OST Risk Index and Calcaneus Bone Densitometry in Osteoporosis Diagnosis (original) (raw)
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Calcified Tissue International, 2002
The study assessed the precision, sensitivity, and speci®city of a recently developed peripheral dualenergy X-ray absorptiometry (DXA) scanner, applied to the calcaneus, in the identi®cation of individuals with osteoporosis at axial sites by DXA. Two hundred and two women, aged 55.2 l3.7 years (mean SD), participated in the study. The precisions (coecient of variation) of measurements in vitro (0.48%) and in vivo (1.40%) were very good. The in vivo precision was independent of the operator, foot size, foot width, weight, height, and body mass index. Calcaneus BMD correlated moderately (r = 0.494±0.690, P < 0.001) with axial BMD measurements by DXA. Using the World Health Organization (WHO) criterion for de®ning osteoporosis (T score £ )2.5) the speci®city of the calcaneus to identify patients with osteoporosis at total hip, femoral neck, spine, or any of these axial sites was excellent (97.0%, 97.0%, 96.5%, and 97.1%, respectively); however, the sensitivity was poor (58.8%, 36.4%, 21.8%, and 20.3%, respectively). Therefore, the WHO criterion is not appropriate for DXA calcaneus. Based on femoral neck BMD for detection of osteoporosis, a more appropriate calcaneus T score threshold would be )1.4 by analyses of receiver-operator characteristic curves; this might serve to select those patients who might appropriately be referred for axial DXA.
Dual-Energy X-Ray Absorptiometry (DEXA) Scan Versus Computed Tomography for Bone Density Assessment
Cureus
Rationale and objective Osteoporosis, a common non-pathological disease of bones, has been the cause of many disastrous consequences, in terms of physical, psychological, social, and economic loss. Therefore, it is crucial to diagnose it early for timely prevention and treatment of osteoporotic fractures. Dual-Energy X-Ray Absorptiometry (DEXA) is currently routinely used for determining bone mineral density. However, it has its limitations. Nowadays, CT technology has advanced so rapidly that the Hounsfield units (HU) values can be used in opportunistic screening for osteoporosis in patients during routine CT abdomen for other causes. Hence, there would be no need for additional study with DEXA and also reduce radiation exposure. The aim of our research is to determine whether there is a correlation between the bone mineral density and the Tscore measured by DEXA and the HU values measured from the diagnostic CT images of L1-4 vertebrae. Also, to determine reference CT values that would help in screening the patients with osteoporosis. Materials and methods We conducted a retrospective study of 78 female patients who underwent CT lumbar spine, abdomen, and pelvis in our hospital between the years 2016-2020. We collected data of patients who performed DEXA and CT scans within an interval of up to two years. The final collected data was analyzed to find correlation values of HU with age group and with DEXA bone mineral density (BMD) and T-score using Pearson correlation coefficient.
Prevalence of Osteoporosis Using DXA Bone Mineral Density Measurements at the Calcaneus
Journal of Clinical Densitometry, 2005
The objective of this article is to evaluate different T-score cut-off points in the calcaneus in order to establish the prevalence of osteoporosis in the general population and to evaluate the clinical value of bone mineral density at the calcaneus as a tool to identify patients with spine or hip osteoporosis.
Journal of orthopaedic surgery (Hong Kong), 2005
To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius. Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed. The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was s...
