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Analay P, Kara M, Sertçelik A, Demirel K, Yalçınkaya B, Kaymak B, Çakır B, Özçakar L. Diagnosing (severe) osteoporosis by Hologic vs. Lunar measurements: A single-center retrospective study. J Clin Densitom 2024; 27:101509. [PMID: 39098172 DOI: 10.1016/j.jocd.2024.101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Although different dual-energy X-ray absorptiometry (DXA) scanners provide different bone mineral density (BMD) values, there is not a gold standard DXA scanner. T-score is used to facilitate the interpretation of BMD, and osteoporosis (OP) is diagnosed based on T-scores. In this retrospective study, we aimed to evaluate the BMD and T-score differences between Lunar Prodigy and Hologic Horizon DXA scanners. METHODOLOGY Data were collected for patients with previous BMD measurement on Lunar Prodigy and Hologic Horizon DXA scanners within one year in the same medical center. RESULTS In a total of 55 patients, BMD values of femoral neck/total, and lumbar vertebrae were all lower at Hologic than Lunar (all p < 0.01). The mean T-score difference at the lumbar spine was 0.74 ± 0.42 (p < 0.001). Of the 49 patients diagnosed as OP (T-score ≤-2.5) with the Hologic, the diagnoses were changed for 25 individuals (51.0 %) with Lunar (p < 0.001). Herewith, although the diagnoses of OP did not change by the repeat technique in other 24 patients (49 %), 13 of them (26.5 %) were categorized as having "high fracture risk" instead of "very high fracture risk" group (i.e., T-score <-3.0). We observed moderate-to-good reliabilities (with an intraclass correlation coefficient [ICC] of 0.633-0.878 and 0.733-0.842 for BMD and T-scores, respectively) between measurements with the Lunar and Hologic scanners. Except for one measurement in L3, L4, L1-4 vertebrae, the Bland-Altman plot did not reveal any consistent bias between the measurements of the Lunar and Hologic scanners. CONCLUSIONS The consistency between different DXA scanners (especially for Hologic vs. Lunar) is important for proper management, especially in patients with low T-scores and OP.
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Affiliation(s)
- Pelin Analay
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey.
| | - Murat Kara
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey
| | - Ahmet Sertçelik
- Department of Public Health, Division of Epidemiology, Ankara, Turkey
| | - Kübranur Demirel
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey
| | - Berkay Yalçınkaya
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey
| | - Bayram Kaymak
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey
| | - Banu Çakır
- Department of Public Health, Division of Epidemiology, Ankara, Turkey
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Turkey
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Cirnigliaro CM, Myslinski MJ, Parrott JS, Cross GT, Gilhooley S, La Fountaine MF, Kirshblum SC, McClure IA, Forrest GF, Spungen AM, Bauman WA. Generation of a Reference Dataset to Permit the Calculation of T-scores at the Distal Femur and Proximal Tibia in Persons with Spinal Cord Injury. J Clin Densitom 2022; 25:308-318. [PMID: 35216904 DOI: 10.1016/j.jocd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Persons with traumatic spinal cord injury (SCI) have severe bone loss below the level of lesion with the distal femur (DF) and proximal tibia (PT) being the skeletal regions having the highest risk of fracture. While a reference areal bone mineral density (aBMD) database is available at the total hip (TH) using the combined National Health and Nutrition Examination Survey (NHANES) III study and General Electric (GE) combined (GE/NHANES) to calculate T-score (T-scoreGE/NHANES), no such reference database exists for aBMD of the DF, and PT. The primary objectives of this study were (1) to create a reference dataset of young-healthy able-bodied (YHAB) persons to calculate T-score (T-scoreYHAB) values at the DF and PT, (2) to explore the impact of time since injury (TSI) on relative bone loss in the DF and PT regions using the two computation models to determine T-score values, and (3) to determine agreement between T-score values for a cohort of persons with SCI using the (T-scoreYHAB) and (T-scoreGE/NHANES) reference datasets. A cross-sectional prospective data collection study. A Department of Veterans Affairs Medical Center and a Private Rehabilitation Hospital. A normative reference aBMD database at the DF and PT was collected in 32 male and 32 female Caucasian YHAB participants (n=64) and then applied to calculate T-score values at the DF and PT in 105 SCI participants from a historical cohort. The SCI participants were then grouped based on TSI epochs (E-I: TSI < 1y, E-II: TSI 1-5y, E-III: TSI 6-10y, E-IV: TSI 11-20y, E-V: TSI > 20y). N/A. The knee and hip aBMD values were obtained by dual energy X-ray absorptiometry (GE Lunar iDXA) using standard clinical software for proximal femur orthopedic knee software applications. There were no significant differences in mean aBMD values across the four YHAB age subgroups (21-25, 26-30, 31-35, and 36-40 yr of age) at the TH, DF, and PT; mean aBMD values were higher in men compared to the women at all skeletal regions of interest. Using the mean YHAB aBMD values to calculate T-score values at each TSI epoch for persons with SCI, T-score values decreased as a function of TSI, and they continued to decline for 11-20 yr. Moderate kappa agreement was noted between the YHAB and the GE/NHANES reference datasets for the T-score cutoff criteria accepted to diagnose osteoporosis (i.e., SD <-2.5). A homogeneous reference dataset of YHAB aBMD values at the DF and PT was applied to calculate T-score values in persons with chronic SCI. There was a moderate level of agreement at the TH between the YHAB and GE/NHANES reference datasets when applying the conventional T-score cutoff value for the diagnosis of osteoporosis.
