Major Discordance in the Diagnosis of Osteoporosis Among Participants With Degenerative Lumbar Spine Using Spine and Hip Dual-Energy X-ray Absorptiometry

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Alisara Wongsuttilert Kasem Chaiklongkit Sutasinee Kongpromsuk Wanlop Jaidee

Abstract

Background: Major T-score discordance in the diagnosis of osteoporosis at spine and the hip may induce misinterpretation in people with degenerative lumbar spine.


Objective: To investigate major T-score discordance in the diagnosis of osteoporosis using bone mineral density (BMD) at the lumbar spine and the hip among people with degenerative lumbar spine.


Methods: Demographic data, anthropometric measurements, and dual-energy X-ray absorptiometry (DXA) scans at the lumbar spine and the hip were retrieved from a database of Burapha University Hospital. The interrater reliabilities of image interpretation were performed. The correlation between degenerative lumbar spine lesions with T-scores at the lumbar spine and the hip was analyzed. Major discordance was defined when one site is osteoporotic and the other site is osteopenia or normal.


Results: Major T-score discordance of the lumbar spine and the hip was 28.6% and the hip BMD detected in participants with osteoporosis was less than the lumbar spine BMD (15.7% vs 36.5%). T-score at lumbar spine showed a false negative rate of 25.0%. Degenerative lumbar spine lesions showed a poor correlation with T-score at the lumbar spine (R2 = 0.21, P < 0.01) and the hip (R2 at femoral neck = 0.24, P < 0.01; R2 at total hip = 0.32, P < 0.01).


Conclusions: Twenty-six percent of participants with degenerative lumbar spine were not evaluated L1-L4 BMD. While the hip seems to be the best measurement site, 28.6% of T-score discordance between lumbar spine and hip was still observed. T-score at lumbar spine showed a false negative rate of 25.0% and associated with older age. This study suggested that it would not be suitable to use the hip BMD alone to diagnose osteoporosis in older adults with degenerative spine disease.


 

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How to Cite
Wongsuttilert, A., Chaiklongkit, K., Kongpromsuk, S., & Jaidee, W. (2018). Major Discordance in the Diagnosis of Osteoporosis Among Participants With Degenerative Lumbar Spine Using Spine and Hip Dual-Energy X-ray Absorptiometry. Ramathibodi Medical Journal, 41(3), 13-20. https://doi.org/10.14456/rmj.2018.33
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Original Articles

References

1. Jain RK, Vokes T. Dual-energy X-ray absorptiometry. J Clin Densitom. 2017;20(3):291-303. doi:10.1016/j.jocd.2017.06.014.

2. ISCD. Official Positions-Adult, 2015. International Society for Clinical Densitometry ISCD).
https://www.iscd.org/official-positions/2015-iscd-official-positions-adult/. Accessed May 27, 2018.

3. Rand T, Seidl G, Kainberger F, et al. Impact of spinal degenerative changes on the evaluation of bone mineral density with dual energy X-ray absorptiometry (DXA). Calcif Tissue Int. 1997;60(5):430-433.

4. Muraki S, Yamamoto S, Ishibashi H, et al. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int. 2004;15(9):724-728. doi:10.1007/s00198-004-1600-y.

5. Schneider DL, Bettencourt R, Barrett-Connor E. Clinical utility of spine bone density in elderly women. J Clin Densitom. 2006;9(3):255-260. doi:10.1016/j.jocd.2006.04.116.

6. Tenne M, McGuigan F, Besjakov J, Gerdhem P, Åkesson K. Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women. Osteoporos Int. 2013;24(4):1419-28. doi:10.1007/s00198-012-2048-0.

7. Moayyeri A, Soltani A, Bahrami H, Sadatsafavi M, Jalili M, Larijani B. Preferred skeletal site for osteoporosis screening in high-risk populations. Public Health. 2006;120(9):863-871. doi:10.1016/j.puhe.2006.05.013.

8. Atalay A, Kozakcioglu M, Cubuk R, Tasali N, Guney S. Degeneration of the lumbar spine and dual-energy X-ray absorptiometry measurements in patients without osteoporosis. Clin Imaging. 2009;33(5):374-378. doi:10.1016/j.clinimag.2008.12.005.

9. Krege JH, Miller PD, Lenchik L, Misurski DA, Chen P. New or worsening lumbar spine vertebral fractures increase lumbar spine bone mineral density and falsely suggest improved skeletal status. J Clin Densitom. 2006;9(2):144-149. doi:10.1016/j.jocd.2006.02.001.

10. Bonnick SL, Lewis LA. Bone Densitometry for Technologists. 3rd ed. New York, NY: Springer; 2013.

11. El Maghraoui A, Mouinga Abayi DA, Rkain H, Mounach A. Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. J Clin Densitom. 2007;10(2):153-156. doi:10.1016/j.jocd.2006.12.003.

12. World Health Organization. WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry. Geneva, Switzerland: World Health Organization; 1995. https://apps.who.int/iris/bitstream/handle/10665/37003/WHO_TRS_854.pdf?sequence=1&isAllowed=y. Accessed May 27, 2018.

13. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148. doi:10.1002/jbmr.5650080915.

14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174.

15. Moayyeri A, Soltani A, Tabari NK, Sadatsafavi M, Hossein-Neghad A, Larijani B. Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocr Disord. 2005;5(1):3. doi:10.1186/1472-6823-5-3.

16. Mounach A, Abayi DA, Ghazi M, et al. Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Semin Arthritis Rheum. 2009;38(6):467-471. doi:10.1016/j.semarthrit.2008.04.001.

17. Singh M, Magon N, Singh T. Major and minor discordance in the diagnosis of postmenopausal osteoporosis among Indian women using hip and spine dual-energy X-ray absorptiometry. J Midlife Health. 2012;3(2):76-80. doi:10.4103/0976-7800.104457.

18. Ikegami S, Kamimura M, Uchiyama S, et al. Bone mineral density measurement at both spine and hip for diagnosing osteoporosis in Japanese patients. J Clin Densitom. 2009;12(3):337-344. doi:10.1016/j.jocd.2009.03.099.

19. Faulkner KG, von Stetten E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom. 1999;2(3):343-350.

20. Woodson G. Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites. J Clin Densitom. 2000;3(4):319-324.

21. O'Gradaigh D, Debiram I, Love S, Richards HK, Compston JE. A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int. 2003;14(1):13-18. doi:10.1007/s00198-002-1311-1.

22. Carey JJ, Delaney MF, Love TE, et al. DXA-generated Z-scores and T-scores may differ substantially and significantly in young adults. J Clin Densitom. 2007;10(4):351-358. doi:10.1016/j.jocd.2007.06.001.

23. Callréus M, McGuigan F, Akesson K. Country-specific young adult dual-energy X-ray absorptiometry reference data are warranted for T-score calculations in women: data from the peak-25 cohort. J Clin Densitom. 2014;17(1):129-135. doi:10.1016/j.jocd.2013.03.008.

24. Pye SR, Reid DM, Adams JE, Silman AJ, O'Neill TW. Radiographic features of lumbar disc degeneration and bone mineral density in men and women. Ann Rheum Dis. 2006;65(2):234-238. doi:10.1136/ard.2005.038224.