More evidence to support a lower quantitative computed tomography (QCT) lumbar spine bone mineral density (BMD) cutpoint value for classifying osteoporosis among older East Asian women than for Caucasians

Wáng, Yì Xiáng J.; Yu, Wei; Leung, Jason C. S.; Griffith, James F.; Xiao, Ben-Heng; Diacinti, Daniele; Guermazi, Ali; Chan, Wing P.; Blake, Glen M.

doi:10.21037/qims-24-429

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…Figure 5A is a prospective study with baseline spine quantitative computed tomography (QCT) measure, while Figure 5B-5H are cross-sectional studies. All these 8 studies show most of the subjects with radiographic vertebral FF had LS DOP, or mean LS DXA T-score below −2.5, or a mean QCT BMD below 80 mg/mL for Caucasian women and a mean QCT BMD below 45 mg/mL for Japanese and Chinese women [45–50 mg/mL is our recommended QCT LS BMD threshold for classifying DOP among East Asian women ( 51 , 52 )], despite varying criteria were used to classify radiographic vertebral FF including Genant semi-quantitative approach, algorithm-based qualitative approach, and morphometric approach. This trend appears to be more apparent with QCT results than the DXA results.…”

Section: Bmd Status Of Radiographic Vertebral Ff Patientsmentioning

confidence: 99%

For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis

Wáng

2024

Quant Imaging Med Surg

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It has been frequently cited that ‘ the majority of fragility fractures (FF) occur at non-osteoporotic bone mineral density (BMD) ’. For the reports with T-score measured around the time of a hip fracture, we conducted a systematic literature search in December 2022, and resulted in 10 studies with five for Caucasian women and five for East Asian women. Femoral neck (FN) T-score was reported in five Caucasian studies and three East Asian studies, three of five Caucasian studies had a mean T-score ≤−2.5, and one study had the majority of their patients measuring a mean T-score ≤−2.5. All three East Asian studies reported a mean FN T-score ≤−2.7. Total hip T-score was reported in two Caucasian studies and three East Asian studies, the two Caucasian studies both had a mean T-score ≤−2.5, and all three East Asian studies had a mean T-score ≤−2.6. A new literature search conducted in April 2024 results in additional three studies, with results being consistent with the data described above. A trend was noted that ‘younger’ patients suffer from hip fractures at a ‘higher’ T-score. For the highly cited articles where the notion the majority of FF occur at non-osteoporotic BMD was derived from, authors reported prospective epidemiological studies where BMD was not measured at the timepoint of hip fracture, instead, BMD was measured at the study baseline. These epidemiological studies suggest that >50% of hip fractures likely occur in women with an osteoporotic FN or hip T-score. However, a pattern was seen that older men suffer from hip fracture at a notably higher T-score than older women. For the cases of radiographic vertebral FF, despite varying criteria being used to classify these FFs, the majority of female patients had spine densitometric osteoporosis. Literature shows, compared with the cases of hip fracture, distal forearm fracture occurs at a ‘younger’ age and ‘higher’ BMD, suggesting distal forearm fracture is more likely associated with a ‘higher’ trauma energy level.

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Section: Bmd Status Of Radiographic Vertebral Ff Patientsmentioning

confidence: 99%

For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis

Wáng

2024

Quant Imaging Med Surg

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Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older Chinese men can be the same as that of older Chinese women, both much lower than the value for Caucasians

Wáng,

Chan,

et al. 2024

Skeletal Radiol

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For older Caucasian women and men, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) threshold for classifying osteoporosis is 80 mg/ml. It was recently proposed that, for older East Asian women, the QCT LS BMD value equivalent to the Caucasian women’s threshold of 80 mg/mL is about 45∼50 mg/ml. For a data of 328 cases of Chinese men (age: 73.6 ± 4.4 years) who had QCT LS BMD and DXA LS BMD at the same time and with the DXA BMD value of ≤ 0.613 g/cm2 to classify osteoporosis, the corresponding QCT LS BMD threshold is 53 mg/ml. Osteoporotic-like vertebral fracture sum score (OLVFss) ≤ -2.5 has been proposed to diagnose osteoporosis. For 316 cases of Chinese men (age:73.7±4.5 years), OLVFss ≤ -2.5 defines an osteoporosis prevalence of 4.4%; to achieve this osteoporosis prevalence, the corresponding QCT LS BMD value is < 47.5 mg/ml. In the China Action on Spine and Hip Status study, a Genant grades 2/3 radiographic ‘osteoporotic vertebral fracture’ prevalence was 2.84% for Chinese men (total n = 1267, age: 62.77 ± 9.20 years); to achieve this osteoporosis prevalence, the corresponding BMD value was < 42.5 mg/ml. In a study of 357 Beijing older men, according to the clinical fragility fracture prevalence and femoral neck DXA T-score, the QCT LS BMD value to classify osteoporosis was between 39.45 mg/ml and 51.38 mg/ml. For older Chinese men (≥ 50 years), we recommend the cutpoint for the QCT LS BMD definition of osteoporosis to be 45∼50 mg/ml which is the same as the value for Chinese women.

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More evidence to support a lower quantitative computed tomography (QCT) lumbar spine bone mineral density (BMD) cutpoint value for classifying osteoporosis among older East Asian women than for Caucasians

Cited by 2 publications

References 40 publications

For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis

For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis

Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older Chinese men can be the same as that of older Chinese women, both much lower than the value for Caucasians

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