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Moonkum N, Withayanuluck T, Somarungsan A, Sichai N, Wongsiri A, Chawkhaodin W, Ruengdach P, Boonsuk P, Pukdeeyorng M, Tochaikul G. Osteopenia and Osteoporosis Screening Detection: Calcaneal Quantitative Ultrasound with and without Calibration Factor Comparison to Gold Standard Dual X-ray Absorptiometry. J Clin Densitom 2024; 27:101470. [PMID: 38342001 DOI: 10.1016/j.jocd.2024.101470] [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: 10/25/2023] [Revised: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND osteoporosis is a worldwide major health problem that normally diagnosed in advanced stages. So, an early detection at preclinical stage is now an interesting issue. A key factor to early diagnosis the disease is the used of noninvasive bone densitometry. Dual energy x-ray absorptiometry (DXA) is the gold standard techniques for the proposed. However, the high cost, non-widely available and exposed to ionizing radiation are still a drawback of the machine. Therefore, a cheaper, smaller and non-ionizing device such quantitative ultrasound (QUS) is now a favor alternative method, but the possibility of used QUS measurement instead of DXA is still limited due to their uncertainties. So, the aim of our study was to calibrated the QUS with the DXA to allowing the possible to establish a calibration factor (CF) to improve the measured value closer to the standard method. METHODOLOGY 135 healthy men and women aged 30-88 years were recruited for lumbar spine/femoral neck DXA and calcaneal QUS scanning. The Pearson's correlation between T- and Z-score from the two systems were studied. Moreover, the sensitivity, specificity and percentage of diagnosed accuracy for both with and without CF were calculated. RESULTS The significant correlation between the two systems showed a positive trajectory in highly correlation (r = 0.784-0.899). Analyses showed a higher sensitivity, specificity and reduced the misdiagnosed rates when applied the CF in QUS values. CONCLUSIONS QUS results showed a significantly correlated with DXA results for both lumbar spine and femoral neck sites with some percentage differences. These differences can be reduced by applied an individual specific machine CF to improve a QUS results. As identification of high risk of osteopenia and osteoporosis to reduce the demand of DXA propose, using a QUS alternative method can be a reliable that provide a cheaper and lack of ionizing radiation.
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Affiliation(s)
- Nutthapong Moonkum
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand
| | | | - Arun Somarungsan
- Department of Radiology, Paolo Kaset Hospital, Bangkok 10900, Thailand
| | - Naphondej Sichai
- Department of Radiology, Paolo Kaset Hospital, Bangkok 10900, Thailand
| | - Arisa Wongsiri
- Department of Radiology, Paolo Kaset Hospital, Bangkok 10900, Thailand
| | - Witchayada Chawkhaodin
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand
| | - Podjana Ruengdach
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand
| | - Pasinee Boonsuk
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand
| | - Marut Pukdeeyorng
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand
| | - Gunjanaporn Tochaikul
- Faculty of Radiological Technology, Rangsit University, 52/347 Lak Hok, Mueang Pathum Thani District, Pathumthani 12000, Thailand.
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Tabor E, Pluskiewicz W, Tabor K. Clinical Conformity Between Heel Ultrasound and Densitometry in Postmenopausal Women: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:363-369. [PMID: 28777482 DOI: 10.1002/jum.14340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the conformity between heel ultrasound and densitometry, and the clinical application of densitometry T-score "gold standard" in quantitative ultrasound as a method of osteoporosis diagnosis in postmenopausal women. METHODS The study is a systematic review of studies published in the last 17 years in PubMed, NLM Gateway, Medline, Embase, and Cochrane Library. Calcaneal quantitative ultrasound sensitivity and specificity were analyzed with regard to densitometry measurements in postmenopausal women. In addition, we summarized the values of ultrasound T-scores, for which their accuracy in osteoporosis diagnosis is the highest. RESULTS The inclusion criteria met 15 research studies conducted on postmenopausal women. In 11 of them, the authors concluded that clinical conformity between heel ultrasound and densitometry is good. The recommended quantitative ultrasound T-score for osteoporosis diagnosis ranged between -1 and -3.65. CONCLUSIONS Heel ultrasound should be considered to be as accurate as densitometry in diagnosing osteoporosis. Nevertheless, it needs to have separate T-score ranges determined, because those used in densitometry are not adequate.
