) WHO World Health Organization( 世界衛生組織 ) 國際臨床骨密檢測學會版權, 2013 七月 取代所有先前出版之官方立場 - 可上網進一步查詢 : Traditional Chinese version was translated by Zih-Jie Sun and Paulo, Chih-Hsing Wu ( 繁體中文版由孫子傑 / 吳至行翻譯 ) 24

25 25