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Nishida M, Yagi M, Suzuki S, Takahashi Y, Nori S, Tsuji O, Nagoshi N, Fujita N, Matsumoto M, Nakamura M, Watanabe K. Persistent low bone mineral density in adolescent idiopathic scoliosis: A longitudinal study. J Orthop Sci 2023; 28:1099-1104. [PMID: 35985936 DOI: 10.1016/j.jos.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Since osteopenia has been reported to potentially associated with the progression of scoliosis, bone mineral density (BMD) might have some influences on adolescent idiopathic scoliosis (AIS). However, little is known about longitudinal BMD changes in AIS patients. This study aimed to investigate whether osteopenia in preoperative AIS patients persist at bone maturity, and to evaluate the association between BMD and AIS severity. METHODS We reviewed 61 AIS patients who underwent surgery when they were Risser grade 4 or below and less than 20 years old (16.6 ± 1.9 years), were followed until they were at least 18 years old and had a Risser grade of 5, and followed at least 2 years after the surgery (mean follow-up 4.9 ± 1.7 years). We evaluated radiographical parameters and proximal femur BMD before surgery and at the final follow-up. A BMD of less than the mean minus 1SD was considered as low BMD. Based on preoperative BMD, 37 patients were assigned to normal BMD (N) group (1.02 ± 0.08 g/cm2) and 24 patients to low BMD (L) group (0.82 ± 0.06 g/cm2). RESULTS All patients in the N-group had normal BMD at the final follow-up. In the L group, 15 patients (62.5%) had low BMD at the final follow-up (L-L group; preoperative 0.79 ± 0.05 g/cm2 and final follow-up 0.78 ± 0.05 g/cm2). The mean preoperative Cobb angle was significantly larger in the L-L group (67.8 ± 11.2°) than in those with normal BMD at the final follow-up (L-N group, 55.6 ± 11.8°) or the N-N group (50.8 ± 7.6°). Preoperative BMD was significantly negative correlated with the preoperative Cobb angle. The age at surgery and mean preoperative BMI were similar in the L-N and L-L groups. CONCLUSIONS Of AIS patients with low preoperative BMD, 62.5% still had low BMD after reaching bone maturity, and low BMD was associated with the severity of scoliosis.
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Affiliation(s)
- Mitsuhiro Nishida
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan; KSRG (Keio Spine Research Group)
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group)
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan; KSRG (Keio Spine Research Group).
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Thomas MA, Jimenez JE, Fahrenholtz SJ, Hamdani K, Erwin WD. Understanding entrance-air-kerma as a quality-control metric for dual-energy x-ray absorptiometry. J Appl Clin Med Phys 2022; 23:e13779. [PMID: 36057962 PMCID: PMC9588270 DOI: 10.1002/acm2.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The low exposures, unique x‐ray beam geometry, and scanning design in dual‐energy x‐ray absorptiometry (DXA) make measurement and quality‐control strategies different from traditional x‐ray equipment. This study examines the dependence of measured entrance‐air‐kerma (EAK) on both dose sensor type and scan length. The feasibility of using EAK to compare scanner output between different scan modes, individual scanners, and scanner platforms was also established. Finally, the congruence between measured and vendor‐reported EAK was analyzed. Methods Four Hologic DXA scanners at two institutions and all four available scan modes were tested. EAK was measured directly by three types of Radcal dose sensors: 60‐cc pancake ion‐chamber (IC), 180‐cc pancake IC, and solid‐state detector. The coefficient of variation (COV) was used to assess the dependence of EAK on scan length. Variations in EAK between the types of dose sensors as well as measured versus vendor‐reported values were evaluated using Bland–Altman analysis: mean ±95% prediction interval (PI): 1.96σ. Results Dose sensor variations in EAK were minimal, with a −3.5 ± 3.5% (mean ±95% PI) percent difference between the two sizes of IC's. The solid‐state detector produced highly similar measurements to the 180‐cc IC. These small differences were consistent across all scanners and all scan modes tested. Neither measured nor vendor‐reported EAK values were found to show relevant dependence on scan length, with all COV values ≤4%. Differences between measured and reported EAK were higher at −6 ± 48%. Likely errors in vendor‐reported EAK calculations were also identified. Conclusion It is feasible to quantify DXA scanner stability using EAK as a quality‐control metric with a variety of solid‐state and IC dose sensors, and the scan length used is not critical. Although vendor‐reported EAK was consistent among scanners of the same platform, measured EAK varied significantly from scanner to scanner. As a result, measured and reported EAK may not always be comparable.
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Affiliation(s)
- Matthew Allan Thomas
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Samuel John Fahrenholtz
- Section of Medical Physics, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Khushnood Hamdani
- Section of Medical Physics, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - William Daniel Erwin
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
➤ Our ability to accurately identify high fracture risk in individuals has improved as the volume of clinical data has expanded and fracture risk assessment tools have been developed. ➤ Given its accessibility, affordability, and low radiation exposure, dual x-ray absorptiometry (DXA) remains the standard for osteoporosis screening and monitoring response to treatment. ➤ The trabecular bone score (TBS) is a DXA software add-on that uses lumbar spine DXA imaging to produce an output that correlates with bone microarchitecture. It has been identified as an independent fracture risk factor and may prove useful in further stratifying fracture risk among those with a bone mineral density (BMD) in the osteopenic range (-1.0 to -2.4 standard deviations), in those with low-energy fractures but normal or only mildly low BMD, or in those with conditions known to impair bone microarchitecture. ➤ Fracture risk assessment tools, including the Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator, and QFracture, evaluate the impact of multiple clinical factors on fracture risk, even in the absence of BMD data. Each produces an absolute fracture risk output over a defined interval of time. When used appropriately, these enhance our ability to identify high-risk patients and allow us to differentiate fracture risk among patients who present with similar BMDs. ➤ For challenging clinical cases, a combined approach is likely to improve accuracy in the identification of high-risk patients who would benefit from the available osteoporosis therapies.