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Affiliation(s)
- Elżbieta Tabor
- School of Medicine, Division of Dentistry, Doctoral Studies, Medical University of Silesia in Katowice, Poland
| | - Wojciech Pluskiewicz
- Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry, Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Zabrze, Poland
| | - Kamil Tabor
- School of Medicine, Division of Dentistry, Doctoral Studies, Medical University of Silesia in Katowice, Poland
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Nagai A, Tajika T, Yamamoto A, Okura C, Kanazawa S, Takagishi K. Relations between quantitative ultrasound assessment of calcaneus and grip and key pinch power in Japanese mountain village residents. J Orthop Surg (Hong Kong) 2017; 25:2309499017690321. [PMID: 28219302 DOI: 10.1177/2309499017690321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE It seems to be important to recognize bone health condition using a simple method in Japanese super-aged society. The aim of our study was to investigate whether grip and key pinch strength were associated with bone quality. METHODS Medical examinations were conducted of 337 adult residents (123 men, 214 women; average age of 64.7 years) of a mountain village. Bilateral grip and key pinch strength were measured. The sound of speed (SOS) of calcaneus was assessed using an ultrasound bone densitometer. Study participants were divided into non-osteoporotic and osteoporotic groups according to the relevant WHO classification to evaluate statistical significance by age-adjusted analysis. Stepwise linear regression was used to identify the predictor of SOS using the following factors as explanatory variables: age, height, weight BMI, grip and key pinch power strength in bilateral side. A P value of < .05 was regarded as statistically significant. RESULTS In age-adjusted analysis, significant associations were found between osteoporosis and BMI (OR 0.87, 95%CI 0.80-0.95), gender (OR 3.21, 95%CI 1.83-5.62), grip strength (right side:, OR 0.95, 95%CI 0.92-0.98; left side: OR 0.95, 95% CI 0.92-0.98) and key pinch strength (right side: OR 0.76, 95%CI 0.65-0.88; left side: OR 0.79, 95%CI 0.68-0.91). In stepwise linear regression, age and left key pinch strength were predictors of calcaneal SOS (age β coefficient = -0.46, P = .00; left key pinch strength β coefficient = 0.17, P = .0049). CONCLUSIONS Key pinch strength assessment might be useful to predict calcaneal SOS in general population.
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Affiliation(s)
- Ayako Nagai
- 1 Department of Orthopaedic Surgery, Saiseikai Maebashi Hospital, Gunma, Maebashi, Japan
| | - Tsuyoshi Tajika
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Maebashi, Japan
| | - Atsushi Yamamoto
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Maebashi, Japan
| | - Chisa Okura
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Maebashi, Japan
| | - Saeko Kanazawa
- 3 Department of Orthopaedic Surgery, Isesaki Municipal Hospital, Gunma, Isesaki, Japan
| | - Kenji Takagishi
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Maebashi, Japan
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Villa P, Lassandro AP, Moruzzi MC, Amar ID, Vacca L, Di Nardo F, De Waure C, Pontecorvi A, Scambia G. A non-invasive prevention program model for the assessment of osteoporosis in the early postmenopausal period: a pilot study on FRAX(®) and QUS tools advantages. J Endocrinol Invest 2016; 39:191-8. [PMID: 26141076 DOI: 10.1007/s40618-015-0341-4] [Citation(s) in RCA: 7] [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: 01/12/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study analyses the performances of FRAX algorithm and quantitative ultrasound (QUS) tool in relationship to the dual-energy X-ray absorptiometry (DXA) categorization to identify patients at risk of osteoporosis during menopause and to reach new thresholds for recommending the first DXA examination. DESIGN Retrospective cohort study. PATIENTS AND MEASUREMENTS Two hundred eighty-two postmenopausal patients filled out a questionnaire which determined their FRAX index and performed a bone evaluation by QUS of the calcaneus to determine their stiffness index (SI). Thereafter, they underwent assessments by the gold-standard DXA bone examination. RESULTS Statistically significant correlations were observed between FRAX (calculated without BMD) and both QUS and DXA diagnosis. FRAX mean indices of risk corresponding to the diagnosis of osteoporosis by QUS and DXA were similar. Receiver operating characteristic (ROC) curve analysis showed that both FRAX and QUS tests were sufficiently accurate in predicting the alteration of bone mineral composition. The ROC curves of QUS allowed us to identify, in our population, SI cutoff for normal patients (SI > 90.5) and for patients having osteoporosis (SI < 78.5). We selected a cutoff screening value from FRAX ROC curve for major clinical fracture (2.94). The following diagnostic algorithm demonstrated that the use of FRAX test alone has a sensitivity of 85.3 % and a specificity of 33.8 % while the use of QUS exam alone showed a sensitivity of 81.3 % and a specificity of 45.1 %. When considering the capacity of QUS exam in combination with FRAX test, the final algorithm showed a sensitivity of 69.4 % and a specificity of 57.7 %. CONCLUSIONS The use of QUS test with adjusted cutoffs offers a similar performance to the FRAX test alone in terms of sensitivity. The combined use of the tests reduces the sensibility but increases the specificity and adds clinical information related to the bone status of the patient.
