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Correlation of Bone Mineral Density (BMD) of the Lumbar Spine, Femur and Radius by Dual X-ray Absorptiometry (DXA) in Thai Perimenopausal and Menopausal Women, WHO Received the DXA Measurement in Faculty of Medicine, Chiang Mai University, Thailand
382
ISCD Annual Meeting Abstracts
femur respectively. BMC of neck and total femur also significantly changed while areas remained the same. See Table 1. This study shows that using Hologic’s standard rule will misidentify the HAL about 44% of the population. This may affect estimates of hip fracture risk that use HAL. Studies have shown that each centimeter (10%) increase in HAL increases hip fracture risk by approximately 50%. We estimate that in our population, the mean difference of 0.262 cm would represent an increase in perceived hip fracture risk by as much as 13%. We conclude that care must be exercised when using the current global ROI definition by Hologic for quantifying HAL. Changes in the ROI definition could be made that would improve HAL measures with marginal changes in the bone density measures. Table 1 Difference in Mean, Standard deviation of BMD, BMC and bone area of trochanter, neck and total femur regions as well as hip axis length before and adjusting global ROI Regions
Trochanter
Variables
BMD (g/cm2) BMC (g) AREA (cm2) Neck BMD (g/cm2) BMC (g) AREA (cm2) Total Femur BMD (g/cm2) BMC (g) AREA (cm2) Hip Axis Length (mm)
Difference N
Mean
Std Dev Std Err
Minimum
Maxi- P-value mum
Post - Pre 50
0.0023
0.0019
0.0003
0.0010 0.0085 !.001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.004 0.0320 0.0025
0.0834 0.1160 0.0038
0.0118 0.0164 0.0005
0.3220 0.1375 0.9706 0.4970 0.1776 0.0594 0.0140 0.0128 !.0001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.0213 0.0095 0.0028
0.0579 0.0651 0.0024
0.0082 0.0092 0.0003
0.1650 0.2732 0.0122 0.1580 0.3653 0.3046 0.0005 0.0116 !.0001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.0749 0.0150 2.6151
0.1110 0.0848 1.3517
0.0157 0.0120 0.1912
0.4810 0.3245 !.0001 0.5280 0.1910 0.2277 2.2160 5.6809 !.0001
years) and late group of menopause (LGM, O5 years). The similar findings were demonstrated in these two groups. Conclusion: This study found good correlation of BMD from various skeletal sites. Interestingly,correlation was found highest between LS vs TR,and TF vs TR. Clearly, estrogen-deficient plays important role on the low BMD values in all skeletal sites.
Variable s
Table 1 Clinical characteristics and BMD of the study groups Perimenopaus e Postmenopaus e EGM
Weight (kg) Height (m) BMI (kg/m2) BMD of LSs BMD of TF BMD of FN BMD of TR BMD of 1/3 radius
48.2 4.2 1.5 0.4 36.1 5.2 0.938 0.122 0.836 0.108 0.759 0.095 0.638 0.092
60.9 9.3 1.5 0.1 37.0 5.9 0.800 0.148 0.748 0.131 0.677 0.113 0.554 0.112 0.600 0.086
60.0 8.5 1.5 0.6 37.2 5.4 0.849 0.132 0.802 0.105 0.727 0.097 0.601 0.088 0.647 0.601
LGM 55.4 9.9 1.5 0.6 36.9 6.1 0.779 0.150 0.724 0.134 0.656 0.112 0.579 0.088
Values are mean SD unless indicated otherwise. Table 2 Correction coefficients (r values) of the BMD of the various skeletal sites Measurement Sites Status Overall
Perimenopausal status
Postmenopausal status
Poster Number 117
Central DXA
CORRELATION OF BONE MINERAL DENSITY (BMD) OF THE LUMBAR SPINE, FEMUR AND RADIUS BY DUAL X-RAY ABSORPTIOMETRY (DXA) IN THAI PERIMENOPAUSAL AND MENOPAUSAL WOMEN, WHO RECEIVED THE DXA MEASUREMENT IN FACULTY OF MEDICINE, CHIANG MAI UNIVERSITY, THAILAND Sirianong Namwongprom, Intructor of Nuclear Medicine, Chiang Mai University, Thailand Objective: To determine the correlation of BMD in various skeletal sites include lumbar spine, non-dominant proximal femur and 1/3 radial site (non-dominant side). Material And Method: The data of this study was collected from the medical