基于定量CT的绝经后妇女髋部脆性骨折风险评估研究进展

Quantitative CT Analysis for Predicting Hip Fragility Fracture Risk in Postmenopausal Women: A Value Assessment

摘要: 骨质疏松性骨折(或称脆性骨折)指受到轻微创伤或日常活动中即发生的骨折，是骨质疏松症的严重后果，而绝经后妇女髋关节骨折又是最严重的脆性骨折，是老年患者致残和致死的主要原因之一。随着社会人口老龄化的加剧，绝经后妇女髋部由于骨质疏松所致的脆性骨折已经成为一个日益严重的全球性问题。目前用于诊断骨质疏松症的方法存在一定的局限性，因此影像学准确测量和评估就显得尤为重要。脆性骨折的发生一方面是因为其他伴随疾病导致患者摔倒的风险增高，另一方面是由于各种原因导致骨量(骨密度或大小)减少，骨量的空间分布(即宏观结构和微观结构)破坏以及构成骨骼的材料属性改变，使得骨骼抵抗骨折的能力减低，脆性增加，使之不能承载一定外力所致。因此影像学成像技术旨在测量单个或多个骨强度决定因素来进行老年髋关节脆性骨折的风险评估。本文综合分析当前CT定量研究在绝经后妇女髋部骨折风险预测领域的最新进展，重点评述CT衍生骨密度和影像指标、体成分评估、预测模型构建以及临床转化应用，并讨论该领域面临的挑战与发展趋势，以期为相关研究和临床实践提供参考。

Abstract: Osteoporotic fractures, also known as fragility fractures, refer to fractures that occur as a result of minor trauma or during daily activities. They represent a severe consequence of osteoporosis, with hip fractures in postmenopausal women being the most serious type of fragility fracture and one of the leading causes of disability and mortality among elderly patients. With the increasing aging of the global population, fragility fractures of the hip due to osteoporosis in postmenopausal women have become a growing worldwide concern. Current methods for diagnosing osteoporosis have certain limitations, making accurate imaging measurements and assessments particularly important. The occurrence of fragility fractures is attributed, on one hand, to an increased risk of falls due to comorbid conditions, and on the other hand, to reduced bone mass (bone density or size), disruption in the spatial distribution of bone mass (i.e., macro- and micro-architecture), and alterations in the material properties of bone tissue. These factors collectively diminish the bone’s ability to resist fractures, increase its fragility, and render it incapable of withstanding certain external forces. Therefore, imaging techniques aim to measure single or multiple determinants of bone strength to assess the risk of hip fragility fractures in the elderly. This article provides a comprehensive analysis of the latest advancements in quantitative CT research for predicting hip fracture risk in postmenopausal women, with a focus on CT-derived bone density and imaging indicators, body composition assessment, predictive model construction, and clinical translation. It also discusses the challenges and future trends in this field, aiming to offer valuable insights for related research and clinical practice.