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Affiliation(s)
- Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
| | - Mary Jane Myslinski
- Department of Physical Therapy, School of Biomedical and Health Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Scott Parrott
- Department of Physical Therapy, School of Biomedical and Health Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Gregory T Cross
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Shawn Gilhooley
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA; Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Isa A McClure
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Gail F Forrest
- Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ann M Spungen
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dash AS, Agarwal S, McMahon DJ, Cosman F, Nieves J, Bucovsky M, Guo XE, Shane E, Stein EM. Abnormal microarchitecture and stiffness in postmenopausal women with isolated osteoporosis at the 1/3 radius. Bone 2020; 132:115211. [PMID: 31870633 PMCID: PMC8853460 DOI: 10.1016/j.bone.2019.115211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postmenopausal women with isolated osteoporosis at the 1/3 radius (1/3RO) present a therapeutic dilemma. Little is known about whether these patients have generalized skeletal fragility, and whether this finding warrants treatment. The aim of this study was to investigate the biochemical and microarchitectural phenotype of women with 1/3RO compared to women with classic postmenopausal osteoporosis by DXA at the spine and hip (PMO), and controls without osteoporosis at any site. METHODS This cross-sectional study enrolled 266 postmenopausal women, who were grouped according to densitometric pattern. Subjects had serum biochemistries, areal BMD (aBMD) measured by DXA, trabecular and cortical vBMD, microarchitecture, and stiffness by high resolution peripheral QCT (HR-pQCT, voxel size ~82 μm) of the distal radius and tibia. RESULTS Mean age was 68 ± 7 years. DXA T-Scores reflected study design. By HR-pQCT, 1/3RO had abnormalities at both radius and tibia compared to controls: lower total, cortical and trabecular vBMD, cortical thickness and trabecular number, higher trabecular separation and heterogeneity, and lower whole bone stiffness. In contrast, the magnitude and pattern of abnormalities in vBMD, microarchitecture and stiffness in 1/3RO were similar to those in PMO; the difference compared to controls was similar among the two groups. Serum calcium, creatinine, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urine calcium did not differ. CONCLUSIONS Although aBMD appeared relatively preserved at the spine and hip by DXA, women with 1/3RO had significant microarchitectural and biomechanical deficits comparable to those in women with typical PMO. Further study is required to guide treatment decisions in this population.
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Affiliation(s)
- Alexander S Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Felicia Cosman
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Jeri Nieves
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
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Guimarães NS, Guimarães MMM, Kakehasi AM, Paula MGPD, Caporali JFDM, Vieira ÉLM, Tanajura PR, Tupinambás U. Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals. Rev Soc Bras Med Trop 2018; 51:596-602. [PMID: 30304264 DOI: 10.1590/0037-8682-0475-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.