records and the BMD results of perimenopausal and postmenopausal women who had the standard BMD measurement in Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chiang Mai University between January 2007 and December 2007. BMD was measured using DXA (Hologic, QDR-4500C). Women who had disease or treatment known to affect bone and calcium metabolism, history of surgical menopause, and history of fracture or bone surgery at the measurement sites were excluded from this study. We applied the WHO classification to axial BMD measurements as the gold standard for defining the risk of osteoporosis. Results: 885 women were included in this retrospective study. Mean age ( SD) was 55.8 9.3 year. The lowest BMD was found 51.6% at lumbar spine (LS), 29.2 % at 1/3 radial site, 13.8% at femoral neck (FN), 2.9% at total femur (TF) and 2.5% at trochanter region (TR). There was found to be significant correlation between age, BMI, duration of menopause and BMD at the LS, TF, FN, TR and 1/3 radial site (p ! 0.01). No significant correlation was found between the BMI and the duration after menopause (p 5 0.17). The correlation between the BMD measures at LS, and TF, FN, TR and one-third radial site were 0.708, 0.667, 0.721 and 0.633, respectively (p ! 0.01). For the different sites of the proximal femur, this study found statistically significant correlation between TF, FN and TR regions; r 5 0.935 (TF vs TR), r 5 0.893 (TF vs FN), r5 0.830 (FN vs TR). Women with perimenopausal status had higher height and BMD values at all five observed sites than postmenopausal women. The difference was significant for both height and BMD values at all sites (p ! 0.01). However, there were no statistically significant differences of the weight and BMI between two groups. This study also classified postmenopausal women into early group of menopause (EGM, 5 5
Journal of Clinical Densitometry: Assessment of Skeletal Health
EGM
LGM
LS TF FN LS TF FN LS TF FN LS TF FN LS TF FN
TF
FN
TR
1/3 radius
0.708 0.893 0.686 0.870 0.684 0.888 0.619 0.855 0.629 0.886
0.667 0.893 0.590 0.870 0.0643 0.888 0.595 0.855 0.680 0.886 -
0.721 0.935 0.830 0.691 0.914 0.782 0.695 0.933 0.822 0.685 0.898 0.748 0.629 0.935 0.824
0.633 0.692 0.648 0.246 0.379 0.296 0.633 0.696 0.656 0.548 0.504 0.451 0.629 0.711 0.663
All r values are statistically significant (P!.001). Table 3 Group
Prevalence of osteopenia and osteoporosis ini different study groups. Number Normal BMD Osteopenia Osteoporosis
Overall Perimenopausal status Postmenopausal status EGM LGM
855 149 736 220 516
Poster Number 118
222 82 14 69 71
(25.1%) (55.0%) (19.0%) (31.4%) (13.8%)
425 59 366 116 250
(48.0%) (39.6%) (49.7%) (52.7%) (48.4%)
238 8 230 35 195
(26.9%) (5.4%) (31.3%) (15.9%) (37.8%)
Central DXA
DISAGREEMENT IN THE DIAGNOSIS OF OSTEOPENIA AND OSTEOPOROSISIN THE SPINE AND HIP REGIONS Diana Wiluzanski, A.L.Ronco, A.Perroni Centro´seo Clinic, Montevideo, Uruguay Introduction: The aim of this paper is to study the disagreement in the diagnosis of low bone density (osteopenia) and osteoporosis through bone densitometry in column A-P, femoral neck and total hip. Method: We studied a retrospective data base of densitometries carried out with a GE Lunar Prodigy Advance densitometer. We analyzed data on 527 postmenopausal women (mean age 62.5 8.1) who made consultations in our Clinic during 2006e2008. Age, age at menopause, T-score (TS) and bone mineral density (BMD) at the spine (L1-L4 vertebrae), femoral neck and total hip were measured and registered. Pearson correlation coefficients were calculated for both variables in the whole sample and for age groups (in tertiles). According to densitometry, patients were categorized in significant osteopenia (OPN) having TS !5 2.0 and osteoporosis (OPS) having TS !5 2.5. We determined the fractions having OPN and OPS in only one region and not in the other one. Results: There were 138 patients with OPN only at the spine region
