Background Low BMD taken from a single non-dominant hip is typically used to predict fracture; especially in FRAX. However, the average BMD from both hips could be used to predict fracture. No studies to date have questioned whether an average value from both hips predicts fracture better than using the lower single hip value. It is therefore important to consider whether combined hip BMD is superior at predicting fracture compared to the lowest BMD in a single hip. This may be important for clinical practice. Objectives To discover whether low BMD in a single hip predicts fracture better than the aggregate average BMD of both hips. Methods Dual X-ray Absorptiometry scan results of patients referred to a DGH between 2004 and 2010 were used. The following were recorded: age, sex, BMI and BMD. Patients were divided into a fracture and non-fracture group. Baseline characteristics were compared using students T-test for continuous and chi2 test for categorical variables. Logistic models were fitted to determine the predictors of fracture, one using the non-dominant hip, one using the dominant hip and one using the mean BMD of both hips. Fit of the model was assessed by fitting receiver operating characteristic (ROC) curves Results 14,584 patients were included in the study and 27% had sustained a fracture. Baseline demographics are summarised in Table 1. Linear regression analysis comparing left and right mean hip BMD showed coefficient of 0.948 with 95% confidence interval 0.943-0.953 (p<0.05). Logistic regression analysis is summarized in Table 2. Table 1. Table showing baseline demographics of fracture and non-fracture groups Variable Fracture (n=4000) Non-fracture (n=10584) p Age 66.8 (11.3) 62 (12.5) <0.05 Number Females 3,419 (85%) 8,926 (85%) 0.09 BMI (m/kg2) 27.2 (5.6) 26.7 (5.2) <0.05 Total left hip BMD 0.862 (0.15) 0.918 (0.155) <0.05 Total right hip BMD 0.86 (0.152) 0.95 (0.155) <0.05 Total combined hip BMD 0.861 (0.149) 0.917 (0.153) <0.05 Number of patients with left hip lowest 1,893 (47%) 5,198 (49%) 0.05 Data is mean (SD) or numbe r (%) with statistically significant values are p<0.05. Table 2. Table showing logistic regression analysis of fracture and non-fracture groups Hip with Lowest BMD Hip BMD Used to Predict Fracture Odds Ratio 95% CI p Area under ROC curve Left Left Hip 11.86 8.21–17.1 <0.05 0.607 Right Hip 11.77 8.38–16.5 <0.05 0.609 Average Combined Left and Right Hips 11.49 7.95–16.6 <0.05 0.605 Right Left Hip 10.72 7.44–15.45 <0.05 0.604 Right Hip 12.81 9.12–18.03 <0.05 0.612 Average Combined Left and Right Hips 12.63 8.96–17.6 <0.05 0.611 Either Left or Right Aggregate Average hip BMD 12.12 9.42–15.6 <0.05 0.608 Conclusions There is little difference between using the lowest, highest or combined hip BMD to predict fractures. When the total left hip BMD is lowest, this predicts fracture just as well as the higher right or total combined (OR 11.86 vs 11.77 vs 11.49 respectively). A similar pattern is found using the right total hip BMD as...
Background A relatively small amount of research has been carried out on male osteoporosis (OP). Thus, the appropriate age at which to test for OP via DXA scan in men is not known. Further, the t-score threshold at which to diagnose OP in men is not known - the female level of a t-score lower than -2.5 in either the hip or lumbar spine is generally defined as OP in men. Objectives To identify the most appropriate age at which to start testing for OP via DXA scan in males, assuming that male OP is defined as a t-score lower than -2.5. Methods Data of men that attended for a DXA scan at a UK district general hospital between June 2004 and October 2010 were included in the analysis. The following data was collated: age, t-scores of lumbar spine and proximal femur, and previous fragility fracture status. Analysis was carried out for each of the following lowest t-score levels in the hip or lumbar spine: -1.5, -2, -2.5, -3. For each t-score level, receiver operating characteristic (ROC) curve analysis was used to identify the lower age threshold at which to start testing for low BMD in men. The lower age threshold was identified as the age that gave 85% sensitivity that older individuals had a lower t-score. The area under the curve (AUC) was calculated for each ROC curve. Results 8,196 males were included in the analysis. The mean age of the group was 63.41 years (SD 12.70). Mean BMI was 27.37 Kg/m2 (SD 3.82). The mean lowest t-score was -1.61 (SD 1.30). 999 (12.19%) of the group had previously sustained a fragility fracture. The lower age threshold for each t-score level, the associated specificity and the AUC of each ROC curve are displayed in table 1. Conclusions This study indicates that an appropriate lower age threshold at which to start testing for OP with DXA scan in males is 63 years. The study also indicates that the t-score level at which male OP is defined may significantly affect the appropriate age threshold at which to test via DXA scan. These findings can guide cost-effective DXA scanning in the male population. Further research is required to evaluate the most appropriate age range at which to test for low BMD via DXA in the male population. Disclosure of Interest None Declared
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