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Affiliation(s)
- P Villa
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy.
| | - A P Lassandro
- Department of Endocrinology, Catholic University of Sacred Heart, Rome, Italy
| | - M C Moruzzi
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - I D Amar
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - L Vacca
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - F Di Nardo
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - C De Waure
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University of Sacred Heart, Rome, Italy
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
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Thomsen K, Jepsen DB, Matzen L, Hermann AP, Masud T, Ryg J. Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis? Osteoporos Int 2015; 26:1459-75. [PMID: 25634771 DOI: 10.1007/s00198-014-3012-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022]
Abstract
Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8%) and misclassification rates (0-12.4%) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used.
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Affiliation(s)
- K Thomsen
- Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29 Entrance 112, 7th floor, 5000, Odense C, Denmark,
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McLeod KM, Johnson S, Rasali D, Verma A. Discriminatory Performance of the Calcaneal Quantitative Ultrasound and Osteoporosis Self-Assessment Tool to Select Older Women for Dual-Energy X-ray Absorptiometry. J Clin Densitom 2015; 18:157-64. [PMID: 25937306 DOI: 10.1016/j.jocd.2015.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/12/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff <65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice.
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Affiliation(s)
- Katherine M McLeod
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada; Saskatchewan Population Health and Evaluation Research Unit, University of Regina, Regina, Saskatchewan, Canada.
| | - Shanthi Johnson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada; Saskatchewan Population Health and Evaluation Research Unit, University of Regina, Regina, Saskatchewan, Canada
| | - Drona Rasali
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada; Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Ashok Verma
- Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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Shivaprasad C, Marwaha RK, Tandon N, Kanwar R, Mani K, Narang A, Bhadra K, Singh S. Correlation between bone mineral density measured by peripheral and central dual energy X-ray absorptiometry in healthy Indian children and adolescents aged 10-18 years. J Pediatr Endocrinol Metab 2013; 26:695-702. [PMID: 23612636 DOI: 10.1515/jpem-2012-0359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/07/2013] [Indexed: 11/15/2022]
Abstract
There are few large-scale studies on the utility of peripheral dual energy X-ray absorptiometry (pDXA) in children. As central dual energy X-ray absorptiometry (cDXA) equipment is not commonly available in the developing world, we assessed the correlation of bone mineral density (BMD) with cDXA and pDXA in children to determine the optimal Z-score thresholds of pDXA for predicting two predefined Z-score cutoffs (≤-1, ≤-2) of cDXA in 844 subjects (441 boys, 403 girls) aged 10-18 years. The BMD of antero-posterior lumbar spine (L1-L4), proximal femur and forearm was measured by cDXA, while the peripheral BMD of forearm and calcaneus was estimated using pDXA. The correlation was statistically significant at all sites (p<0.01). The coefficients ranged from 0.56 to 0.79 in boys and 0.17 to 0.32 in girls. A significant positive correlation was observed between BMD by pDXA and cDXA in Indian children, with a strong gender difference in both the extent of correlation and the ability of peripheral BMD to predict central BMD.
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Rivas A, Romero A, Mariscal-Arcas M, Monteagudo C, Feriche B, Lorenzo ML, Olea F. Mediterranean diet and bone mineral density in two age groups of women. Int J Food Sci Nutr 2012; 64:155-61. [PMID: 22946650 DOI: 10.3109/09637486.2012.718743] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We hypothesized that adherence to the Mediterranean diet measured as a Mediterranean diet score (MDS) has a beneficial effect on bone mineral density (BMD). For the purposes of this study, a sample of healthy women from Southern Spain was chosen. Subjects were grouped into two major groups: a first group consisted of women of reproductive age (premenopausal, pre-M) and a second group consisted of postmenopausal women (pos-M). The consumption of vegetables and fruit was found to be significantly related to BMD in both groups of subjects studied. In the pre-M group, the lipid ratio was positively associated with BMD and in pos-M women nuts intake was also associated with BMD. After implementing the analysis of covariance analysis, significant linear trends between the MDS and BMD were observed in all subjects studied. Our results indicate that a varied diet based on Mediterranean diet patterns may be beneficial in the prevention of osteoporosis.
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Affiliation(s)
- Ana Rivas
- Department of Nutrition and Food Science, School of Pharmacy, University of Granada, Granada, Spain.
