Efficacy of weight adjusted bone mineral content in osteoporosis diagnosis in Chinese female population

Abstract

Background: Areal bone mineral density (aBMD) applied for osteoporosis diagnosis unavoidably results in the missingdiagnosis in patients with large bones and misdiagnosis in those with small bones. Therefore, we try to find a new adjusted index of bone mineral content (BMC) to make up shortcomings of aBMD in osteoporosis diagnosis. Methods: In this multi-center epidemiological study, BMC and aBMD of lumbar spines ( n = 5510) and proximal femurs ( n = 4710) were measured with dual energy X-ray absorptiometry (DXA). We analyzed the correlation between the bone mass and body weight in all subjects including four age groups (<19 years, 20–39 years, 40–49 years, >50 years). And then the body weight was used for standardizing BMC (named wBMC) and applied for the epidemiological analysis of osteoporosis. Results: The correlation of body weight and BMC is 0.839 to 0.931 of lumbar vertebra 1–4 (L 1–4 ), and 0.71 to 0.95 of femoral neck in different age groups. When aBMD was applied for diagnosing osteoporosis, the prevalence was 7.55%, 16.39%, and 25.83% in patients with a high, intermediate, and low body weight respectively. However, the prevalence was 21.8%, 18.03%, and 11.64% by wBMC applied for diagnosing osteoporosis. Moreover, the prevalence of osteoporosis increased by 3.76% by wBMC with the body weight increased by 5 kg. The prevalence decreased by 1.94% when the body weight decreased by 5 kg. Conclusions: wBMC can reduce the missed diagnosis in patients with large body weight and reduce misdiagnosis in those with small body weight. Including children, wBMC may be feasible for osteoporosis diagnosis individuals at any age.

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“…The BMD results were expressed in g/ cm. 2 The femur was scanned by Skyscan (Brooke micro CT, Kentucky, Belgium) and analyzed by Skyscan software. The measurement was performed with 40 kV and 250 μA.…”

“…1 Among women over 60 in China, the prevalence of osteoporosis is as high as 40% −50%, of which about 30% −50% experience osteoporosis-related fractures. 2 It seriously affects the physical health and life quality, and even lead to shortened life span. 3 And osteoporosis and its related fractures seriously increase the financial and human burden of the country and family.…”

Extension of weight-standardized bone mineral content in osteoporosis diagnosis

“…To the Editor: We appreciate the attentive and interesting article “ Efficacy of weight adjusted bone mineral content in osteoporosis diagnosis in Chinese female population ” written by Liu et al [1] The authors have nicely shown bones are three dimensional tissues, only volumetric bone mineral density (vBMD) can be regarded as completely standardized, since the areal bone mineral density (aBMD) is two-dimensional and could result in missed diagnosis in subjects with large bones and misdiagnosis in those with small bones. In addition, although vBMD has undeniable advantages, the most sophisticated dual-energy X-ray absorptiometry (DXA) instrument is not able to measure the bone volume in vivo .…”

“…Based on the regression coefficient, the researchers proposed “analysis self-assessment tool for Asia (OSTA),” with the formula of OSTA score = (weight – age) × 0.2, and populations with an OSTA score less than or equal to 4 was considered high-risk for the osteoporosis, which has been applied in many Asian countries. However, Gu et al [1] wrote in the article that OSTA score less than or equal to 5 is considered as a high risk of osteoporosis, so the value of 5 in this sentence should be changed to 4 to be more appropriate. In addition, Koh et al [3] and some studies have also shown that age has a great correlation with bone mineral content (BMC), so should age be considered in wBMC?…”