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Affiliation(s)
| | - Lisa K Schroder
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
| | - Julie A Switzer
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
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Yoon BH, Koh YD, Yoo JI, Kim S, Lee GY, Park SB, Ha YC. Does Bone Mineral Density Differ between Fan-Beam and Pencil-Beam?: A Meta-Analysis and Systemic Review. J Bone Metab 2021; 28:67-77. [PMID: 33730785 PMCID: PMC7973396 DOI: 10.11005/jbm.2021.28.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Dual energy X-ray absorptiometry (DXA) has evolved from pencil-beam (PB) to narrow fan-beam (FB) densitometers. We performed a meta-analysis of the available observational studies to determine how different modes of DXA affect bone mineral density (BMD) measurements. Methods A total of 1,233 patients (808 women) from 14 cohort studies were included. We evaluated the differences in BMD according to the DXA mode: PB and FB. Additionally, we evaluated the differences in BMD between the 2 types of FB mode: FB (Prodigy) and the most recent FB (iDXA). Pairwise meta-analysis was performed, and weighted mean differences (WMD) were calculated for (total lumbar, total hip, and total body). Results No significant difference was observed in total lumbar (pooled WMD, −0.013; P=0.152) and total hip BMD (pooled WMD, −0.01; P=0.889), between PB and FB. However, total body BMD was significantly lower in the PB compared to the FB group (pooled WMD, −0.014; P=0.024). No significant difference was observed in lumbar BMD (pooled WMD, −0.006; P=0.567), total hip (pooled WMD, −0.002; P=0.821), and total body (pooled WMD, 0.015; P=0.109), between Prodigy and iDXA. Conclusions The results of this study warrant the recommendation that correction equations should not be used when comparing BMD from different modes. Further research is still needed to highlight the ways in which differences between DXA systems can be minimized.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Do Koh
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Guen Young Lee
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Llorente I, Merino L, Escolano E, Quintanilla DM, García-Vadillo JA, González-Álvaro I, Castañeda S. Reproducibility of Metacarpal Bone Mineral Density Measurements Obtained by Dual-Energy X-Ray Absorptiometry in Healthy Volunteers and Patients With Early Arthritis. J Clin Densitom 2020; 23:678-684. [PMID: 30910402 DOI: 10.1016/j.jocd.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023]
Abstract
Reduction in cortical bone mineral density at diaphysis of metacarpal bones of the hand, evaluated by dual X-ray radiogrammetry, has a bad prognostic value in patients with early arthritis. Nevertheless, this technique is hardly accessible in clinical practice. By contrast, evaluation of cortical bone mineral density at that location has not been previously assessed by conventional dual X-ray absorptiometry. The aim of this study is to evaluate the reproducibility of bone mineral density measurements at diaphysis of metacarpal bones using conventional dual X-ray densitometry in a population of healthy volunteers and patients with early arthritis. Nondominant hand dual X-ray densitometry was performed at three consecutive times with complete hand replacement in 27 subjects: 10 early arthritis and 17 healthy volunteers. Three different evaluators analyzed the 3 measurements of second to fourth metacarpal bones. To assess the reproducibility and accuracy of the measurements, intra- and interobserver agreement degrees, intra- and interclass correlation coefficients, smallest difference detectable assessment, and Bland Altman graphs were calculated. The coefficients of variation obtained for the different metacarpal evaluations were 2.25%, 2.91%, 2.85%, and 2.07% for metacarpal-2, metacarpal-3, metacarpal-4, and mean metacarpal-second to fourth, respectively, with a smallest difference detectable of 0.028, 0.034, 0.028, and 0.03 g/cm2, respectively. The mean intra- and interobserver correlation coefficients between of metacarpal second to fourth were 0.990 (95% confidence interval [CI]: 0.982-0.995) and 0.995 (95% CI: 0.991-0.997), respectively. As expected, women had lower bone mineral density at metacarpal bones, especially after menopause. The results obtained in this study show an excellent reproducibility of bone mineral density measurements at diaphysis of metacarpal bones of the hand, measured by conventional dual X-ray densitometry, in a mixed population of healthy subjects and patients with early arthritis. This is of great interest for longitudinal studies in patients with early arthritis.
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Affiliation(s)
- Irene Llorente
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - Leticia Merino
- Rheumatology Department, Hospital Universitario de San Pedro, Logroño, Rioja, Spain
| | - Eugenio Escolano
- Radiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.
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Hind K, Oldroyd B. Bone Mineral Density Precision for Individual and Combined Vertebrae Configurations From Lumbar Spine Dual-Energy X-Ray Absorptiometry Scans. J Clin Densitom 2020; 23:673-677. [PMID: 31036447 DOI: 10.1016/j.jocd.2019.04.001] [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: 02/20/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
Abstract
The accurate interpretation of repeat DXA scan measurements and the understanding of what constitutes a true and meaningful change require knowledge of measurement error (precision) and least significant change. The interpretation of lumbar spine bone mineral density in particular can be confounded by artefacts and as such, the International Society for Clinical Densitometry (ISCD) recommends exclusion of individual vertebrae if they are affected by local structural change or an artefact. The aim of this study was to determine the precision of bone mineral density measures of individual and various configurations of vertebrae from PA lumbar spine scans. The study group comprised of 30 women (age 36.3 ± 6.5 years; height: 165.2 ± 5.7 cm; weight: 67.7 ± 12.6 kg) who each received 2 consecutive anterior-posterior lumbar spine scans (Lunar iDXA, GE Healthcare, Madison, WI), with repositioning. Precision errors varied by individual vertebrae and by different configurations of vertebrae but all were within the ISCD acceptable range of precision. For vertebrae configurations containing at least 2 vertebrae, precision error ranged from 0.005 to 0.008 RMS-SD (0.44%-0.70% CV). Of the individual vertebrae, the lowest precision error was observed at L4, and from the different configurations, for L2L3L4 and L1L2L3L4. In conclusion, this study group demonstrated excellent precision for BMD measurements of individual and various configurations of L1-L4 vertebrae using the GE Lunar iDXA densitometer.