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Persson GR, Berglund J, Persson RE, Renvert S. Prediction of hip and hand fractures in older persons with or without a diagnosis of periodontitis. Bone 2011; 48:552-6. [PMID: 20951243 DOI: 10.1016/j.bone.2010.09.237] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 08/25/2010] [Accepted: 09/29/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE In a prospective study, we assessed if a diagnosis of osteoporosis and periodontitis could predict hip and hand fractures in older persons. MATERIALS AND METHODS Bone density was assessed by a Densitometer. Periodontitis was defined by evidence of alveolar bone loss. RESULTS 788 Caucasians (52.4% women, overall mean age: 76 years, S.D.± 9.0, range: 62 to 96) were enrolled and 7.4% had a hip/hand fracture in 3 years. Calcaneus PIXI T-values < -1.6 identified osteoporosis in 28.2% of the older persons predicting a hip/hand fracture with an odds ratio of 3.3:1 (95% CI: 1.9, 5.7, p < 0.001). Older persons with osteoporosis had more severe periodontitis (p < 0.01). Periodontitis defined by ≥ 30% of sites with ≥ 5 mm distance between the cemento-enamel junction (CEJ) and bone level (ABL) was found in 18.7% of the older persons predicting a hip/hand fracture with an odds ratio of 1.8:1 (95% CI: 1.0, 3.3, p < 0.05). Adjusted for age, the odds ratio of a hip/hand fracture in older persons with osteoporosis (PIXI T-value < -2.5) and periodontitis was 12.2:1 (95% CI: 3.5, 42.3, p < 0.001). CONCLUSIONS Older persons with osteoporosis and periodontitis have an increased risk for hip/hand fractures.
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Affiliation(s)
- G Rutger Persson
- Department of Periodontology, University of Bern, Bern, Switzerland
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10
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Edelmann-Schäfer B, Berthold LD, Stracke H, Lührmann PM, Neuhäuser-Berthold M. Identifying elderly women with osteoporosis by spinal dual X-ray absorptiometry, calcaneal quantitative ultrasound and spinal quantitative computed tomography: a comparative study. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:29-36. [PMID: 21084160 DOI: 10.1016/j.ultrasmedbio.2010.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/05/2010] [Accepted: 10/03/2010] [Indexed: 05/30/2023]
Abstract
The ability of spinal dual x-ray absorptiometry (DXA), calcaneal quantitative ultrasound (QUS) and spinal quantitative computed tomography (QCT) to identify women with osteoporosis within the GISELA study was evaluated in 43 women, aged 62-87 years. Osteoporosis was defined as a T-score below or equal to -2.5 using DXA (femoral neck). To determine the performance of each method, the sensitivity, specificity and area under the curve (by means of a receiver operating characteristic [ROC] analysis) were calculated. The median T-scores from the measurements differed significantly (p < 0.0001). DXA (spine) identified 75% of women with osteoporosis; QUS and QCT identified 100%. The specificity was 89% for DXA (spine), 66% for QUS and 29% for QCT. ROC analysis showed that all three methods are qualified to identify women with osteoporosis; however, the different sensitivities and specificities of the methods, as well as the thresholds used for diagnosing osteoporosis have to be considered.
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Jin N, Lin S, Zhang Y, Chen F. Assess the discrimination of Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: Compared with dual energy X-ray absorptiometry measurements. Eur J Radiol 2010; 76:265-8. [DOI: 10.1016/j.ejrad.2009.05.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/30/2009] [Accepted: 05/26/2009] [Indexed: 11/16/2022]
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Performance of calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry in the discrimination of prevalent asymptomatic osteoporotic fractures in postmenopausal women. Rheumatol Int 2008; 29:551-6. [DOI: 10.1007/s00296-008-0751-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 10/05/2008] [Indexed: 10/21/2022]
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Thorpe JA, Steel SA. The Alara Metriscan phalangeal densitometer: evaluation and triage thresholds. Br J Radiol 2008; 81:778-83. [DOI: 10.1259/bjr/69540165] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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García-Tejero P, García-Frasquet M, Borrás A, Carpintero R, Nieto I. La densitometría de calcáneo permite discriminar fracturas de muñeca en mujeres ancianas. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0482-5985(07)75552-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saarelainen J, Rikkonen T, Honkanen R, Kröger H, Tuppurainen M, Niskanen L, Jurvelin JS. Is discordance in bone measurements affected by body composition or anthropometry? A comparative study between peripheral and central devices. J Clin Densitom 2007; 10:312-8. [PMID: 17451985 DOI: 10.1016/j.jocd.2007.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 03/09/2007] [Accepted: 03/13/2007] [Indexed: 11/28/2022]
Abstract
Screening of osteoporosis using peripheral bone measurements has become more common, even though diagnostic discrepancies are known to exist between peripheral dual-energy X-ray (pDXA) or quantitative ultrasound (QUS) and central DXA measurements. Values of diagnostic parameters such as bone mineral density, speed of (ultra)sound, and broadband ultrasound attenuation are affected by bone size and soft tissue composition. However, their significance for the discordance between peripheral and central techniques is unclear. In this study, bone status and total body composition of 139 women (mean age 68.3 yr [1.7 SD], mean body mass index 26.5 kg/m2 [3.6 SD]) were assessed by 3 GE Lunar devices. Heel pDXA and heel QUS were conducted using peripheral instantaneous X-ray imaging (PIXI) and Achilles, respectively, and central DXA measurements were taken at the posterior-anterior lumbar spine (L2-L4) and at the left femoral neck using Prodigy. Positive significant associations were found between body height or fat (%) and most DXA or QUS parameters. The discordance between the site-dependent DXA or QUS T-score values typically increased (p<0.05) as a function of body weight or fat (%), but not with body height. On an average, body adiposity accounted for less than 11% of the differences between the techniques; however, increase of total body fat from 20% to 45% led to a discrepancy of one T-score between DXA(HEEL) and QUS(HEEL). To avoid diagnostic bias, comparative assessment of the devices using the same population is recommended.
