Discordance in Diagnosis of Osteoporosis Using Spine and Hip Bone Densitometry

Maghraoui, A. El; Abayi, D.A. Mouinga; Rkain, Hanan; Mounach, Aziza

doi:10.1016/j.jocd.2006.12.003

Cited by 17 publications

(14 citation statements)

References 19 publications

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“…Some physiologic and/or pathologic risk factors for this phenomenon include older age, menopause, and obesity ( 9 , 10 ). Another possible reason could be the performance or analysis of the DXA ( 11 ). This over-or underestimation of osteoporosis prevalence could also result from considering whole-body BMD measurements, as various skeletal regions with different dynamic properties and types (for example, long bones versus cancellous bones) will be considered as one region.…”

Section: Discussionmentioning

confidence: 99%

Correlating Whole-Body Bone Mineral Densitometry Measurements to Those From Local Anatomical Sites

et al. 2016

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Background:Using the same cutoff points for whole-body measurements as for site-specific measurements will result in underestimation of osteoporosis.Objectives:We assessed the correlation between densitometry measurements for the whole body with those for the femur, lumbar spine, and forearm to evaluate the possibility of replacing site-specific values with whole-body measurements.Patients and Methods:In this cross-sectional study, we evaluated all patients referred to a single rheumatology clinic for bone mineral density measurements from 2009 to 2010. All patients who had bone mineral density measurements taken from the hip, lumbar spine, forearm, and whole body were enrolled in the study. Standard bone mineral density measurements were performed using a dual energy X-ray absorptiometry device (Hologic Delphi A; Hologic, Bedford, MA, USA). Bone mineral density, Z-score, and T-score were measured for all patients and all body regions.Results:The mean age of the 152 participating patients was 56.7 ± 12.6 years, and 97.4% were female. Pearson correlation coefficients of the whole-body bone mineral density values compared with site-specific values in patients over age 50 were 0.66 – 0.75. Using T-score cutoff points of -1 and -2.5 for osteopenia and osteoporosis, whole-body measurements underestimated the percentage of abnormal patients compared with the site-specific measurements (all P < 0.001). Using receiver operating characteristic (ROC) analysis, the whole-body bone mineral density showed respective areas under the curve of 0.96 and 0.84 for the diagnosis of abnormal hip bone mineral density and osteoporosis.Conclusion:Using the same cutoff points for whole-body measurements as for site-specific measurements will result in overestimation or especially underestimation of osteopenia and osteoporosis diagnosis. Choosing new and appropriate cutoff points for whole-body densitometric measurements when we want to substitutes this assessment instead of site specific measurements seems mandatory and will decrease the rate of false diagnoses of densitometric deficiencies in these anatomical sites.

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Section: Discussionmentioning

confidence: 99%

Correlating Whole-Body Bone Mineral Densitometry Measurements to Those From Local Anatomical Sites

et al. 2016

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“…Bone densitometry is the standard tool for the diagnosis of osteoporosis based on parameters defined by the World Health Organization (WHO 1994). However, the result may vary depending on the method employed (Faulkner et al 1999, Blake et al 2002, the part of the skeleton that is analyzed (El Maghraoui et al 2007, Mounach et al 2009) and the body composition of the patient (Saarelainen et al 2007). This occurs partly because, although osteoporosis is a systemic disease, bone loss is not uniform within the skeleton (Shea & Miller 2005), as the activity of bone cells depends on the local blood supply and mechanical stimulation (Weinstein & Manolagas 2000, Hazenberg et al 2006.…”

Section: Discussionmentioning

confidence: 99%

Effects of chronic mild stress on parameters of bone assessment in adult male and female rats

