Escolar Documentos
Profissional Documentos
Cultura Documentos
685-686, 1998
Pergamon
P I h S0969-8043(97)00090-0
a n d C. M . B O I V I N *
Department of Nuclear Medicine, Queen Elizabeth Hospital, Birmingham B15 2TH, U.K.
Bone mineral density (BMD) measured using dual energy X-ray absorptiometry (DXA) can be expressed
in terms of standard deviations, above or below mean young adult T-scores and above or below
age-matched Z-scores. The differences between the left neck of the femur (LN), right neck of the femur
(RN) and lumbar spine (L2 L4) were statistically significant, irrespective of whether expressed as T-scores
or Z-scores. Therefore skeletal status assessment should involve as many sites as practically possible.
Considering the low radiation dose and short scanning time, it is suggested that at least the two femurs
and lumbar spine BMD be used in routine osteoporosis risk assessment. ~) 1998 Elsevier Science Ltd.
All rights reserved
Introduction
Osteoporosis is characterised by low bone mass and
micro-architectural deterioration of bone tissue,
leading to increased risk of fragility fractures. Bone
mineral density (BMD) measured using D X A is
currently the most widely used method of quantifying
the development and degree of osteoporosis. Some of
the clinically available machines such as the Lunar
D P X - L have the capability to measure B M D at
various sites, including spine-PA, lateral spine,
proximal femur, hand and total body. Using the
W H O definition (WHO, 1994), a patient is osteoporotic if their B M D is 2.5 SD or more below the
young adult mean (i.e. T-score < - 2.5). It has been
reported that using a T-score of - 2.5 as a cut-off
point, the number of patients classified as osteoporotic varied between sites (Njeh et al., 1996).
Also, it has been reported that degenerative joint
disease affects B M D measurements (Yu et al., 1995).
To reduce variation due to pathological conditions
such as rheumatoid arthritis and osteoarthritis, we
restricted our study to a local normal population. The
most commonly measured sites are the spine and
proximal femur. However, the number of sites
measured varies between centres. This study investigated retrospectively site differences in measured
B M D in a local normal population.
Method
B M D at the spine (L2 L4), right and left proximal
femur (neck of femur, Ward's triangle and
trochanter) were measured using a Lunar D P X - L
*To whom all correspondence should be addressed.
685
Resultsand Discussion
There were highly significant correlations between
B M D at all regions in both left and right femurs with
the coefficients varying from 0.74 to 0.93 (p < 0.0001)
(Table 1). There was a consistently better correlation
between identical regions on the two femurs
(r = 0.92, SEE = 0.057 g/cm2). A moderate correlation between femur regions and the lumbar spine
(r = 0.69-0.70, p < 0.0001, SEE = 0.106-0.136 g/
cm 2) was observed. These results are consistent
with previous reports (Faulkner et al., 1995a).
The mean ( + SD) T-scores of the left femoral
neck, right femoral neck and L2-L4 lumbar
spine were - 0.480__ 1.198, - 0.430 + 1.197 and
- 0 . 5 8 0 _+ 1.574, respectively. The differences between these T-scores were statistically significant
686
Right neck
Right Ward's triangle
Right trocbanter
Left neck
Left Ward's triangle
Left trocbanter
0,93
0.83
0,79
0.92
0.87
0.80
0.88
0.92
0.75
0.93
0.79
0.74
0.92
0.83
0.79
0.70
0.70
0.70
0.70
0.70
0.69
Conclusions
One would expect to observe a difference in
T-scores between hip and spine, but not Z-scores
because of the different rates of bone loss. The
differences observed here indicate t h a t either there is
a genetic variation or there are pathological causes
which were not/could not be scrutinised by the
questionnaire. We conclude that B M D expressed as
T-scores or Z-scores may vary between sites and
therefore skeletal status assessment should involve as
m a n y sites as practically possible. Considering the
low radiation dose and short scanning time, it is
suggested that at least the two femurs a n d l u m b a r
spine B M D be used in routine osteoporosis risk
assessment. This will increase the sensitivity of B M D
for diagnosis of osteoporosis. In cases where only one
femur was measured, longitudinal studies should be
carried out on the same femur otherwise false
deductions might be made. There is the need to
reassess the use of Z-scores and T-scores in
osteoporosis risk assessment, in particular to see if
left and right hip measurements better predict
fractures o f the same hip.
References
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