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Affiliation(s)
- J Saarelainen
- Bone and Cartilage Research Unit, Clinical Research Center, University of Kuopio, Kuopio, Finland.
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Calcaneal Densitometry as a Tool for Identifying Wrist Fractures in Older Women. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Frediani B, Acciai C, Falsetti P, Baldi F, Filippou G, Siagkri C, Spreafico A, Galeazzi M, Marcolongo R. Calcaneus ultrasonometry and dual-energy X-ray absorptiometry for the evaluation of vertebral fracture risk. Calcif Tissue Int 2006; 79:223-9. [PMID: 16969597 DOI: 10.1007/s00223-005-0098-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 05/27/2006] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective, cross-sectional, controlled, non-population-based study was to evaluate the specificity and sensitivity of quantitative ultrasonometry (QUS) of the heel and of dual-energy X-ray absorptiometry (DXA) in the prediction of morphometric vertebral fracture in postmenopausal women and to establish whether the combination of the two devices could improve the capacity to identify the presence of vertebral fracture. Also, we tried to identify the best T-score threshold for high risk of vertebral fracture for both QUS and DXA, highlighting the discrepancies between the two methodologies and between the various sites examined with DXA. From 6,300 patients examined by DXA (total body, lumbar spine, total femur, femoral neck), QUS and DXA vertebral morphometry (MXA), we selected 764 postmenopausal women with nontraumatic vertebral fractures; 770 postmenopausal women with normal morphometry were chosen as a control group. Logistic regression analysis yielded odds ratios (ORs) for bone mineral density (BMD) measurements and QUS that were comparable: BMD-total body 4.16, BMD-lumbar spine 4.80, BMD-total femur 3.77, BMD-femoral neck 3.86, and QUS 4.41, without statistical differences even after correction for different confounding variables (menopausal years, weight, height, body mass index, and age). The ORs obtained from different combinations of QUS and DXA results did not show statistically significant differences compared to those from a single method alone. The sensitivity and specificity of all measurements were determined by area using the receiver operating characteristic curve; these were 0.94 for total body, 0.95 for lumbar spine, 0.86 for total femur, 0.89 for femoral neck, and 0.93 for QUS, without statistical difference. The areas under the curve obtained from the combination of QUS and DXA were higher but without statistical significance compared to QUS alone. In conclusion, both QUS and DXA were able to discriminate women with fracture from women without fracture and independently contributed to determining the association with fracture. The combination of QUS and BMD did not improve the diagnostic ability of either individual technique. We found different diagnostic thresholds for QUS and DXA.
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Affiliation(s)
- B Frediani
- Department of Clinical Medicine and Immunological Sciences, Rheumatology Unit, University of Siena, Policlinico Le Scotte, viale Bracci, 53100 Siena, Italy.