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Affiliation(s)
- Karen Hind
- Department of Sport and Exercise Sciences and the Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, United Kingdom.
| | - Brian Oldroyd
- School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Khadilkar A, Chiplonkar S, Sanwalka N, Khadilkar V, Mandlik R, Ekbote V. A Cross-Calibration Study of GE Lunar iDXA and GE Lunar DPX Pro for Body Composition Measurements in Children and Adults. J Clin Densitom 2020; 23:128-137. [PMID: 30981615 DOI: 10.1016/j.jocd.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To cross-calibrate dual energy X-ray absorptiometry machines when replacing GE Lunar DPX-Pro with GE Lunar iDXA. METHODS A cross-sectional study was conducted in 126 children (3-19 years) and 135 adults (20-66 years). Phantom cross calibration was carried out using aluminum phantom provided with each of the machines on both machines. Total body less head (TBLH), lumbar spine (L2-L4) and left femoral neck bone mineral density (BMD), bone mineral content (BMC), and bone area were assessed for each patient on both machines. TBLH lean and fat mass were also measured. Bland-Altman analysis, linear regressions, and independent sample t test were performed to evaluate consistency of measurements and to establish cross-calibration equations. RESULTS iDXA measured 0.33% lower BMD and 0.64% lower BMC with iDXA phantom as compared to DPX-Pro phantom (p < 0.001). In children, TBLH-BMC, femoral BMC and area were measured 10%-14% lesser, TBLH area was higher by 1%-2% and L2-L4 area by 10%-14% by iDXA as compared to DPX-Pro. iDXA measured higher TBLH fat [15% (girls), 31% (boys)] than DPX-Pro. In adults, TBLH-BMD (1.7%-3.4%), BMC (6.0%-10.9%) and area (4.2%-7.6%) were measured lesser by iDXA than DPX-Pro. L2-L4 BMD was higher [2.7% (men), 1.8% (women)] by iDXA than DPX-Pro. Femoral BMC was 2.11% higher in men and 4.1% lower in women by iDXA as compared to DPX-Pro. In children, R2 of cross-calibration equations, ranged from 0.91 to 0.96; in adults, it ranged from 0.93 to 0.99 (p < 0.01). After the regression equations were applied, differences in BMD values between both machines were negligible. CONCLUSION A strong agreement for bone mass and body composition was established between both machines. Cross-calibration equations need to be applied to transform DPX-Pro measurements into iDXA measurements to avoid errors in assessment. This study documents a need for use of cross-calibration equations to transform DPX-Pro body composition data into iDXA values for clinical diagnosis.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Mathisen TF, Heia J, Raustøl M, Sandeggen M, Fjellestad I, Sundgot‐Borgen J. Physical health and symptoms of relative energy deficiency in female fitness athletes. Scand J Med Sci Sports 2020; 30:135-147. [PMID: 31593622 PMCID: PMC6916539 DOI: 10.1111/sms.13568] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Competing in aesthetic sports increases the risk of low energy availability and associated health impairments. Fitness physique sport is a popular, but understudied aesthetic sport. We evaluated health and symptoms of relative energy deficiency in sport (RED-s) in female fitness athletes (FA) and female references (FR) during a competitive season. METHODS Totally, 25 FA and 26 FR, mean (SD) age of 28.9 (5.7), were included. Assessments were at baseline (T1), 2-weeks pre-competition (T2), and 1-month post-competition (T3), by dual-energy x-ray absorptiometry scan, indirect calorimetry, diet registration, The Low Energy Availability in Females Questionnaire, The Beck Depression Inventory, and Eating Disorder Examination Questionnaire (EDE-Q). RESULTS A history of eating disorders was reported by 35% FA and 12% FR. There were no between-group differences at T1, besides less mean (99% CI) fat mass (FM) of 3.1 kg (-0.4, 6.5) in FA (P = .02). At T2, FA had lower BW of 6.7 kg (-12.0, -1.3), fat mass of -9.0 kg (-12.5, -5.5), and resting heart rate of -8.0 beats per minute (-14.5, -1.5) compared to FR (P ≤ .006). FA reduced resting metabolic rate by -191 kcal (-11, -371) and increased symptoms of gastrointestinal dysfunction (GD) by 1.4 points (0.3, 2.5) and prevalence of amenorrhea from 8% to 24%, (P < .003). At T3, there was a between-group difference in fat mass, and a high number of FA with amenorrhea and GD. CONCLUSION Manifestation of symptoms of RED-s, some with persistence one-month post-competition, raises concern for the health of FA and those complying with the fit body ideal.