Volume 12, 2009
ISCD Annual Meeting Abstracts
femur respectively. BMC of neck and total femur also significantly changed while areas remained the same. See Table 1. This study shows that using Hologic’s standard rule will misidentify the HAL about 44% of the population. This may affect estimates of hip fracture risk that use HAL. Studies have shown that each centimeter (10%) increase in HAL increases hip fracture risk by approximately 50%. We estimate that in our population, the mean difference of 0.262 cm would represent an increase in perceived hip fracture risk by as much as 13%. We conclude that care must be exercised when using the current global ROI definition by Hologic for quantifying HAL. Changes in the ROI definition could be made that would improve HAL measures with marginal changes in the bone density measures. Table 1 Difference in Mean, Standard deviation of BMD, BMC and bone area of trochanter, neck and total femur regions as well as hip axis length before and adjusting global ROI Regions
Trochanter
Variables
BMD (g/cm2) BMC (g) AREA (cm2) Neck BMD (g/cm2) BMC (g) AREA (cm2) Total Femur BMD (g/cm2) BMC (g) AREA (cm2) Hip Axis Length (mm)
Difference N
Mean
Std Dev Std Err
Minimum
Maxi- P-value mum
Post - Pre 50
0.0023
0.0019
0.0003
0.0010 0.0085 !.001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.004 0.0320 0.0025
0.0834 0.1160 0.0038
0.0118 0.0164 0.0005
0.3220 0.1375 0.9706 0.4970 0.1776 0.0594 0.0140 0.0128 !.0001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.0213 0.0095 0.0028
0.0579 0.0651 0.0024
0.0082 0.0092 0.0003
0.1650 0.2732 0.0122 0.1580 0.3653 0.3046 0.0005 0.0116 !.0001
Post - Pre 50 Post - Pre 50 Post - Pre 50
0.0749 0.0150 2.6151
0.1110 0.0848 1.3517
0.0157 0.0120 0.1912
0.4810 0.3245 !.0001 0.5280 0.1910 0.2277 2.2160 5.6809 !.0001
years) and late group of menopause (LGM, O5 years). The similar findings were demonstrated in these two groups. Conclusion: This study found good correlation of BMD from various skeletal sites. Interestingly,correlation was found highest between LS vs TR,and TF vs TR. Clearly, estrogen-deficient plays important role on the low BMD values in all skeletal sites.
Variable s
Table 1 Clinical characteristics and BMD of the study groups Perimenopaus e Postmenopaus e EGM
Weight (kg) Height (m) BMI (kg/m2) BMD of LSs BMD of TF BMD of FN BMD of TR BMD of 1/3 radius
48.2 4.2 1.5 0.4 36.1 5.2 0.938 0.122 0.836 0.108 0.759 0.095 0.638 0.092
60.9 9.3 1.5 0.1 37.0 5.9 0.800 0.148 0.748 0.131 0.677 0.113 0.554 0.112 0.600 0.086
60.0 8.5 1.5 0.6 37.2 5.4 0.849 0.132 0.802 0.105 0.727 0.097 0.601 0.088 0.647 0.601
LGM 55.4 9.9 1.5 0.6 36.9 6.1 0.779 0.150 0.724 0.134 0.656 0.112 0.579 0.088
Values are mean SD unless indicated otherwise. Table 2 Correction coefficients (r values) of the BMD of the various skeletal sites Measurement Sites Status Overall
Perimenopausal status
Postmenopausal status
Poster Number 117
Central DXA
CORRELATION OF BONE MINERAL DENSITY (BMD) OF THE LUMBAR SPINE, FEMUR AND RADIUS BY DUAL X-RAY ABSORPTIOMETRY (DXA) IN THAI PERIMENOPAUSAL AND MENOPAUSAL WOMEN, WHO RECEIVED THE DXA MEASUREMENT IN FACULTY OF MEDICINE, CHIANG MAI UNIVERSITY, THAILAND Sirianong Namwongprom, Intructor of Nuclear Medicine, Chiang Mai University, Thailand Objective: To determine the correlation of BMD in various skeletal sites include lumbar spine, non-dominant proximal femur and 1/3 radial site (non-dominant side). Material And Method: The data of this study was collected from the medical records and the BMD results of perimenopausal and postmenopausal women who had the standard BMD measurement in Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chiang