Diagnostic disagreement of imaging quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur

Impact of beverage consumption, age, and site dependency on dual energy X-ray absorptiometry (DEXA) measurements in perimenopausal women: a prospective study

INTRODUCTION

The aim of this study was to determine the best site for bone mineral density (BMD) measurements based on T-scores, age, and beverage consumption.

MATERIAL AND METHODS

In this prospective study, 271 women stratified by age (average age: 61.9 years) underwent dual energy X-ray absorptiometry (DEXA) scanning of their lumbar spine, hips, and forearms. Osteoporosis was defined as a BMD of 2.5 standard deviations or more below the mean peak bone mass based on a reference population of adult women (translated as a T-score ≤ -2.5), as measured by DEXA. Participants were also evaluated regarding alcohol and caffeine consumption by a semiquantitative questionnaire.

RESULTS

A significant discrepancy was observed in the classification of osteoporosis at different locations, with hip and forearm showing the best correlation (Pearson's r = 0.627, p < 0.001). In addition, for participants over 50 years of age, hip and forearm showed the best correlation. Significant correlations were also noted between forearm T-scores and caffeine consumed and, to a lesser extent, the level of alcohol consumption. In the group ≤ 50 years of age, lumbar spine and forearm T-scores were only associated with alcohol consumption. In the group over 50 years of age, hip and forearm T-scores were only associated with caffeine consumption.

CONCLUSIONS

Bone mineral density measurements at the hip and forearm correlated with caffeine consumption in elderly Taiwanese women. This is an important finding since age and caffeine consumption are known risk factors for osteoporosis.

Comparisons of bone mass measurements on various skeletal sites including quantitative ultrasonography of the calcaneus for assessing age-related losses, their correlations, and diagnostic agreement using the Japanese and WHO criteria for osteoporosis

PURPOSE

The aim of this study was to compare age-related bone losses and correlations among several bone mass measurements and to evaluate diagnostic agreement among them using the Japanese and WHO criteria for osteoporosis.

MATERIALS AND METHODS

A total of 846 women (mean +/- SD: age 54 +/- 9 years) were evaluated. Bone mineral densities of the lumbar spine, femoral neck, and calcaneus were measured by dual X-ray absorptiometry and distal radius by peripheral computed tomography. Quantitative ultrasonography (QUS) parameters of the calcaneus were also measured. The age-related bone losses after 50 years of age and correlations among bone mass results were evaluated using linear regression analysis. Diagnostic agreement was evaluated by kappa statistics.

RESULTS

The annual losses ranged from 1.0% to 1.6%. The correlation coefficients ranged from 0.54 to 0.78. The kappa scores ranged from 0.52 to 0.30 for all subjects using the Japanese criteria and from 0.38 to 0.15 using the WHO criteria.

CONCLUSION

Bone mass measurements including QUS on various skeletal sites documented age-related changes similarly, and their bone masses correlated moderately. The diagnostic agreements among them were fair to poor. To screen out women with a risk of osteoporosis, it is important to choose which technique to use and which skeletal site to measure.

Correlation of quantitative heel ultrasonography with central dual-energy X-ray absorptiometric bone mineral density in postmenopausal women

OBJECTIVES

In this study, we sought the proper cutoff level for quantitative ultrasonography (QUS) of the heel in identifying bone mineral density (BMD) categories as determined by dual-energy x-ray absorptiometry (DXA) in postmenopausal women.

METHODS

With the use of DXA, BMD categories of the lumbar spine and different areas of the left femur of 420 healthy women according to World Health Organization definitions were determined. Quantitative ultrasonography of the heel was also performed in each subject. Receiver operating characteristic curves were plotted, and sensitivity and specificity of QUS to diagnose osteoporosis were examined at different points to identify the best cutoff level. The diagnostic agreement between the two techniques in identifying osteoporosis was assessed with kappa scores.