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Affiliation(s)
| | - Josefine Heia
- Department of Sports MedicineNorwegian School of Sport SciencesOsloNorway
| | - Marius Raustøl
- Department of Sport PerformanceNorwegian School of Sport SciencesOsloNorway
| | - Mari Sandeggen
- School of Clinical and Applied SciencesLeeds Beckett UniversityLeedsUK
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Wilkinson TJ, Nixon DGD, Richler-Potts D, Neale J, Song Y, Smith AC. Identification of the most clinically useful skeletal muscle mass indices pertinent to sarcopenia and physical performance in chronic kidney disease. Nephrology (Carlton) 2019; 25:467-474. [PMID: 31707760 DOI: 10.1111/nep.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
AIM Patients with chronic kidney disease (CKD) are characterised by low skeletal muscle mass that negatively impacts physical performance. Operational definitions of 'low muscle mass' are inconsistent, and it is unknown how different skeletal muscle mass indices affect the relationship between muscle mass and physical function. METHODS Appendicular skeletal muscle mass (ASM) was measured by dual-energy X-ray absorptiometry in 72 CKD patients. Along with crude ASM, alternative muscle indices were calculated adjusting for height, height-squared, body mass, and BMI. Physical performance was assessed by handgrip strength, sit-to-stand tests, gait speed, the incremental shuttle walk test and 'Short Physical Performance Battery'. RESULTS Prevalence of 'low muscle mass' ranged from 26% to 35% of patients depending on the criteria used. The relationship between muscle mass indices and physical function differed for each criteria. Using average coefficients, the association with overall physical function and muscle indices were as follows: crude ASM (r = .258), ASM/height (r = .249), ASM/height-squared (r = .332), ASM/body mass (r = .249) and ASM/BMI (r = .206). Muscle adjusted for markers of adiposity (ASM/body fat %, r = .266; ASM/fat mass, r = .338) provided the best overall associations with physical function. CONCLUSION The use of alternative muscle mass indices provide different estimates of 'low muscle mass' prevalence, and the strongest (and most useful definition in regard to functional status) involves adjustment for either total or relative body fat. ASM adjusted for adiposity may be physiologically and clinically more relevant in patients with renal disease.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Daniel G D Nixon
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Danielle Richler-Potts
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK
| | - Jill Neale
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Yan Song
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,Medical School, Nantong University, Nantong, China
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Wilkinson TJ, Richler-Potts D, Nixon DG, Neale J, Smith AC. Anthropometry-based Equations to Estimate Body Composition: A Suitable Alternative in Renal Transplant Recipients and Patients With Nondialysis Dependent Kidney Disease? J Ren Nutr 2019; 29:16-23. [DOI: 10.1053/j.jrn.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/09/2018] [Accepted: 04/05/2018] [Indexed: 01/10/2023] Open
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Skeletal disproportion in glucocorticoid-treated boys with Duchenne muscular dystrophy. Eur J Pediatr 2019; 178:633-640. [PMID: 30762116 PMCID: PMC6459782 DOI: 10.1007/s00431-019-03336-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/13/2019] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
Abstract
We aimed to compare body segment and bone lengths in glucocorticoid-treated boys with Duchenne muscular dystrophy (DMD) with healthy controls using dual-energy absorptiometry (DXA) images. Total height (Ht), sitting height (SH), leg length (LL) and bone lengths (femur, tibia) in boys with DMD and age-matched control boys were measured using DXA. Thirty boys with DMD (median age 10.0 years (6.1, 16.8)) were compared with 30 controls. SH in DMD was 3.3 cm lower (95% CI - 6.1, - 0.66; p = 0.016). LL in DMD was 7.3 cm lower (95% CI - 11.2, - 3.4; p < 0.0001). SH:LL of boys with DMD was higher by 0.08 (95% CI 0.04, 0.12; p < 0.0001). Femur length in DMD was 2.4 cm lower (95% CI - 4.6, - 0.12; p = 0.04), whereas tibial length in DMD was 4.8 cm lower (95% CI - 6.7, - 2.9; p < 0.0001). SH:LL was not associated with duration of glucocorticoid use (SH:LL β = 0.003, 95% CI - 0.01 to 0.002, p = 0.72).Conclusion: Glucocorticoid-treated boys with DMD exhibit skeletal disproportion with relatively shorter leg length and more marked reduction of distal long bones. As glucocorticoid excess is not associated with such disproportion, our findings raise the possibility of an intrinsic disorder of growth in DMD. What is Known • Severe growth impairment and short stature are commonly observed in boys with Duchenne muscular dystrophy (DMD), especially those treated with long-term glucocorticoids (GC). • In other groups of children with chronic conditions and/or disorders of puberty, skeletal disproportion with lower spinal length has been reported. What is New • Growth impairment in GC-treated boys with DMD was associated with skeletal disproportion in relation to age, with lower limbs and distal long bones affected to a greater degree.
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12
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Body weight difference between dual-energy X-ray absorptiometry and multi-frequency bioelectrical impedance analysis attenuates the equivalence of body-composition assessment. Eur J Clin Nutr 2018; 73:387-394. [PMID: 29670261 DOI: 10.1038/s41430-018-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 03/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES Low agreement of body-composition analysis (BCA) using dual-energy X-ray absorptiometry (DXA) and multi-frequency bioelectrical impedance analysis (MF-BIA) has been reported. We examined whether this discrepancy is influenced by the precision of body weight (BW) measurement using DXA. SUBJECTS/METHODS This cross-sectional study enrolled 1353 participants aged 53-83 years. A whole-body DXA scan and an eight-polar tactile-electrode impedance-meter using four electronic frequencies of 5, 50, 250, and 500 kHz were employed for BCA. The level of agreement between BW estimated using DXA and actual BW (WgtA) was calculated. The agreement of BCA parameters using DXA and MF-BIA across WgtA groups was also assessed. RESULTS DXA incorrectly estimated BW, especially in men. In total, 13.5%, 5.1%, and 5.6% of the participants had BW bias levels of 2%, 3%, and ≥4%, respectively. Correlations of BCA parameters measured using DXA and MF-BIA, including body fat mass, percent body fat, and lean body mass (LBM), were gradually reduced, whereas the root mean square error was increased in accordance with the reduction in WgtA. DXA provided a lower LBM amount compared to MF-BIA and this difference increased significantly across groups with poor WgtA. CONCLUSIONS Lower WgtA greatly contributed to the difference in BCA measured using DXA and MF-BIA.
