Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men

Abstract

Objective The objective of this study was to investigate the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. Methods A total of 313 males older than 60 years, who underwent both spinal QCT and lumbar spine and hip DXA in our department, were included. The diagnostic criteria established by the World Health Organisation in 1994 were used for DXA to diagnose osteoporosis, and the criteria recommended by the International Society of Clinical Densitometry were used for QCT. The osteoporosis detection rate by the two techniques was calculated, and the difference was compared. The minor discordance was considered present when the different diagnostic classes between the two techniques were adjacent. Major discordance was present when the diagnosis by one technique was osteoporosis and the other was normal. The computed tomography images were reviewed by radiologists to assess whether vertebral fracture, aorta calcification or degeneration was present. Results In the 313 participants (mean age, 79.6 ± 7.2 years), the osteoporosis detection rate was 10.9% for DXA (lumbar spine and hip) and 45.1% for QCT, a significant difference ( p < 0.001). The major discordance, minor discordance and concordance of diagnosis between the two techniques were seen in 8.3%, 50.8% and 40.9%, respectively. QCT detected osteoporosis better than DXA. The causes of this discordance were degeneration of spine, abdominal aorta calcification and vertebral fractures. Conclusion Our study demonstrated that discordance was common when using QCT and DXA to diagnose osteoporosis and that spinal degeneration, aorta calcification and fracture obscure the bone mineral density measurement of spine by DXA. QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. The translational potential of this article This study investigated the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. The results demonstrated that QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. This work may help clinicians make an appropriate choice of technique for the accurate diagnosis of osteoporosis and identify the patients at high risk of osteoporosis who should be treated early to prevent fractures. This may influence the therapeutic plan and the overall prognosis of patients.

Application of bone turnover markers and DXA and QCT in an elderly Chinese male population

“…DXA remains the gold standard for the diagnosis of OP; however, although DXA is widely available, its detection performance is relatively limited. The previous study of our hospital found that QCT had a higher OP detection rate than did DXA (12).…”

Nobiletin promotes the pyroptosis of breast cancer via regulation of miR‐200b/JAZF1 axis

“…33 Additionally, a recent research also found NF-κB (p65) is a key transcription factor that acts as a crucial modulator in cell growth cell apoptosis and tumorigenesis. 34 Furthermore, suppression of migration and invasion was found once NF-κB pathway was inactivated, 35 which is a key step in mediation of MMP transcription. Our research first found nobiletin could increase the level of NF-κB in the nuclei of BC cells.…”

The Association of Lumbar Disc Herniation with Lumbar Volumetric Bone Mineral Density in a Cross-Sectional Chinese Study

“…DXA cannot distinguish between cortical bone and trabecular bone, and it is sensitive to the presence of aortic calcifications, vertebral fracture, spine degeneration such as vertebral osteophytes, end-plate sclerosis, facet joint degeneration, and ligament calcification, which can all lead to falsely increased lumbar vertebral areal BMD (aBMD) [ 39 ]. Although DXA is a well-established technique, QCT is a more accurate method for BMD assessment and a more sensitive modality for the evaluation of BMD changes [ 7 , 40 ]. Xu et al found that the detection rate of osteoporosis in men older than 60 years was significantly higher by QCT than by DXA [ 7 ].…”

“…Although DXA is a well-established technique, QCT is a more accurate method for BMD assessment and a more sensitive modality for the evaluation of BMD changes [ 7 , 40 ]. Xu et al found that the detection rate of osteoporosis in men older than 60 years was significantly higher by QCT than by DXA [ 7 ]. Where aBMD measured by DXA includes both cortical and trabecular bone, vBMD derived from QCT is focused on a volumetric measure of vertebral trabecular bone that has a high turnover rate compared to cortical bone [ 40 ].…”

“…The intimate contact of the endplate with marrow is critical to nutrient diffusion into the nuclear matrix [ 5 ]. Bone mineral density (BMD) is considered to be a surrogate for bone strength and can be used to diagnose OP and to predict fractures [ 7 ]. Thus, the investigation of the associations between LDH and BMD would help us understand the impact of LDH on the incidence of osteoporotic vertebral fractures.…”