Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT

Yu, Elaine W.; Thomas, Bijoy J.; Brown, J.K.; Finkelstein, Joel S.

doi:10.1002/jbmr.506

Cited by 222 publications

(186 citation statements)

References 27 publications

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“…The spinal BMD measurement in the biomechanical CT spinal analysis, which is based on well-established clinical guidelines, is a volumetric measure that focuses on only the trabecular bone within the vertebral body, whereas DXA uses a projectional "areal" measure that encompasses the entire vertebral body and all the posterior elements (19,20). As such, the DXA BMD measure is influenced by aortic mineralization-which we found to be common in this cohort-and other degenerative changes, whereas the DXA BMD measurement is not; the DXA-based BMD measurement is also influenced by bone size and high body mass index (18,40,41). Such differences may explain why the risk for vertebral fracture is more highly associated with CT-based measures of vertebral trabecular BMD than it is with DXA-based measures of spinal BMD (22,35,37,42,43).…”

Section: Musculoskeletal Imaging: Comprehensive Assessment Of Osteopomentioning

confidence: 81%

Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography

Fidler¹,

Murthy²,

Khosla³

et al. 2016

Radiology

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).q RSNA, 2015 Purpose:To evaluate the ability of additional analysis of computed tomographic (CT) colonography images to provide a comprehensive osteoporosis assessment. Materials and Methods:This Health Insurance Portability and Accountability Actcompliant study was approved by our institutional review board with a waiver of informed consent. Diagnosis of osteoporosis and assessment of fracture risk were compared between biomechanical CT analysis and dual-energy x-ray absorptiometry (DXA) in 136 women (age range, 43-92 years), each of whom underwent CT colonography and DXA within a 6-month period (between January 2008 and April 2010). Blinded to the DXA data, biomechanical CT analysis was retrospectively applied to CT images by using phantomless calibration and finite element analysis to measure bone mineral density and bone strength at the hip and spine. Regression, Bland-Altman, and reclassification analyses and paired t tests were used to compare results. Results:For bone mineral density T scores at the femoral neck, biomechanical CT analysis was highly correlated (R 2 = 0.84) with DXA, did not differ from DXA (P = .15, paired t test), and was able to identify osteoporosis (as defined by DXA), with 100% sensitivity in eight of eight patients (95% confidence interval [CI]: 67.6%, 100%) and 98.4% specificity in 126 of 128 patients (95% CI: 94.5%, 99.6%). Considering both the hip and spine, the classification of patients at high risk for fracture by biomechanical CT analysis-those with osteoporosis or "fragile bone strength"-agreed well against classifications for clinical osteoporosis by DXA (T score 22.5 at the hip or spine), with 82.8% sensitivity in 24 of 29 patients (95% CI: 65.4%, 92.4%) and 85.7% specificity in 66 of 77 patients (95% CI: 76.2%, 91.8%). Conclusion:Retrospective biomechanical CT analysis of CT colonography for colorectal cancer screening provides a comprehensive osteoporosis assessment without requiring changes in imaging protocols.q RSNA, 2015

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Section: Musculoskeletal Imaging: Comprehensive Assessment Of Osteopomentioning

confidence: 81%

Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography

Fidler¹,

Murthy²,

Khosla³

et al. 2016

Radiology

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“…In this study, the participant group varied widely in terms of body thickness: 15.5 to 27.6cm (lumbar spine), 14.7 to 21.6cm (hip) and percentage tissue fat: 7.5 to 49.4% (lumbar spine) and 9.4 to 36% (hip), and it is known that this can affect BMD measurements (21). This has been demonstrated by two recent studies, which reported errors in BMD due to regional changes of body composition at the lumbar spine (22) and the lumbar spine and femoral neck (23).…”

Section: Discussionmentioning

confidence: 96%

A Cross-Calibration Study of the GE-Lunar iDXA and Prodigy for the Assessment of Lumbar Spine and Total Hip Bone Parameters via Three Statistical Methods