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An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One 2018; 13:e0193377. [PMID: 29565986 PMCID: PMC5863963 DOI: 10.1371/journal.pone.0193377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An unfavorable body composition is often present in chronic arthritis patients. This unfavorable composition is a loss of muscle mass, with a stable or increased (abdominal) fat mass. Since it is unknown when this unfavorable composition develops, we compared body composition in disease-modifying antirheumatic drugs (DMARD)-naive early arthritis patients with non-arthritis controls and explored the association, in early arthritis patients, with disease activity and traditional cardiovascular risk factors. METHODS 317 consecutive early arthritis patients (84% rheumatoid arthritis according to 2010 ACR/EULAR criteria) and 1268 age-/gender-/ethnicity-matched non-arthritis controls underwent a Dual-energy X-ray absorptiometry scan to assess fat percentage, fat mass index, fat mass distribution and appendicular lean (muscle) mass index. Additionally, disease activity, health assessment questionnaire (HAQ), acute phase proteins, lipid profile and blood pressure were evaluated. RESULTS Loss of muscle mass (corrected for age suspected muscle mass) was 4-5 times more common in early arthritis patients, with a significantly lower mean appendicular lean mass index (females 6% and males 7% lower, p<0.01). Patients had more fat distributed to the trunk (females p<0.01, males p = 0.07) and females had a 4% higher mean fat mass index (p<0.01). An unfavorable body composition was associated with a higher blood pressure and an atherogenic lipid profile. There was no relationship with disease activity, HAQ or acute phase proteins. CONCLUSION Loss of muscle mass is 4-5 times more common in early arthritis patients, and is in early arthritis patients associated with a higher blood pressure and an atherogenic lipid profile. Therefore, cardiovascular risk is already increased at the clinical onset of arthritis making cardiovascular risk management necessary in early arthritis patients.
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Watson LPE, Venables MC, Murgatroyd PR. An Investigation Into the Differences in Bone Density and Body Composition Measurements Between 2 GE Lunar Densitometers and Their Comparison to a 4-Component Model. J Clin Densitom 2017; 20:498-506. [PMID: 28756995 DOI: 10.1016/j.jocd.2017.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 02/08/2023]
Abstract
We describe a study to assess the precision of the GE Lunar iDXA and the agreement between the iDXA and GE Lunar Prodigy densitometers for the measurement of regional- and total-body bone and body composition in normal to obese healthy adults. We compare the whole-body fat mass by dual-energy X-ray absorptiometry (DXA) to measurements by a 4-component (4-C) model. Sixty-nine participants, aged 37 ± 12 yr, with a body mass index of 26.2 ± 5.1 kg/cm2, were measured once on the Prodigy and twice on the iDXA. The 4-C model estimated fat mass from body mass, total body water by deuterium dilution, body volume by air displacement plethysmography, and bone mass by DXA. Agreements between measurements made on the 2 instruments and by the 4-C model were analyzed by Bland-Altman and linear regression analyses. Where appropriate, translational cross-calibration equations were derived. Differences between DXA software versions were investigated. iDXA precision was less than 2% of the measured value for all regional- and whole-body bone and body composition measurements with the exception of arm fat mass (2.28%). We found significant differences between iDXA and Prodigy (p < 0.05) whole-body and regional bone, fat mass (FM), and lean mass, with the exception of hip bone mass, area and density, and spine area. Compared to iDXA, Prodigy overestimated FM and underestimated lean mass. However, compared to 4-C, iDXA showed a smaller bias and narrower limits of agreement than Prodigy. No significant differences between software versions in FM estimations existed. Our results demonstrate excellent iDXA precision. However, significant differences exist between the 2 GE Lunar instruments, Prodigy and iDXA measurement values. A divergence from the reference 4-C observations remains in FM estimations made by DXA even following the recent advances in technology. Further studies are particularly warranted in individuals with large FM contents.
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Affiliation(s)
- Laura P E Watson
- NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK.
| | | | - Peter R Murgatroyd
- NIHR/Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK
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15
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Abstract
Bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is the most commonly used method to assess fracture risk. DXA utilizes two different energy X-rays to calculate BMD and, by comparison to a young normative database, the T-score. In 1994, the World Health Organization defined osteoporosis based on T-score, changing the paradigm of the field and forever placing DXA measurements in the center of osteoporosis diagnosis. Since then, many large studies have demonstrated the predictive value of BMD by DXA-for every standard deviation decline in BMD, there is a relative risk of 1.5-2.5 for fracture. This predictive ability is similar to how blood pressure can predict myocardial infarction. Limitations of DXA are also important to consider. While BMD by DXA can identify those at risk, there is a significant overlap in the BMD of patients who will and will not fracture. Special considerations are also needed in men and ethnic minority groups. These groups may have different bone size, thus affecting the normative range of BMD, and/or distinct bone structure that affect the association between BMD and fractures. Finally, BMD can be affected by positioning errors or artifacts, including osteoarthritis, fracture, and jewelry. Of course, DXA has tremendous strengths as well-namely its wide availability, its low radiation exposure, and a large body of evidence that relate DXA measurements to fracture risk. For these reasons, DXA remains the cornerstone of fracture assessment now and for the foreseeable future.