RESULTS

The kappa scores were 0.31 for the lumbar region and 0.5 for the femoral neck region. On the receiver operating characteristic study, a score of -1 was found to be the appropriate cutoff point for QUS studies, in which the sensitivity of QUS to diagnose BMD osteoporosis varied between 78% and 87.5% depending on the site of the DXA study. With the proposed cutoff point (-1), sensitivity and specificity of QUS in detecting osteoporosis at the lumbar spine were 83.9% and 51%, respectively, and at the femoral neck were 84% and 50%, respectively.

CONCLUSIONS

Insufficient agreement between QUS and DXA led to uncertainty on expected BMD in people tested by QUS. The proposed cutoff value could achieve higher sensitivity but only by accepting higher rates of false-positive results.

Limited diagnostic agreement of quantitative sonography of the radius and phalanges with dual-energy x-ray absorptiometry of the spine, femur, and radius for diagnosis of osteoporosis

OBJECTIVE

The aim of our study was to evaluate the diagnostic agreement of quantitative sonography of the radius and proximal phalanx and dual-energy X-ray absorptiometry (DXA) of the radius, lumbar spine, and femoral neck for the detection of osteoporosis.

MATERIALS AND METHODS

In 95 women (mean age, 53 +/- 13 years) and 26 men (mean age, 53 +/- 13 years), DXA measurements of the lumbar spine (posterior-anterior, L1-L4) and the femoral neck, as well as quantitative sonography of the radius and proximal phalanx of the third finger were obtained. The percentage of patients below a given threshold was calculated for each imaging technique. A T score of less than -2.5 indicated presence of osteoporosis. Diagnostic agreement in identifying individuals with osteoporosis was assessed using kappa scores.

RESULTS

Between 14% and 22% of the patients were classified as osteoporotic after DXA of the various regions of interest of the radius, 31% after DXA of the spine, 43% after DXA of the femoral neck, 32% after quantitative sonography of the distal radius, and 34% after quantitative sonography of the phalanx of the third finger. Correlation coefficients between T values for quantitative sonography and those for DXA varied between not significant and 0.54 at the different regions. Kappa analysis showed the diagnostic agreement among quantitative sonography and DXA to be fair to moderate (kappa = 0.38-0.48). The highest agreement was between quantitative sonography of the proximal phalanx of the third finger and DXA of the total radius (kappa 0.48; p < 0.05).

CONCLUSION

Considerable diagnostic disagreement exists between quantitative sonography and DXA of the forearm, as is true for most quantitative techniques in the assessment of skeletal status. The lack of correlation makes quantitative sonography impractical for routine diagnostic use but might characterize different parameters related to bone quality.

Comparison of imaging-guided and non-imaging-guided quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur

OBJECTIVE

The purpose of our study was to evaluate the diagnostic agreement between imaging-guided and non-imaging-guided quantitative sonography of the calcaneus and dual X-ray absorptiometry of the spine and femur to show osteoporosis.

SUBJECTS AND METHODS

In 113 patients (73 women, 59 +/- 14 years old; 40 men, 48 +/- 16 years old), dual X-ray absorptiometry of the lumbar spine and the proximal femur, imaging-guided quantitative sonography, and non-imaging-guided quantitative sonography of the calcaneus were performed. The percentage of patients having a T-score equal to or less than a threshold of -2.5 SDs (prevalence of osteoporosis) was calculated for each imaging technique. The diagnostic agreement of the three techniques in identifying individuals with osteoporosis was assessed.

RESULTS

Eleven percent of the women and 8% of the men were classified as osteoporotic by imaging-guided quantitative sonography, and 38% of the women and 25% of the men were so classified by non-imaging-guided quantitative sonography. At dual X-ray absorptiometry of the spine, 44% of the women and 38% of the men were classified as osteoporotic, and, at different femoral regions, 19-60% of the women and 8-38% of the men were so classified. Kappa analysis for both quantitative sonography techniques was not significant. Kappa analysis for both quantitative sonography techniques and dual X-ray absorptiometry showed diagnostic agreement to be generally poor.

CONCLUSION

No advantage in diagnostic accuracy could be found for imaging-guided quantitative sonography. The considerable diagnostic disagreement between both quantitative sonography techniques and dual X-ray absorptiometry could be confusing in daily clinical practice.