et al. 2016

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RESUMO.-[Efeito do estresse moderado crônico sobre parâmetros de avaliação óssea em ratos adultos machos e fêmeas.] A osteoporose é uma doença multifatorial, de alta prevalência e que tem um grande impacto na qualidade de vida, principalmente porque os efeitos sobre a estrutura do osso aumentam o risco de fraturas, que podem ser muito debilitantes. Com base na observação de que pacientes com depressão têm menor densidade mineral óssea que indivíduos saudáveis , muitos estudos têm indicado que o estresse pode ser um fator agravante para a perda óssea. Este estudo avalia o efeito de um protocolo de estresse moderado crônico (EMC) em parâmetros de avaliação óssea em ratos machos e fêmeas. Cinco animais de cada sexo, com cinco meses de idade, foram submetidos a um cronograma de aplicação de estressores durante 28 dias. Os estressores incluídos foram: frio, calor, contenção, inclinação da gaiola, isolamento, iluminação durante a noite e privação de água e ração. Cinco animais de cada sexo foram mantidos com um Osteoporosis is a multifactorial disease of high prevalence and has great impact on quality of life, because the effects on bone structure increase the risk of fractures, what may be very debilitating. Based on the observation that patients with depression have lower bone mineral density than healthy individuals, many studies have indicated that stress could be an aggravating factor for bone loss. This study evaluates the effect of a protocol of chronic mild stress (CMS) on parameters of bone assessment in male and female rats. Five 5-monh--old rats of each sex underwent a schedule of stressor application for 28 days. Stressors included cold, heat, restraint, cage tilt, isolation, overnight illumination, and water and food deprivation. Five rats of each sex were kept under minimum intervention as control group. The animals were weighed at beginning and end of the period, and after euthanasia had their bones harvested. Femur, tibia and lumbar vertebrae were analyzed by bone densitometry. Biomechanical tests were performed in femoral head and diaphysis. Trabecular bone volume was obtained from histomorphometric analysis of femoral head and vertebral body, as well as of femoral midshaft cross-sectional measures. Not all parameters analyzed showed effect of CMS. However, tibial and L4 vertebral bone mineral density and cross--sectional cortical/medullar ratio of femoral shaft were lower in female rats submitted to the CMS protocol. Among male rats, the differences were significant for femoral trabecular bone volume and maximum load obtained by biomechanical test. Thus, it could be confirmed that CMS can affect the balance of bone homeostasis in rats, what may contribute to the establishment of osteopenia or osteoporosis. Effects of chronic mild stress on parameters of bone assessment in adult male and female rats mínimo de intervenção como grupo controle. Os animais foram pesador no início e no final do período, e após eutanásia tiveram seus ossos coletados. Fêmur, tíbia e vértebra lombar foram analisados por dens...

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“…Although the BMDs at different anatomic regions are correlated, the agreement between sites is low when it comes to classifying individual subjects as osteoporotic or not. Thus, T -score discordance between the lumbar spine and hip testing sites is a commonly observed phenomenon in densitometry [5, 6]. T -score discordance is the observation that the T -score of an individual patient varies from one key measurement site to another.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Discordance between Left- and Right-Hip Bone Mineral Density Using DXA

et al. 2012

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To determine the prevalence of significant left-right differences in hip bone mineral density (BMD), and the impact of this difference on osteoporosis diagnosis, we measured bilateral proximal femora using dual energy X-ray absorptiometry (DXA) in 3481 subjects (608 males, 2873 females). The difference between left and right hip was considered significant if it exceeded the smallest detectable difference (SDD) for any of the three hip subregions. Contralateral femoral BMD was highly correlated at all measuring sites (r = 0.92–0.95). However, significant left-right differences in BMD were common: the difference exceeded the SDD for 54% of patients at total hip, 52.1% at femoral neck, and 57.7% at trochanter. The prevalence of left-right differences was greater in participants >65 years. For 1169 participants with normal spines, 22 (1.9%) had discordant left-right hips in which one hip was osteoporotic; for 1349 patients with osteopenic spines, 94 (7%) had osteoporosis in one hip. Participants with BMI < 20 kg/m2 were more likely to show major T-score discordance (osteoporosis in one hip and normal BMD in the other). Multiple regression analysis showed that the only significant statically parameter that persists after adjusting for all potential confounding parameters were age over 65 years.

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Discordance in Diagnosis of Osteoporosis Using Spine and Hip Bone Densitometry

Cited by 17 publications

References 19 publications

Correlating Whole-Body Bone Mineral Densitometry Measurements to Those From Local Anatomical Sites

Correlating Whole-Body Bone Mineral Densitometry Measurements to Those From Local Anatomical Sites

Effects of chronic mild stress on parameters of bone assessment in adult male and female rats

Prevalence and Risk Factors of Discordance between Left- and Right-Hip Bone Mineral Density Using DXA

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