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Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; Department of Medicine, Section of Diabetes, Metabolism, and Endocrinology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637
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Saarelainen J, Hakulinen M, Rikkonen T, Kröger H, Koivumaa-Honkanen H, Honkanen R, Jurvelin JS. Inclusion of Regional Body Composition Parameters Improves Bone Mineral Density Cross-Calibration Between GE Lunar Prodigy and iDXA Densitometers. J Clin Densitom 2017; 20:97-105. [PMID: 27546558 DOI: 10.1016/j.jocd.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/30/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Abstract
Since 1989, the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE, n = 14220) Study has followed long-term changes of bone mineral density (BMD) and body composition in women with GE Lunar devices. During the course of OSTPRE, the dual-energy X-ray absorptiometry device had to be replaced by a newer model. Then, it was essential to determine whether systematic measurement differences in BMD and body composition will occur. As a part of the OSTPRE study, BMD was measured in 54 women, whereas body composition was determined in 55 women, aged 27-71, by using both the GE Healthcare Lunar Prodigy and iDXA narrow-angle fan beam densitometers during the same visit. The total body fat mass (FM) and lean body mass (LBM) results of these scanners showed a high linear correlation (r = 0.981-0.994, p < 0.0001). However, the mean total body FM and LBM values measured by iDXA were on average 2.3% (0.5 kg, 95% confidence interval: 0.3-0.7 kg) higher and 0.8% (0.3 kg, 95% confidence interval: 0.1-0.6 kg) lower, respectively, than those measured by Prodigy. Inclusion of local soft tissue measurements (total body LBM, legs/android FM) improved the agreement of total body, total hip, and lumbar spine BMD values between the devices but not femoral neck BMD agreement. Equations, based on linear regression analyses, were derived to minimize differences between the instruments. Then, the differences in BMD and body composition measurements were negligible between Prodigy and iDXA. Using correction equations enables an objective comparison of longitudinal BMD and body composition measurements.
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Affiliation(s)
- J Saarelainen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - M Hakulinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - H Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - H Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland; Departments of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland; Department of Psychiatry, North Karelia Central Hospital, Joensuu, Finland; Department of Psychiatry, SOSTERI, Savonlinna, Finland; Department of Psychiatry, SOTE, Iisalmi, Finland; Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland; Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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Lee JH, Lee YK, Oh SH, Ahn J, Lee YE, Pyo JH, Choi YY, Kim D, Bae SC, Sung YK, Kim DY. A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men. Osteoporos Int 2016; 27:1691-9. [PMID: 26782682 DOI: 10.1007/s00198-015-3436-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of vertebral fractures (VFs). VFA appeared to have moderate sensitivity and high specificity for detecting VFs when compared with spinal radiography. INTRODUCTION VFs are recognized as the hallmark of osteoporosis, and a previous VF increases the risk of a future fracture. Therefore, the timely detection of VFs is important for prevention of further fractures. This systematic review examined the diagnostic accuracy of VFA using dual X-ray absorptiometry (DXA) to identify VFs. METHODS We searched for potentially relevant studies using electronic databases, including Ovid-Medline, Ovid-EMBASE, Cochrane library, and four Korean databases, from their inception to May 2013. We compared the diagnostic accuracy of VFA with that of spinal radiography for detection of VFs by analyzing the sensitivity and specificity using a 2 × 2 contingency table. Subgroup analyses were also performed on studies with a low risk of bias and applicability. RESULTS Twelve studies were analyzed for the diagnostic accuracy of VFA. The sensitivity and specificity were 0.70-0.93 and 0.95-1.00, respectively, analyzed on a per-vertebra basis, and 0.65-1.00 and 0.74-1.00 on a per-patient basis. The sensitivity and specificity of five studies in subgroups with a low risk of bias in the intervention test were 0.70-0.84 and 0.96-0.99, respectively. In studies with a low risk of bias in the patient selection, those based on a per-vertebra basis in three studies were 0.70-0.93 and 0.96-1.00, respectively. CONCLUSIONS VFA had moderate sensitivity and high specificity for detecting VF when compared with spinal radiography. However, the present findings are insufficient to assess whether spinal radiography should be replaced by VFA.
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Affiliation(s)
- J-H Lee
- Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Y K Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - S-H Oh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - J Ahn
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Y E Lee
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - J H Pyo
- WHO Collaborating Centre for Pharmaceutical Science and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands
| | - Y Y Choi
- Department of Nuclear Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - D Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - S-C Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Y-K Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - D-Y Kim
- Department of Nuclear Medicine, School of Medicine, Kyung Hee University Hospital, Seoul, 130-872, Republic of Korea.
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Cross-Calibration of GE Healthcare Lunar Prodigy and iDXA Dual-Energy X-Ray Densitometers for Bone Mineral Measurements. J Osteoporos 2016; 2016:1424582. [PMID: 27239366 PMCID: PMC4863119 DOI: 10.1155/2016/1424582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/08/2016] [Accepted: 03/27/2016] [Indexed: 11/17/2022] Open
Abstract
In long-term prospective studies, dual-energy X-ray absorptiometry (DXA) devices need to be inevitably changed. It is essential to assess whether systematic differences will exist between measurements with the new and old device. A group of female volunteers (21-72 years) underwent anteroposterior lumbar spine L2-L4 (n = 72), proximal femur (n = 72), and total body (n = 62) measurements with the Prodigy and the iDXA scanners at the same visit. The bone mineral density (BMD) measurements with these two scanners showed a high linear association at all tested sites (r = 0.962-0.995; p < 0.0001). The average iDXA BMD values were 1.5%, 0.5%, and 0.9% higher than those of Prodigy for lumbar spine (L2-L4) (p < 0.0001), femoral neck (p = 0.048), and total hip (p < 0.0001), respectively. Total body BMD values measured with the iDXA were -1.3% lower (p < 0.0001) than those measured with the Prodigy. For total body, lumbar spine, and femoral neck, the BMD differences as measured with these two devices were independent of subject height and weight. Linear correction equations were developed to ensure comparability of BMD measurements obtained with both DXA scanners. Importantly, use of equations from previous studies would have increased the discrepancy between these particular DXA scanners, especially at hip and at spine.