A Comparison of a Peripheral DXA System with Conventional Densitometry of the Spine and Femur
Journal of Clinical Densitometry, 1998
Because of the perceived high cost of dual-energy X-ray absorptiometry (DXA) studies of the spine and femur, there is renewed interest in small, low-cost X-ray devices for scanning the peripheral skeleton. We have compared forearm bone mineral density (BMD) measurements (distal and ultradistal sites) performed on a DTX-200 (Osteometer MediTech, Hoersholm, Denmark) with spine (L1-L4) and femur (femoral neck and total hip sites) scans performed on a QDR-4500 (Hologic, Waltham, MA) in 172 white UK women aged 22-84 yr with a view to establishing differences caused by inconsistent reference ranges and different age-related changes in BMD. All BMDs were expressed as T-scores using the manufacturers' reference ranges for the forearm and spine, and the National Health and Nutrition Examination Survey (NHANES) ranges for the femur. Linear regression between peripheral and axial sites gave correlation coefficients r = 0.71-0.74 and roof mean standard errors (RMSE) 0.88-1.14 in T-score units. Subjects were divided into the following five age groups: <40 yr; 40-49 yr; 50-59 yr; 60-69 yr and ≥70 yr. A large systematic difference between distal and ultradistal T-scores (mean ∆T = 0.59, SEM = 0.05) was found affecting all age groups. When the mean difference in T-score between each forearm site (distal, ultradistal) and each axial site (spine, femoral neck, total hip) was examined for premenopausal subjects (n = 58) the mean difference between forearm and axial T-score showed a consistent negative offset (∆T = -0.41 to -0.48) for the distal forearm site and a consistent positive offset (∆T = +0.30 to +0.37) for the ultradistal site. When interpreting results in postmenopausal women, age-related T-score changes in the forearm were in close agreement with the femoral neck region of exterest (ROI), but systematic differences were found between the forearm and the spine and total hip sites. The two forearm and three axial sites were compared to evaluate the number of postmenopausal subjects identified as osteoporotic on the basis of the World Health Organization (WHO) Study Group criteria (T-score <-2.5). Although forearm and spine T-scores identified approximately equal numbers of subjects as osteoporotic (distal 38/114; ultradistal 31/114; spine 30/114), the two femur sites identified fewer subjects as osteoporotic (femoral neck 25/114; total hip 16/114). The number for the total hip site was statistically significantly smaller than the spine and forearm sites. In conclusion, we have identified systematic differences between T-score results for a peripheral and an axial DXA device that may have a significant effect on the interpretation of BMD measurements.
BONE DENSITOMETRY :A PPLICATIONS AND LIMITATIONS
Osteoporosis is clinically diagnosed in its advanced stages, usually following a fracture. Accurate, precise, and noninvasive skeletal assessment is now possible for early detection of osteoporosis at a preclinical stage. Currently, the gold standard in bone mass measurement and fracture prediction is dual energy X-ray absorptiometry (DEXA) of the hip and spine. Exponential increases in fracture risk have been observed with small decreases in bone mineral density. Bone mineral density (BMD) should be considered in conjunction with independent clinical risk factors for fracture, including: low body weight, history of postmenopausal fracture, family history of fracture, and poor neuromuscular function. The World Health Organization (WHO) diagnostic criteria for osteoporosis and osteopenia are appropriate for postmenopausal Caucasian women and are applicable to DEXA assessments at the hip, spine, or forearm. This review explores the relationship between BMD and fracture risk, the principles of bone densitometry interpretation, and the applications as well as the limitations of DEXA technology, and presents cases illustrating common errors seen in the interpretation of DEXA studies. colonne et de l'avant-bras au moyen de DEXA. Cet article passe en revue le rapport entre la DMO et le risque de fracture, les principes de l'interprétation de l'absorptiométrie osseuse et ses applications, ainsi que les limites de la technique DEXA. Il présente des cas illustrant des erreurs fréquentes faites dans l'interprétation des examens menés par DEXA.