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Minihane KP, Lee C, Ahn C, Zhang LQ, Merk BR. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma 2006; 20:562-6. [PMID: 16990728 DOI: 10.1097/01.bot.0000245684.96775.82] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the biomechanical properties of posterolateral antiglide plating and lateral locked plating for fixation of displaced short oblique fractures of the fibula in osteoporotic bone. METHODS Short oblique fractures of the distal fibula at the level of the syndesmosis were simulated with a fibular osteotomy and ligamentous sectioning in 18 paired fresh frozen ankles. The fractures were fixed with either a lateral locking plate with an independent lag screw or a posterolateral antiglide plate with a lag screw through the plate. The specimens were tested under a torsional load to failure. The torque to failure, angular rotation at failure, and construct stiffness of the two groups were compared. RESULTS The torque to failure and construct stiffness were significantly greater on the side with the posterolateral antiglide plate than on the side with the the lateral locking plate (P = 0.01 and 0.005, respectively). CONCLUSIONS The posterolateral antiglide plate demonstrated improved biomechanical stability as compared to the lateral locking plate in osteoporotic bone. In situations where fixation needs to be optimized, use of an antiglide plate may be favored over a lateral locking plate construct.
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Affiliation(s)
- Keith P Minihane
- Department of Orthopaedic Surgery, Northwestern University School of Medicine, 645 North Michigan Ave, Suite 910, Chicago, IL 60611, USA
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Lawrenson R, Nicholls P, Rivers-Latham R, Brown T, Barnardo J, Gray R. PIXI bone density screening for osteoporosis in postmenopausal women. Maturitas 2006; 53:245-51. [PMID: 15985347 DOI: 10.1016/j.maturitas.2005.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 05/03/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate a pragmatic screening programme for osteoporosis based on the identification of known risk factors. A secondary aim was to assess the validity of peripheral instantaneous X-ray imager (PIXI) scanning against dual energy X-ray absorptiometry (DEXA) in women identified as having osteopenia. METHODS A cross-sectional two stage screening programme. The study was carried out in 14 practices in Surrey. Women aged 60-80 years of age were screened with a questionnaire. Those identified with one or more risk factors were offered a PIXI scan of the ankle in their own surgery. Those with an intermediate score on PIXI scan were offered a DEXA scan of hip, spine and forearm. RESULTS Four thousand six hundred and forty-six women completed questionnaires, 2688 had a PIXI scan and 553 were found to be at high risk of osteoporosis. Multivariate analysis identified the three most important risk factors associated with increased risk of osteoporotic fracture as age, a previous fracture and the presence of a stooped posture. Hormone replacement therapy (HRT) was shown to be protective. Twenty three percent of women with an intermediate score on PIXI scan were found to have osteoporosis on DEXA scan of hip and spine. CONCLUSIONS PIXI scanning proved acceptable, practicable but only had moderate comparability with DEXA. The findings suggest that patients over the age of 60 years with a history of a fracture or evidence of spinal collapse are likely to have osteoporosis and should be offered screening. HRT past the menopause would seem to confer benefit and the recent reduction in its use may lead to increasing numbers of women suffering osteoporotic fractures.
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Affiliation(s)
- Ross Lawrenson
- Postgraduate Medical School, University of Surrey, Guildford, Surrey, UK.
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20
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Assantachai P, Angkamat W, Pongpim P, Weattayasuthum C, Komoltri C. Risk factors of osteoporosis in institutionalized older Thai people. Osteoporos Int 2006; 17:1096-102. [PMID: 16544053 DOI: 10.1007/s00198-006-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION There are very few published studies on osteoporosis among the institutionalized elderly in Asian countries, where the incidence of osteoporosis is increasing rapidly. Our objectives were to determine both the prevalence and risk factors of osteoporosis, as assessed by calcaneal bone mineral density (BMD) measurements, in a Thai nursing home. METHODS Activities of daily living, the Mini-Mental State Examination, blood chemistry, body composition analysis, calcaneal quantitative ultrasound (QUS) and serum C-terminal telopeptides of type I collagen (serum beta-CTx) were assessed in 108 older people living in the largest nursing home for the elderly in Bangkok. Calcaneal BMD was measured by dual-energy X-ray absorptiometry (DXA). RESULTS The prevalence of osteoporosis, as defined by a calcaneal BMD T-score <1.6, was 79.6%. The prevalence of low bone mass, as defined by a T-score of broadband ultrasound attenuation <1.0, was 80.6%. The prevalence of osteoporosis detected by these two methods was not significantly different (p=1.00). The prevalence of increased bone turnover [with the cutoff point being the mean + 2 standard deviation (SD) of the serum beta-CTx level of a sex- and age-matched control group] was 13.9%. In multiple linear regression analysis, five risk factors -- serum beta-CTx, mental health, mobility index, height and lean body mass -- were able to predict calcaneal BMD at a coefficient of determination R(2)) of 0.54. CONCLUSIONS These results indicate the importance of mental health and self-care ability as factors associated with osteoporosis. Increased bone turnover was also a significant risk factor of low bone mass. Calcaneal QUS was a useful screening tool for diagnosing osteoporosis in this population and was comparable to calcaneal DXA.