Mai University between January 2007 and December 2007. BMD was measured using DXA (Hologic, QDR-4500C). Women who had disease or treatment known to affect bone and calcium metabolism, history of surgical menopause, and history of fracture or bone surgery at the measurement sites were excluded from this study. We applied the WHO classification to axial BMD measurements as the gold standard for defining the risk of osteoporosis. Results: 885 women were included in this retrospective study. Mean age ( SD) was 55.8 9.3 year. The lowest BMD was found 51.6% at lumbar spine (LS), 29.2 % at 1/3 radial site, 13.8% at femoral neck (FN), 2.9% at total femur (TF) and 2.5% at trochanter region (TR). There was found to be significant correlation between age, BMI, duration of menopause and BMD at the LS, TF, FN, TR and 1/3 radial site (p ! 0.01). No significant correlation was found between the BMI and the duration after menopause (p 5 0.17). The correlation between the BMD measures at LS, and TF, FN, TR and one-third radial site were 0.708, 0.667, 0.721 and 0.633, respectively (p ! 0.01). For the different sites of the proximal femur, this study found statistically significant correlation between TF, FN and TR regions; r 5 0.935 (TF vs TR), r 5 0.893 (TF vs FN), r5 0.830 (FN vs TR). Women with perimenopausal status had higher height and BMD values at all five observed sites than postmenopausal women. The difference was significant for both height and BMD values at all sites (p ! 0.01). However, there were no statistically significant differences of the weight and BMI between two groups. This study also classified postmenopausal women into early group of menopause (EGM, 5 5
Journal of Clinical Densitometry: Assessment of Skeletal Health
EGM
LGM
LS TF FN LS TF FN LS TF FN LS TF FN LS TF FN
TF
FN
TR
1/3 radius
0.708 0.893 0.686 0.870 0.684 0.888 0.619 0.855 0.629 0.886
0.667 0.893 0.590 0.870 0.0643 0.888 0.595 0.855 0.680 0.886 -
0.721 0.935 0.830 0.691 0.914 0.782 0.695 0.933 0.822 0.685 0.898 0.748 0.629 0.935 0.824
0.633 0.692 0.648 0.246 0.379 0.296 0.633 0.696 0.656 0.548 0.504 0.451 0.629 0.711 0.663
All r values are statistically significant (P!.001). Table 3 Group
Prevalence of osteopenia and osteoporosis ini different study groups. Number Normal BMD Osteopenia Osteoporosis
Overall Perimenopausal status Postmenopausal status EGM LGM
855 149 736 220 516
Poster Number 118
222 82 14 69 71
(25.1%) (55.0%) (19.0%) (31.4%) (13.8%)
425 59 366 116 250
(48.0%) (39.6%) (49.7%) (52.7%) (48.4%)
238 8 230 35 195
(26.9%) (5.4%) (31.3%) (15.9%) (37.8%)
Central DXA
DISAGREEMENT IN THE DIAGNOSIS OF OSTEOPENIA AND OSTEOPOROSISIN THE SPINE AND HIP REGIONS Diana Wiluzanski, A.L.Ronco, A.Perroni Centro´seo Clinic, Montevideo, Uruguay Introduction: The aim of this paper is to study the disagreement in the diagnosis of low bone density (osteopenia) and osteoporosis through bone densitometry in column A-P, femoral neck and total hip. Method: We studied a retrospective data base of densitometries carried out with a GE Lunar Prodigy Advance densitometer. We analyzed data on 527 postmenopausal women (mean age 62.5 8.1) who made consultations in our Clinic during 2006e2008. Age, age at menopause, T-score (TS) and bone mineral density (BMD) at the spine (L1-L4 vertebrae), femoral neck and total hip were measured and registered. Pearson correlation coefficients were calculated for both variables in the whole sample and for age groups (in tertiles). According to densitometry, patients were categorized in significant osteopenia (OPN) having TS !5 2.0 and osteoporosis (OPS) having TS !5 2.5. We determined the fractions having OPN and OPS in only one region and not in the other one. Results: There were 138 patients with OPN only at the spine region
Volume 12, 2009