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19
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Blank RD. Dual-Energy X-ray Absorptiometry Image Resolution and TBS Precision. J Clin Densitom 2015; 18:143-4. [PMID: 25937305 PMCID: PMC4593399 DOI: 10.1016/j.jocd.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Robert D Blank
- Medical Service, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA; Division of Endocrinology, Metabolism, and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
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20
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Krueger D, Libber J, Binkley N. Spine Trabecular Bone Score Precision, a Comparison Between GE Lunar Standard and High-Resolution Densitometers. J Clin Densitom 2015; 18:226-32. [PMID: 25659179 DOI: 10.1016/j.jocd.2014.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
Trabecular bone score (TBS) is related to microarchitecture and fracture risk independently of bone mineral density (BMD) and clinical risk factors. Widespread clinical TBS use requires documentation of reproducibility and ideally comparability across scanners. This study evaluated TBS reproducibility and explored differences between Lunar Prodigy and iDXA densitometers. Reproducibility was assessed from replicate scans in 210 men and women participating in various dual-energy X-ray absorptiometry (DXA) precision assessments. iDXA-to-Prodigy comparability was evaluated using 155 participants from 3 study groups. L1-L4 BMD and TBS precision was similar on iDXA and Prodigy (BMD coefficient of variation = 1.9% and 1.5% and TBS coefficient of variation = 1.4% and 1.6%, respectively). Precision did not differ between men and women; however, between-technologist differences (p < 0.05) of similar magnitude were observed for both BMD and TBS. Prodigy-to-Prodigy TBS values were highly correlated (R(2) = 0.85 with bias of -0.010 TBS units). Agreement was less robust comparing Prodigy with iDXA instruments (TBS R(2): 0.72-0.81 with biases of 0.012-0.034 TBS units). In conclusion, TBS precision is comparable to that of BMD and does not differ between men and women. Additionally, in these cohorts, slight TBS differences were observed between iDXA and Prodigy scans. These data suggest a potential difference between densitometer models perhaps due to higher iDXA image resolution.
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Affiliation(s)
- Diane Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA.
| | - Jessie Libber
- Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI, USA
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Hind K, Cooper W, Oldroyd B, Davies A, Rhodes L. A cross-calibration study of the GE-Lunar iDXA and prodigy for the assessment of lumbar spine and total hip bone parameters via three statistical methods. J Clin Densitom 2015; 18:86-92. [PMID: 24120577 DOI: 10.1016/j.jocd.2013.09.011] [Citation(s) in RCA: 8] [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: 04/04/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
This study assessed agreement between the GE Lunar iDXA and Prodigy densitometers for bone measurements and used 3 statistical methods to derive cross-calibration equations: linear regression, the Deming method, and multivariate analysis. Compatibility of machines for the measurements of bone mineral density, bone mineral content, and bone area also was explored. Eighty-five adults, age: 45.5 (SD 12.8) years; body mass index: 25.6 (SD 3.7) kg.m(-2) were measured once at the lumbar spine: L1-L4 and total hip on each densitometer, within 24 hours. Both linear regression and Deming analysis indicated that cross-calibration equations were required at the lumbar spine and total hip but not at the femoral neck. Multivariate analysis identified femur thickness and femur percent fat as predictive variables at the femoral neck and total hip. Bland Altman analysis (Prodigy-iDXA) indicated significant positive bone mineral density bias at the lumbar spine and femoral neck. Significant bone mineral content biases were observed at all 3 sites and bone area biases at both hip sites. These initial results suggest there are small significant differences in the bone parameters and that all 3 bone parameters should be evaluated when comparing densitometers, especially when there are differences in pixel size between the densitometers.
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Affiliation(s)
- Karen Hind
- Carnegie Research Institute, Leeds Metropolitan University, Leeds, UK.
| | - William Cooper
- Academic Division of Medical Physics, University of Leeds, Leeds, UK
| | - Brian Oldroyd
- Academic Division of Medical Physics, University of Leeds, Leeds, UK
| | - Andrew Davies
- Academic Division of Medical Physics, University of Leeds, Leeds, UK
| | - Laura Rhodes
- Academic Division of Medical Physics, University of Leeds, Leeds, UK
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Kim S, Yang KH, Lim H, Lee YK, Yoon HK, Oh CW, Park KK, Min BW, Ryu JA, Kwack KS, Lee YH. Detection of prefracture hip lesions in atypical subtrochanteric fracture with dual-energy x-ray absorptiometry images. Radiology 2013; 270:487-95. [PMID: 24126368 DOI: 10.1148/radiol.13122691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess how often and how early hip dual-energy x-ray absorptiometry (DXA) images show prefracture lesions in patients with atypical subtrochanteric fracture (ASF) and determine whether DXA images with assessment of prodromal symptoms could be used for early ASF prediction. MATERIALS AND METHODS The retrospective research protocol complied with HIPAA and was institutional review board approved, with waiver of informed consent. Among 62 women with ASF, nine without hip DXA images and seven without clear documentation of prodromal symptoms were excluded. Serial DXA images of 52 hips in 46 patients were included. Among them, 33 hips were assessed with ipsilateral DXA. For this ipsilateral group, each hip was assessed for prodromal symptoms and focal cortical changes in the lateral subtrochanteric femur cortex at DXA. Overall and cumulative detection rates for prodromal symptoms, DXA, and DXA with prodromal symptoms were measured and compared with a general linear model for overall detection rate and Cox proportional hazard models for cumulative detection rate. Thirty-three representative ipsilateral images and 199 images from subjects without fractures were reviewed in random order for prefracture lesions by three musculoskeletal radiologists independently, and the performance of DXA in ASF prediction was assessed. RESULTS Overall detection rates for DXA, prodromal symptoms, and DXA with prodromal symptoms were 61% (20 of 33), 42% (14 of 33), and 73% (24 of 33), respectively, in the ipsilateral group. Overall detection rate comparisons showed that DXA with prodromal symptoms was superior to prodromal symptoms alone (P = .0377). The cumulative detection rate curve for DXA with prodromal symptoms was also superior to that of prodromal symptoms alone (P = .0018). Sensitivity and specificity of DXA in ASF prediction ranged from 52% (17 of 33) to 58% (19 of 33) and 99% (197 of 199) to 100% (199 of 199), respectively. CONCLUSION Assessment of hip DXA images combined with conventional assessment of prodromal symptoms enables detection of more ASFs earlier than assessment based on prodromal symptoms alone.