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Affiliation(s)
- P Assantachai
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Aspray TJ, Stevenson P, Abdy SE, Rawlings DJ, Holland T, Francis RM. Low bone mineral density measurements in care home residents--a treatable cause of fractures. Age Ageing 2006; 35:37-41. [PMID: 16364932 DOI: 10.1093/ageing/afj018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE to assess predictors of fracture risk and treatment for osteoporosis among elderly care home residents. SUBJECTS AND METHODS DESIGN cross-sectional survey; SETTING residents of care homes in Newcastle upon Tyne, UK; PARTICIPANTS representative sample from residential care (87), nursing homes (105) and specialist homes for elderly people with dementia [elderly mentally infirm (EMI)]: residential (124) and nursing (76); MAIN OUTCOME MEASURES dual-energy X-ray absorptiometry bone mineral density (BMD) at calcaneum; functional assessments, including cognition, using Mini-Mental State Examination (MMSE), Clifton Assessment Procedure for the Elderly-Behaviour Rating Score (CAPE-BRS) and Functional Assessment Staging Test (FAST) scores; current drug prescription. RESULTS MMSE, CAPE, FAST (all ANOVA P < 0.001) and weight (ANOVA P < 0.02) were lower in EMI homes. Drugs with sedative effects (chi-square, P < 0.0001) were more likely and calcium and vitamin D (CaD) supplementation (chi-square, P < 0.02) less likely in EMI care. For residential care, the odds ratio (OR) for sedative drugs in EMI was 2.13 (95% CI 1.11-4.06) with no significant difference between nursing homes. For CaD supplementation, the OR for EMI nursing homes was 0.19 (95% CI 0.05-0.72) and for EMI residential homes 0.38 (NS to 95% CI 0.12-1.27). BMD was low: mean T-score was -2.29 (95% CI -2-48 to -2.09) and Z-score -0.96 (95% CI -1.16 to -0.76) with a prevalence of osteoporosis (T-score < -1.6) of 69.2%. MMSE and FAST scores did not predict BMD. In EMI residential care, a decrease of CAPE score by 5 points was associated with a decrease in T-score by 0.6 (95% CI 0.15-1.1). CONCLUSIONS of the tools used to assess function, only CAPE predicted low BMD in EMI residential care. Rates of CaD supplementation are particularly low in EMI care, where risk factors for fracture were the greatest. We conclude that fracture risk is neglected in these homes, and targeted education and treatment are warranted.
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Affiliation(s)
- Terry J Aspray
- Department of Geriatric Medicine, Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK.
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22
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Barr RJ, Adebajo A, Fraser WD, Halsey JP, Kelsey C, Stewart A, Reid DM. Can peripheral DXA measurements be used to predict fractures in elderly women living in the community? Osteoporos Int 2005; 16:1177-83. [PMID: 15703863 DOI: 10.1007/s00198-005-1836-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 01/12/2005] [Indexed: 11/24/2022]
Abstract
While axial dual energy X-ray absorptiometry (DXA) is the accepted "gold standard" method both for diagnosing osteoporosis and predicting fractures, appropriate equipment is not universally available. Peripheral bone mass measurements may have the potential to identify patients at risk of fracture and to be used to target appropriate treatment. We assessed the effectiveness of peripheral DXA (PIXI, GELunar) in the assessment of risk and targeting treatment to prevent future fracture in 7,604 women aged 60-80 from five centres across Britain. At enrolment women completed a lifestyle and risk factor questionnaire and had a PIXI DXA scan of the heel. Women were categorised by PIXI DXA bone mineral density (BMD) into high, medium or low risk of future osteoporotic fracture. Treatment was recommended to those at highest risk. Follow-up was by simple questionnaire 18-24 months after baseline assessment. Seventy-four percent returned the follow-up questionnaire. The area under the receiver operator characteristic (ROC) curves for any fracture and osteoporotic fracture were comparable to those published using other sites and technologies. A 1-SD decrease in PIXI BMD was associated with an 86% increase in risk of osteoporotic fracture. Of the women identified as high risk, 74% had started treatment following their heel scan and 84.7% continued to take treatment at follow-up. No significant difference was noted in fracture rates in those who started treatment after assessment compared to those who did not. While peripheral DXA is highly effective for predicting older women who are at increased risk of future fracture, it has yet to be established as an effective method for targeting bisphosphonate or other therapy.