Hind

Cooper

Oldroyd

et al. 2015

Journal of Clinical Densitometry

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This study assessed agreement between the GE Lunar iDXA and Prodigy densitometers for bone measurements and used 3 statistical methods to derive cross-calibration equations: linear regression, the Deming method, and multivariate analysis. Compatibility of machines for the measurements of bone mineral density, bone mineral content, and bone area also was explored. Eighty-five adults, age: 45.5 (SD 12.8) years; body mass index: 25.6 (SD 3.7) kg.m −2were measured once at the lumbar spine: L1-L4 and total hip on each densitometer, within 24 hours. Both linear regression and Deming analysis indicated that cross-calibration equations were required at the lumbar spine and total hip but not at the femoral neck. Multivariate analysis identified femur thickness and femur percent fat as predictive variables at the femoral neck and total hip. Bland Altman analysis (Prodigy-iDXA) indicated significant positive bone mineral density bias at the lumbar spine and femoral neck. Significant bone mineral content biases were observed at all 3 sites and bone area biases at both hip sites. These initial results suggest there are small significant differences in the bone parameters and that all 3 bone parameters should be evaluated when comparing densitometers, especially when there are differences in pixel size between the densitometers.

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“…Third, the significant increases in circulating concentrations of bone turnover markers suggest a bone catabolic state. It is important to consider bone turnover markers in this field of research, because the accuracy and precision of DXA is known to decrease with increasing BMI (84) and when participants undergo changes in body weight, (85)(86)(87)(88) and because BMD measured at time points earlier than 6 months are not considered to be clinically significant, given that a complete cycle of bone remodeling takes 4 to 6 months. (53) Thus, diet-induced weight loss induces small but statistically significant losses in total hip BMD that would likely not otherwise be seen in overweight or obese individuals.…”

Section: Discussionmentioning

confidence: 99%

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

Zibellini

Seimon

Lee

et al. 2015

Journal of Bone and Mineral Research

108

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Diet-induced weight loss has been suggested to be harmful to bone health. We conducted a systematic review and meta-analysis (using a random-effects model) to quantify the effect of diet-induced weight loss on bone. We included 41 publications involving overweight or obese but otherwise healthy adults who followed a dietary weight-loss intervention. The primary outcomes examined were changes from baseline in total hip, lumbar spine, and total body bone mineral density (BMD), as assessed by dual-energy X-ray absorptiometry (DXA). Secondary outcomes were markers of bone turnover. Diet-induced weight loss was associated with significant decreases of 0.010 to 0.015 g/cm 2 in total hip BMD for interventions of 6, 12, or 24 (but not 3) months' duration (95% confidence intervals [CIs], -0.014 to -0.005, -0.021 to -0.008, and -0.024 to -0.000 g/cm 2 , at 6, 12, and 24 months, respectively). There was, however, no statistically significant effect of diet-induced weight loss on lumbar spine or whole-body BMD for interventions of 3 to 24 months' duration, except for a significant decrease in total body BMD (-0.011 g/cm 2 ; 95% CI, -0.018 to -0.003 g/cm 2 ) after 6 months. Although no statistically significant changes occurred in serum concentrations of N-terminal propeptide of type I procollagen (P1NP), interventions of 2 or 3 months in duration (but not of 6, 12, or 24 months' duration) induced significant increases in serum concentrations of osteocalcin (0.26 nmol/L; 95% CI, 0.13 to 0.39 nmol/L), C-terminal telopeptide of type I collagen (CTX) (4.72 nmol/L; 95% CI, 2.12 to 7.30 nmol/L) or N-terminal telopeptide of type I collagen (NTX) (3.70 nmol/L; 95% CI, 0.90 to 6.50 nmol/L bone collagen equivalents [BCEs]), indicating an early effect of diet-induced weight loss to promote bone breakdown. These data show that in overweight and obese individuals, a single diet-induced weight-loss intervention induces a small decrease in total hip BMD, but not lumbar spine BMD. This decrease is small in comparison to known metabolic benefits of losing excess weight.

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Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT

Cited by 222 publications

References 27 publications

Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography

Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography

A Cross-Calibration Study of the GE-Lunar iDXA and Prodigy for the Assessment of Lumbar Spine and Total Hip Bone Parameters via Three Statistical Methods

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

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