Standards for Performing DXA in Individuals With Secondary Causes of Osteoporosis
2006
This document addresses skeletal health assessment in individuals with secondary causes of osteoporosis. Recommendations are based on consensus of the Canadian Panel of the International Society for Clinical Densitometry and invited international experts. Bone mineral density (BMD) testing in these populations is performed in conjunction with careful evaluation of the disease state contributing to bone loss and increased fragility fracture risk, as well as assessment of other contributing risk factors for fracture. The presence of secondary causes of bone loss may further increase the risk of fracture independently of BMD and may necessitate earlier pharmacologic intervention. Dual-energy X-ray absorptiometry is indicated in the initial workup of secondary causes of osteoporosis. The BMD fracture risk relationship is not known for individuals with chronic renal failure (CRF). The BMD testing in this population may be normal in the presence of skeletal fragility, and quantitative bone histomorphometry is better at evaluating skeletal status than BMD in CRF. Dual-energy X-ray absorptiometry is a valuable tool in assessing skeletal health in individuals with secondary causes of osteoporosis.
Osteoporosis is a disorder of bone that leads to an increased risk of fracture, when it loses an excessive amount of mineral compositions. Bone densitometry techniques are useful to diagnose the disease as well as to predict the future risk of fracture. Dual energy x-ray absorptiometry (DXA) is currently considered as the ‘gold’ standard for measuring areal bone mineral density, BMD (gcm-2). Quantitative computed tomography (QCT) is used to measure volumetric BMD (g cm-3) at lumbar spine using a phantom with a dedicated software; but it cannot be used to measure femur volumetric BMD. The aim of this study was to estimate apparent physical BMD (Estvol.BMD, g cm-3) of the proximal femur from CT image with good accuracy in the evaluation of post-menopausal osteoporosis. A total number of 50 Indian women, age ranged from 20-80 years were studied. No one had previous osteoporotic fractures. Each woman, the following investigations were carried out: i) BMD of the right proximal femur by DXA whole-body bone densitometer; and ii) CT image of the right proximal femur. WHO’s diagnostic criteria based on the measured femur neck BMD was used to classify the patients. According to this, total women were divided into the following groups: i) Normal (n=23, mean ± SD age = 42.8 ±11.1 years); ii) Osteopenia (n= 17, mean ± SD age = 49.6 ±12.5 years); and iii) Osteoporosis (n=10, mean ± SD age =69.2 ±12.7 years); The CT image was analysed by Materialise’s interactive medical image control system (MIMICS) software. Hounsfield Unit (HU) was measured in the regions of the proximal femur: i) Neck; ii) Trochanter, iii) Head; and iv) Shaft; Using the measured mean HU value, Est-vol.BMD (g cm-3) was estimated. Data was analysed by SPSS statistical software package. In osteoporotic Indian women group (n=10), the Est-vol.BMD (g cm-3) of femur neck was correlated statistically significant (p=0.05) with BMD-DXA (g cm-2) of all ROI’s of the proximal femur, viz., femur neck, Ward’s triangle, trochanter, femur shaft, and total hip. The obtained square of the correlation coefficients (r2) were 0.22, 0.25, 0.23, 0.41, and 0.34 respectively. In osteoporotic women, the mean values of BMD-DXA (g cm-2) and Est-vol.BMD (g cm-3) of femur neck were significantly (p=0.01) reduced by 36.7% and 71.8% respectively, when comparing to normal healthy women. Further, in osteoporotic women, the mean values of BMD-DXA as well as Est-vol.BMD of trochanter were significantly (p=0.01) reduced by 45.7% and 80.2% respectively, when comparing to normal healthy women. It was found that the percentage decrease in Est-vol.BMD was greater in osteoporotic women than the measured BMD-DXA, and it can be useful in the evaluation of the disease.
Discordance in Diagnosis of Osteoporosis Using Spine and Hip Bone Densitometry
Journal of Clinical Densitometry, 2007
Diagnostic discordance for osteoporosis is the observation that the T-score of a patient varies between skeletal sites, falling into 2 different diagnostic categories identified by the World Health Organization classification system. Densitometrists and clinicians should expect that at least 4 of every 10 patients tested by dual-energy X-ray absorptiometry (DXA) to demonstrate T-score discordance between spine and total hip measurement sites. T-score discordance can occur for a variety of reasons related to physiologic and pathologic patient factors and the performance or analysis of DXA itself.