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Affiliation(s)
- Nathalia Sernizon Guimarães
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Adriana Maria Kakehasi
- Departamento de Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Mariana Guimarães Penido de Paula
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Júlia Fonseca de Morais Caporali
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Érica Leandro Marciano Vieira
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Pedro Rezende Tanajura
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Unaí Tupinambás
- Programa de Pós-Graduação Strictu Senso em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Muchtar E, Dagan A, Robenshtok E, Shochat T, Oniashvili N, Amitai I, Raanani P, Magen H. Bone mineral density utilization in patients with newly diagnosed multiple myeloma. Hematol Oncol 2016; 35:703-710. [PMID: 27329574 DOI: 10.1002/hon.2303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/14/2016] [Accepted: 03/28/2016] [Indexed: 11/10/2022]
Abstract
Bone disease is a major cause for morbidity in multiple myeloma (MM), with the main focus concerning the manifestation as osteolytic lesions. Bone mineral loss is another reflection of myeloma bone involvement. Recently, osteoporosis has been omitted as a defining criterion for symptomatic disease in MM. We conducted a retrospective study to evaluate the use of bone mineral density (BMD) exams by dual-energy X-ray absorptiometry (DXA) among MM patients in a tertiary medical care centre. One-hundred seventy three patients were included. The T-scores of lumbar spine (LS), left femur neck (FN) and left total hip (TH) were obtained and analysed. The extent of osteolytic disease was categorized based on six bony areas. There was a strong correlation between spine and femur's T-scores (r = 0.56-0.61, p < 0.0001), although different sets of variables were correlated with LS and femur's T-scores. There was no correlation between BMD measurements and osteolytic disease extent. Patients with vertebral fracture(s) had significant lower T-scores of the spine in comparison to patients without vertebral fractures. Sixty-three patients (36.4% of the cohort) had follow-up DXA exam. In general, there was an increase in the LS T-scores, while femoral values decreased. However, in patients who achieved complete response (CR) and in those who retained CR during follow-up, femoral BMD increased as well. Because correlation between BMD and the extent of osteolytic lesions was not seen, our data support the recent exclusion of BMD assessment from the definition of symptomatic myeloma. Still, its use should be considered for evaluation of age- or therapy-related osteoporosis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eli Muchtar
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Dagan
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Robenshtok
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Endocrinology and Metabolism Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Tzippy Shochat
- Statistical unit, Research department, Rabin Medical Center, Petah-Tikva, Israel
| | - Nino Oniashvili
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Irina Amitai
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Magen
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Iki M, Tamaki J, Sato Y, Winzenrieth R, Kagamimori S, Kagawa Y, Yoneshima H. Age-related normative values of trabecular bone score (TBS) for Japanese women: the Japanese Population-based Osteoporosis (JPOS) study. Osteoporos Int 2015; 26:245-52. [PMID: 25149857 DOI: 10.1007/s00198-014-2856-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/12/2014] [Indexed: 01/25/2023]
Abstract
UNLABELLED Trabecular bone score (TBS), a surrogate measure of bone microarchitecture, represents fracture risk independently of bone density. We present normative TBS values from a representative population study of Japanese women. This database would enhance our understanding of trabecular bone microarchitecture and improve osteoporosis management. INTRODUCTION TBS is a texture parameter that quantifies local variation in gray level distribution within dual-energy X-ray absorptiometry (DXA) images of the lumbar spine. While TBS is associated with fracture risk independently of areal bone mineral density (aBMD), normative TBS values have only been reported for Caucasian women. This study provides age-specific normative values of TBS from a representative sample of Japanese women. METHODS We randomly selected 4,550 women aged 15-79 years from 7 areas throughout Japan. Women younger than 20 years and those with any medical history which might affect bone metabolism were excluded, and the remaining 3,069 with at least two assessable vertebrae from the first to the fourth vertebrae were subjected to analysis. TBS values were calculated from spine DXA images using TBS iNsight software (Med-Imaps, France). Age-related models of TBS were constructed using piecewise linear regression analysis. RESULTS Participant age, body mass index (BMI), spine aBMD, and TBS (mean ± SD) were 48.7 ± 16.8 years, 22.9 ± 3.4, 0.888 ± 0.169 g/cm(2), and 1.187 ± 0.137, respectively. A three-piece linear regression model of TBS on age explained 70.7% of the total variance in TBS and comprised very small age-related changes in the youngest segment of the regression line, rapid loss in the middle segment, and small loss in the oldest segment. TBS was lower in Japanese women than in Caucasian women across all age ranges, with the difference increasing with age up through 65 years. CONCLUSIONS The normative values of TBS for Japanese women presented here would enhance our understanding of trabecular bone microarchitecture and help improve the management of osteoporosis.
