背景:骨质疏松症与骨折显著相关,尤其是老年人的健康负担。骨质疏松性骨折引起疼痛,残疾,和死亡率增加。骨质疏松症的早期诊断可以更早地开始治疗,从而降低骨质疏松性骨折的风险。脊医每天都会遇到潜在的骨质疏松患者,并对这些患者和其他患者进行放射学评估,包括为骨质疏松症以外的其他目的进行的X射线评估。因此,脊医可以识别椎骨骨折,没有其他怀疑或记录的椎体畸形或骨质减少。
方法:本研究检查了脊医可用于描述常规X射线的程序,重点是骨质疏松症相关发现。我们回顾了脊椎治疗中放射学检查的适应症,在骨质疏松症领域,我们描述了可用于常规X光检查的放射学方法,以及跨学科交流的必要性。
结果:关于脊椎指压疗法中X线转诊的国家指南。标准化的协议确保在脊医放射科获得最高质量的图像。常规的X线检查不适用于单独的骨质疏松症的临床怀疑,因为骨密度测试是诊断测试。对50岁以上患者的所有可用X射线的放射学评估应包括对骨质量的评估,以及髋部和椎骨骨折评估。辛格指数,Genant半定量工具(GSQ),在解释过程中,应一致使用基于算法的定性方法(ABQ)。必要时,应迅速和系统地转诊其他成像和评估。
结论:本文概述了基于证据的放射学程序,以促进骨质疏松症的早期诊断。我们向临床医生提出建议,建议对X射线进行机会主义评估,出于任何原因,其中包括对骨骼质量的系统评估,髋部和椎骨骨折的存在,所有50岁以上患者的椎体变形。必要时,将详细转诊给医疗保健专业人员进行进一步的诊断评估。一致,在脊骨治疗实践中的高质量放射学程序可能有助于及时诊断骨质疏松症,最终将骨质疏松症相关并发症对患者健康的影响降至最低。
BACKGROUND: Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded.
METHODS: This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in
chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication.
RESULTS: National guidelines are available regarding referral for X-rays in
chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors\' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed.
CONCLUSIONS: This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in
chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients\' health.