Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Diagnosis of Osteoporosis

골다공증의 진단

  • Kim, Jae-Gyoon (Department of Orthopedic Surgery, Guro Hospital, College of Medicine, Korea University) ;
  • Moon, Young-Wan (Department of Orthopedic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University)
  • 김재균 (고려대학교 의과대학 구로병원 정형외과학교실) ;
  • 문영완 (성균관대학교 의과대학 삼성서울병원 정형외과학교실)
  • Published : 2011.06.30
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Abstract

Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength, predisposing an individual to increased fracture risk. Many factors can lead to the development of osteoporosis. It is usually asymptomatic unless osteoporotic fracture and secondary changes of bone structure occur. Early radiographs show normal findings; however, osteopenic appearance, fracture, cortical bone thinning, and roughening of bone trabeculae can be found according to severity of osteoporosis. These symptoms are most frequently found in the spine and proximal femur. Bone mineral density (BMD) is the standard method used to diagnose osteoporosis, and dual energy X-ray absorptiometry (DXA), one of the measurement tools for BMD, is particularly regarded as the appropriate tool applicable to WHO criteria, which defines osteoporosis as a T-score of less than 2.5 SDs below the mean of young adult women. Peripheral densitometry is less useful in predicting the risk of fractures of the spine and proximal femur, and it is not enough to diagnose and treat osteoporosis. Biochemical bone markers have demonstrated utility in clinical research and trials; however, they cannot replace BMD as a diagnostic tool. WHO recently developed FRAX, a novel method we can use to more conveniently evaluate osteoporotic fracture risk.

골다공증은 골강도의 감소로 인하여 골절의 위험성이 증가하는 골격계 질환이며, 그 원인은 다양하다. 골다공증은 골절이나 이차적인 구조적인 변화가 없는 한 증상이 없는 경우가 대부분이다. 방사선 사진 상에서 골다공증은 초기에는 흔히 정상소견을 보이나 진행된 경우에는 골결핍, 골절, 골의 피질골이 얇아지고 골 소주의 모양이 거칠어 지는 소견을 보이며, 척추와 대퇴골 근위에서 가장 흔히 관찰된다. 하지만 골다공증의 진단은 골밀도에 기초하여 내려지며 이중에너지 방사선 흡수법(DXA)이 WHO 진단 기준을 적용할 수 있는 가장 적합한 골밀도 측정방법으로 인정되고 있으며, T-score가 -2.5이하의 경우 골다공증이라고 한다. 말단 골밀도 측정은 척추나 근위 대퇴골의 골절 위험도를 예측하는 데는 그다지 유용하지 못하며, 골다공증의 진단이나 치료를 결정하는데 있어서 충분하지 못하다. 생화학적 골표지자는 임상 연구에서 그 유용성을 보여 주었지만 골밀도 검사를 대체할만한 검사는 아니다. 골절의 위험도를 평가하기 위하여 WHO에서 골절 위험도를 산출하는 방법을 개발하였으며, 최근에 개발된 FRAX로 골다공증성 골절의 위험도가 높은 환자를 더 간편하게 평가할 수 있게 되었다.

Keywords

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