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Affiliation(s)
- Sungjun Kim
- From the Depts of Radiology (S.K.) and Orthopedic Surgery (K.H.Y.), Gangnam Severance Hosp, Yonsei Univ College of Medicine, 211 Eonju-ro, Gangnam-Gu, Seoul 135-720, South Korea; Biostatistics Collaboration Unit, Gangnam Severance Hosp, Biomedical Research Ctr, Yonsei Univ College of Medicine, Seoul, South Korea (H.L.); Dept of Orthopedic Surgery, Seoul National Univ Bundang Hosp, Sungnam-si, South Korea (Y.K.L.); Dept of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hosp, Goyang, South Korea (H.K.Y.); Dept of Orthopedic Surgery, Kyungpook National Univ Hosp, Daegu, South Korea (C.W.O.); Depts of Orthopedic Surgery (K.K.P.) and Radiology (Y.H.L.), Severence Hospital, Yonsei University College of Medicine, Seoul, South Korea; Dept of Orthopedic Surgery, Keimyung Univ Dongsan Medical Ctr, Daegu, South Korea (B.W.M.); Dept of Radiology, Hanyang Univ Guri Hosp, Hanyang Univ, Guri, South Korea (J.A.R.); and Dept of Radiology, Ajou Univ Hosp, Ajou Univ School of Medicine, Uwon, South Korea (K.S.K.)
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Chen RQ, Watanabe K, Hosogane N, Hikata T, Iwanami A, Ishii K, Nakamura M, Toyama Y, Matsumoto M. Spinal coronal profiles and proximal femur bone mineral density in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2433-7. [PMID: 23764767 DOI: 10.1007/s00586-013-2872-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/27/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Although the occurrence and progression of AIS has been linked to low bone mineral density (BMD), the relationships between spinal curvature and bilateral differences in proximal femur BMD are controversial. Few correlation studies have stratified patients by curve type. The purpose of this study was to evaluate the relationships between spinal coronal profile and bilateral differences in proximal femur BMD in patients with adolescent idiopathic scoliosis (AIS). METHODS This study included 67 patients with AIS who underwent posterior correction and fusion surgery between January 2009 and October 2011. The mean age at the time of surgery was 17.4 ± 4.1 years. Bilateral proximal femur BMD was measured before surgery by dual-energy X-ray absorptiometry. We compared the proximal femur BMDs by determining the bilateral BMD ratio (left proximal femur BMD divided by that of the right). We evaluated correlations between coronal parameters, obtained from preoperative radiographs, and the BMD ratio using Pearson's correlation analysis. RESULTS Patients with Lenke type 1 curve (48; all with a right convex curve) had a mean bilateral proximal femur BMD ratio of 1.00 ± 0.04. Patients with Lenke type 5 curve (19; all with a left convex curve) had a mean bilateral proximal femur BMD ratio of 0.94 ± 0.04, indicating that the BMD in the proximal femur on the right side (concave) was greater than that in the left (convex). Coronal balance was significantly correlated with the BMD ratio in both the Lenke type 1 and type 5 groups, with a correlation coefficient of 0.46 and 0.50, respectively. CONCLUSIONS The bilateral proximal femur BMD ratio was significantly correlated with the coronal balance in AIS patients. When the C7 plumb line was shifted toward one side, the BMD was greater in the contralateral proximal femur.
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Affiliation(s)
- Rui-Qiang Chen
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Diacinti D, Del Fiacco R, Pisani D, Todde F, Cattaruzza MS, Diacinti D, Arima S, Romagnoli E, Pepe J, Cipriani C, Minisola S. Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 2012; 91:335-42. [PMID: 22965625 DOI: 10.1007/s00223-012-9643-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate the diagnostic performance of vertebral fracture assessment (VFA) using the Lunar iDXA scanner. Conventional spinal radiographs and images acquired by dual-energy X-ray absorptiometry (DXA) of 350 subjects (269 females, 81 males) were evaluated by two different readers. We visualized 4,476/4,550 (98.4 %) vertebrae from T4 to L4 on VFA images compared to 4,535/4,550 (99.7 %) on radiographs. Among the visualized vertebrae, 205/4,535 (4.5 %) and 190/4,476 (4.2 %) were identified as nonfracture deformities by reading of radiographs and VFA, respectively. Vertebral fractures (VFs) were 231 in 126 patients and 228 in 125 patients by semiquantitative assessment of radiographs (SQ-Rx) and by VFA, respectively. There was excellent agreement between the two techniques and high diagnostic performance of VFA both on a per-vertebra basis (k score = 0.984, 95 % CI 0.972-0.996, sensitivity 98.68 %, specificity 99.91 %, PPV 98.25 %, NPV 99.93 %) and on a per-patient basis (k score = 0.957, 95 % CI 0.925-0.988, sensitivity 96.83 %, specificity 98.66 %, PPV 97.60 %, NPV 98.22 %). In older patients (≥65 years) affected by moderate or severe osteoarthritis, SQ-Rx and VFA identified 96 VFs and 95 versus 90 vertebral deformities, respectively. This study demonstrates that most vertebrae are evaluable using the iDXA scanner, with improved VFA diagnostic performance even in discriminating mild VFs from vertebral deformities. Therefore, VFA may be appropriate as an alternative to conventional radiography in patients at high risk of VF who are undergoing DXA bone densitometry and in the follow-up of osteoporotic patients on treatment.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, RM, Italy
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