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Affiliation(s)
- R J Barr
- Osteoporosis Research Unit of the Department of Medicine and Therapeutics, University of Aberdeen Medical School, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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Andersen S, Boeskov E, Laurberg P. Ethnic differences in bone mineral density between inuit and Caucasians in north Greenland are caused by differences in body size. J Clin Densitom 2005; 8:409-14. [PMID: 16311425 DOI: 10.1385/jcd:8:4:409] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 04/12/2005] [Accepted: 04/12/2005] [Indexed: 11/11/2022]
Abstract
Data on bone mineral density (BMD) in living Inuit are limited and BMD measurements in Arctic Inuit using Dualenergy X-ray Absorptiometry (DXA) are lacking. Ethnicity may be important for bone mass. The aim of this study was to validate DXA in rural Arctic Greenland, to measure BMD in Greenland Inuit and Caucasians, and to estimate the importance of ethnicity for BMD. We measured the BMD in 80 healthy subjects living in Ilulissat and Saqqaq in North Greenland twice in both distal forearms and in both heels using peripheral DXA (pDXA). Participants were stratified by origin (Inuit[settlement])/Caucasians, n = 33 [19]/28), gender (men/women, n = 37/43), and age (30-39/40-49, n = 32/48). Caucasians were bigger than Inuit (men/women, height p < 0.001/p < 0.001; weight p = 0.01/ p = 0.026), but had similar BMI (p = 0.42/0.70). Triplicate pDXA measurements showed individual CV% = 0.16-1.79%; overall CV% = 1.1% (forearm)/1.0% (heel). Data followed the normal distribution (p = 0.65-0.99) with identical variances between Inuit and Caucasians (p = 0.12-0.63). Mean BMD in right forearm/left forearm/right heel/left heel was: Inuit men 0.570/0.568/0.549/0.536 g/cm2; Inuit women 0.484/0.474/0.473/0.464 g/cm2; Caucasian men 0.580/0.570/0.646/0.638 g/cm2; Caucasian women 0.495/0.496/0.552/0.553 g/cm2. An ethnic difference in heel BMD (p < 0.001) disappeared when adjusted for weight (p = 0.30). No difference was found in forearm BMD. In conclusion, pDXA is feasible and reliable in rural Greenland. Ethnic differences in BMD are small and may reflect differences in body size.
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Kiebzak GM. Peripheral Bone Densitometry. South Med J 2004; 97:542-3. [PMID: 15255418 DOI: 10.1097/00007611-200406000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gary M Kiebzak
- Center for Orthopaedic Research and Education, St. Luke's Episcopal Hospital, Houston, TX 77030, USA
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Pearson D, Taylor R, Masud T. The relationship between social deprivation, osteoporosis, and falls. Osteoporos Int 2004; 15:132-8. [PMID: 14685650 DOI: 10.1007/s00198-003-1499-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Accepted: 08/08/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to assess the relationship between heel BMD, risk factors for osteoporosis, falls history, and the Jarman Underprivileged Area Score in an older community population. From the general practice register, 1,187 women (mean age 70, range 60 to 94) were recruited. BMD of the heel was measured using the GE Lunar PIXI densitometer. A T-score cutoff for predicted osteoporosis at the spine or hip of -1.7 was used. A risk factor questionnaire was completed that included fracture history and falls history. The odds ratio (OR) with a 95% confidence interval (CI) was calculated for each risk factor for each quartile of Jarman score and for the diagnosis of osteoporosis. Logistic regression was used to identify the risk factors that predict lone bone mass in the heel. There were no significant differences between women in different quartiles of Jarman score in terms of age and body mass index (BMI). Women in the highest two quartiles of Jarman score (i.e., most deprived) had a significantly higher likelihood of osteoporosis (OR=1.82; 95% CI, 1.03 to 1.63; and OR=1.85; 95% CI, 1.04 to 1.64, respectively) and significantly lower BMD ( p=0.008). Women in these two quartiles were significantly more likely to have had a history of previous fracture (OR=1.66; 95% CI, 1.01 to 1.53), but there was no difference in falls history. Women in the lowest quartile (least deprived) were also significantly less likely to smoke ( p=0.011) but were not significantly different in terms of other risk factors (e.g., dietary calcium and activity). BMI, age, kyphosis, significant visual problems, and quartile of Jarman score were significant risk factors for low bone mass. Risk factors identified those with low bone mass at the heel with a sensitivity and specificity of 72%. In conclusion, women in the lowest quartile of Jarman score (i.e., least deprived) have significantly higher heel BMD compared with the rest of the population.
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Affiliation(s)
- Derek Pearson
- Medical Physics, Nottingham City Hospital NHS Trust, Hucknall Road, NG5 1PB, Nottingham, UK.
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