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Affiliation(s)
- M Iki
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan,
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Schousboe JT, Tanner SB, Leslie WD. Definition of osteoporosis by bone density criteria in men: effect of using female instead of male young reference data depends on skeletal site and densitometer manufacturer. J Clin Densitom 2014; 17:301-6. [PMID: 24269168 DOI: 10.1016/j.jocd.2013.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
Whether to use young male or young female reference data to calculate bone mineral density (BMD) T-scores in men remains controversial. The third National Health and Nutrition Examination and Survey (NHANES III) data show that the mean and standard deviation of femoral neck and total hip BMD is greater in young men than young women, and therefore differences in T-scores at these sites using NHANES III female vs male norms becomes less as BMD decreases. In contrast, manufacturer-specific reference databases generally assume similar standard deviations of BMD in men and women. Using NHANES III reference data for the femoral neck and total hip, respectively we found that men with T-scores of -2.5 when young male norms are used have T-scores of -2.4 and -2.3 when young female norms are used. Using manufacturer-specific reference data, we found that men with T-scores of -2.5 when young male norms are used at the femoral neck, total hip, lumbar spine, or one-third of the forearm would have T-scores ranging from -2.4 to -0.4 when young female norms are used, depending on skeletal site and densitometer manufacturer. The change of proportions of men diagnosed with osteoporosis when young female norms are used instead of young male reference data differs substantially according to skeletal site and densitometer manufacturer.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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Morgan SL, Peace F, Lopez-Ben R, Fineberg N. Distribution of Z-scores in a University cohort with an emphasis on "high" bone mineral density. J Clin Densitom 2010; 13:385-91. [PMID: 21029974 DOI: 10.1016/j.jocd.2010.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 07/08/2010] [Accepted: 07/11/2010] [Indexed: 11/28/2022]
Abstract
High bone mineral density (BMD) is currently not defined by the International Society for Clinical Densitometry with a specific Z-score cutoff; however, it has been suggested that a Z-score greater than or equal to 2.5 is not normal. Institutional Review Board approval was obtained. We evaluated a University dual-energy X-ray absorptiometry database over the previous 24 mo to define Z-score distributions. A Z-score greater than or equal to 2.5 was selected as the outcome event of interest in a logistic regression for adjusted odds ratio. The covariates were height; weight; body mass index (BMI); gender; menopausal status; use of female hormones; presence of insufficiency fractures after 50 yr of age; previous fractures; previous surgeries (back surgeries, vertebroplasty, or kyphoplasty); transplant history; presence of long-term chronic conditions (asthma, lupus, rheumatoid arthritis, or cystic fibrosis); eating disorder; current use of glucocorticoids; smoking status; and current and past use of osteoporosis pharmacological therapies. The study included a total of 8216 patients; 7212 (87.8%) were females, and 1044 (12.2%) were males. In the total population, 13.6% had a Z-score greater than or equal to 2.5 at the lumbar spine, femoral neck, or total hip. Only 0.2% of the males and 0.8% of the females had a Z-score greater than or equal to 2.5 at all 3 sites. The 97.5th percentiles for Z-scores in our population for men and women, respectively, were 3.4 and 3.9 at the lumbar spine, 1.5 and 2.1 at the femoral neck, and 1.6 and 2.2 at the total hip. The 99th percentile for Z-scores for men and women, respectively, were 4.9 and 4.7 at the lumbar spine, 2.4 and 2.7 at the femoral neck, and 2.2 and 2.7 at the total hip. At the lumbar spine, female gender and weight were found to be risk factors for a high Z-score (≥ 2.5). The use of glucocorticoids, bone-active medications, BMI, and smoking were significantly less likely to predict a lumbar spine Z-score greater than or equal to 2.5. A high total-hip Z-score is predicted by increasing weight, whereas those patients using bone-active medications were less likely to have high BMD at the total hip. At the femoral neck, there were no significant risk factors related to a Z-score greater than or equal to 2.5; those taking bone-active medications were significantly less likely to have a high Z-score. These data suggest that a high Z-score is common at 1 or more sites. Further research about the criteria for the diagnosis of high BMD is warranted.
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Affiliation(s)
- Sarah L Morgan
- Osteoporosis Prevention & Treatment Clinic and Bone Densitometry Service, University of Alabama at Birmingham, Birmingham, AL 35294-1270, USA.
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McKenna MJ, Redmond JMT. Response to the letter from Kampmann and Steffensen. Ir J Med Sci 2009. [DOI: 10.1007/s11845-009-0279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Bone fracture occurs when the bone strength (i.e. the ability of the bone to resist a force) is less than the force applied to the bone. In the elderly, falls represent the more severe forces applied to bone. Bone density is a good marker of bone strength, and has been used widely in this respect. Nevertheless, many aspects of bone strength cannot be explained by bone density alone. For this reason there has been increasing interest in studying architectural parameters of bone, beyond bone density, which may affect bone strength. Macro-architectural parameters include e.g. bone size and geometry assessed with techniques such as radiography, dual-energy x-ray absorptiometry (DXA), peripheral quantitative computed tomography (QCT), computed tomography (CT) and magnetic resonance imaging (MRI). Micro-architectural parameters include fine cortical and trabecular structural detail which can be evaluated using high-resolution imaging techniques such as multidetector CT, MRI, and high-resolution peripheral QCT. These techniques are providing a great deal of new information on the physiological architectural responses of bone to aging, weightlessness, and treatment. This will ultimately lead to the prediction of fracture risk being improved through a combined assessment of bone density and architectural parameters.
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Affiliation(s)
- James F Griffith
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Shatin, NT, Hong Kong
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