Discordance Between Changes in Bone Mineral Density Measured at Different Skeletal Sites in Perimenopausal Women—Implications for Assessment of Bone Loss and Response to Therapy: The Danish Osteoporosis Prevention Study

Abrahamsen, Bo; Stilgren, Lis; Hermann, A; Tofteng, Charlotte Landbo; Bärenholdt, O.; Vestergaard, Peter; Brot, Christine; Nielsen, S. Pors

doi:10.1359/jbmr.2001.16.7.1212

Cited by 46 publications

(21 citation statements)

References 23 publications

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“…Most of these discordances (38.9%) are from minor category, presenting difference on only one class, and could be due to minor variation in BMD techniques or some minor physiologic dissimilarity. Minor discordance generally does not influence the overall prognosis of patients; however, in the case of patients with one site normal and the other osteopenic, follow up of patients with hip osteopenia seems reasonable [7]. …”

Section: Discussionmentioning

confidence: 99%

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry

et al. 2005

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BackgroundDiagnostic discordance for osteoporosis is the observation that the T-score of an individual patient varies from one key measurement site to another, falling into two different diagnostic categories identified by the World Health Organization (WHO) classification system. This study was conducted to evaluate the presence and risk factors for this phenomenon in a large sample of Iranian population.MethodsDemographic data, anthropometric measurements, and risk factors for osteoporosis were derived from a database on 4229 patients referred to a community-based outpatient osteoporosis testing center from 2000 to 2003. Dual-energy X-ray absorptiometry (DXA) was performed on L1–L4 lumbar spine and total hip for all cases. Minor discordance was defined as present when the difference between two sites was no more than one WHO diagnostic class. Major discordance was present when one site is osteoporotic and the other is normal. Subjects with incomplete data were excluded.ResultsIn 4188 participants (3848 female, mean age 53.4 ± 11.8 years), major discordance, minor discordance, and concordance of T-scores were seen in 2.7%, 38.9% and 58.3%, respectively. In multivariate logistic regression analysis, older age, menopause, obesity, and belated menopause were recognized as risk factors and hormone replacement therapy as a protective factor against T-score discordance.ConclusionThe high prevalence of T-score discordance may lead to problems in interpretation of the densitometry results for some patients. This phenomenon should be regarded as a real and prevalent finding and physicians should develop a particular strategy approaching to these patients.

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Section: Discussionmentioning

confidence: 99%

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry

et al. 2005

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“…Several studies have shown that T-score discordance can affect diagnosis and management of postmenopausal osteoporosis [9][10][11][12][13][14]. Inconsistencies in the diagnostic classification between skeletal sites also can be present in premenopausal women.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Z-score discordance and contributing factors in healthy premenopausal women with low bone mineral density: the Korean National Health and Nutrition Examination Survey 2008–9

et al. 2015

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The premenopausal period is important for bone health and prevention of future fractures, but measuring bone mineral density (BMD) at only one site may not be sufficient to determine therapeutic strategies for low BMD in premenopausal women due to the presence of Z-score discordance. In this study, we investigated Z-score discordance in addition to contributing factors of idiopathic low BMD in healthy premenopausal Korean women. We studied 3003 premenopausal women aged 18-50 years, without secondary causes for low BMD and history of fragility fracture, who had participated in the Fourth Korean National Health and Nutrition Examination Surveys (2008-2009). Low body mass index (BMI), low vitamin D level, and low body muscle mass were associated with low BMD even in premenopausal women. Risk factors differed depending on the anatomic site. Low BMI and low vitamin D level were risk factors for low femoral neck BMD (FN-BMD), but not for low lumbar spine BMD (LS-BMD). Only total muscle mass had a slight effect on low LS-BMD. Z-score discordance was much higher than expected, in 75 and 73.8 % of the low LS-BMD and low FN-BMD groups, respectively. Our findings suggest the need to consider BMD discordance in premenopausal women and also to provide information on correctable factors affecting low BMD in younger populations. Long-term follow-up is needed to evaluate the possible effect of Z-score discordance on the prognosis of osteoporosis and subsequent fracture risk.

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“…Even within an individual subject, there is discordance of T scores between different sites, and this is especially pronounced in postmenopausal women. 7 Thus, whether a person is classified as having osteoporosis or not based on BMD measurement may depend on the site of measurement. Therefore, there is a drive to standardize the site used for diagnosis, and total hip has been proposed as the standard since it has the highest predictive value of all current techniques assessed prospectively, and it is less affected than the spine by osteoarthrosis and osteoarthritis with age.…”

Section: Bmd and Fracture Riskmentioning

confidence: 99%

Utility of Biochemical Markers of Bone Turnover and Bone Mineral Density in Management of Osteoporosis

Vasikaran

2008

Critical Reviews in Clinical Laboratory Sciences

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2 Biochemical markers of bone turnover (bone-turnover markers) are released during bone formation or resorption and can be measured in blood and/or urine. The concentration of bone-turnover markers in serum or urine reflect bone remodeling activity and can potentially be used as surrogate markers of the rate of bone formation or bone resorption. While the diagnosis of osteoporosis is based on bone mineral density (BMD), the absolute fracture risk for a particular BMD measurement varies several fold depending on age and is also influenced by other clinical risk factors. The measurement of bone-turnover markers may be of additional value to BMD and clinical risk factors in fracture risk assessment by improving the sensitivity and specificity of prediction of future fractures. In clinical practice, bone-turnover markers may help make cost-effective treatment decisions in patients with borderline absolute risk. BMD changes following treatment cannot be detected with confidence for 12-24 months due to measurement imprecision. Bone-turnover markers, which show an early response following treatment, may be useful for monitoring therapy, identifying non-compliance and non-responders, and predicting early response to therapy. This review concludes by identifying the need for internationally agreed-upon standards for bone resorption and formation.

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Discordance Between Changes in Bone Mineral Density Measured at Different Skeletal Sites in Perimenopausal Women—Implications for Assessment of Bone Loss and Response to Therapy: The Danish Osteoporosis Prevention Study

Cited by 46 publications

References 23 publications

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry

Z-score discordance and contributing factors in healthy premenopausal women with low bone mineral density: the Korean National Health and Nutrition Examination Survey 2008–9

Utility of Biochemical Markers of Bone Turnover and Bone Mineral Density in Management of Osteoporosis

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