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Is Central Quantitative Computed Tomography (QCT) Superior to Dual Energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Postmenopausal Women? A Systematic Review and Meta-Analysis
Abstracts
409
Conclusion: For the purposes of opportunistic osteoporosis screening at routine post-contrast abdominopelvic CT scans, a simple offset correction of -0.3 T-score units for femoral neck BMD assessment appears to be appropriate. This simple additive measure could greatly enhance osteoporosis screening since it can be applied regardless of the clinical indication for CT scanning. Disclosure of Interest: A. Maciejewski: None Declared, T. Ziemlewicz: None Declared, N. Binkley: None Declared, A. Brett Salary from: Mindways Software, Inc., Stock owner of: Mindways Software, Inc., K. Brown Salary from: Mindways Software, Inc., Stock owner of: Mindways Software, Inc., P. Pickhardt Consultant for: Mindways Software, Inc.
P117 IS CENTRAL QUANTITATIVE COMPUTED TOMOGRAPHY (QCT) SUPERIOR TO DUAL ENERGY X-RAY ABSORPTIOMETRY (DXA) FOR FRACTURE RISK ASSESSMENT IN POSTMENOPAUSAL WOMEN? A SYSTEMATIC REVIEW AND META-ANALYSIS I. Polidoulis1, A. Tisseverasinghe2,*, G. Tomlinson2, A. M. Cheung2; 1 Departments of Family and Community Medicine, 2Department of Medicine, University of Toronto, Toronto, Canada Aims: Unlike DXA, QCT can assess volumetric BMD (vBMD) and bone strength can be estimated using finite element analysis. Whether these QCT features translate to improved fracture risk assessment is unclear. This study was undertaken to ascertain if QCT-based bone parameters were superior to DXA measurements for determining fracture risk in postmenopausal women. Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for studies published until October 31, 2013, inclusive, comparing QCT-derived bone measurements at the spine or hip between fractured post-menopausal women and nonfractured female controls. Two authors independently selected and reviewed articles, and abstracted data. Discrepancies were resolved by consensus with a third author. We also assessed bias using the QUADAS-2 tool in a similar manner. For bone measures reported in O1 study, the standardized mean difference (SMD) between fractured and non-fractured groups was calculated. ROC curves were plotted for parameters reported in 3 studies, and area under the ROC (AUROC) was calculated. Results: Of 6791 search results, 44 met our inclusion criteria. All but one were cross-sectional studies comparing fractured and nonfractured postmenopausal women. Key results are displayed in Table. The AUROC for spinal trabecular vBMD (0.81 for spine fracture and 0.80 for any assessed fracture) are higher than that for DXA measures (range 0.70-0.74), but with overlapping 95% CIs. There were inadequate numbers of studies to determine AUROC for trabecular or cortical vBMD of femoral neck or total femur. The AUROC for total vBMD at these sites were comparable to DXA BMD for any incident fracture. Conclusion: QCT is comparable to DXA in fracture risk assessment in postmenopausal women. Spinal trabecular vBMD by QCT may be superior to DXA. Disclosure of Interest: None Declared
P118 ANXIETY AND QUALITY OF LIFE IN PATIENTS WITH OSTEOPOROSIS D. M. Farcas1,2,*, F. Marc2,3, C. Suteu2,4, I. Gasparik5, V. Marc2; 1Physical Rehabilitation, Faculty of Medicine, 2ASPOR, 3Internal Medicine, 4 Occupational Medicine, Faculty of Medicine, Oradea, 5ASPOR, Targu Mures, Romania Aims: To assess quality of life and anxiety in patients women and men with osteoporosis from Bihor county, Romania. Methods: We studied patients with osteoporosis; first group consisted in 25 women, second group of 25 men. All the patients were recruited from ambulatory system Bihor county, Romania. The mean age in the group of women was 63.245.31 and in the group of men was of 69.924.49. Educational levels were similar in both groups. The inclusion criteria were: fulfilling the WHO criteria for osteoporosis, complying with the principles of medical ethics. The exclusion criteria were: severe diseases, noncompliance. They were evaluated for osteoporosis by DXA method. All of the subjects completed ‘‘the 1 minute test’’ to assess their risk factors for osteoporosis. All the patients were assessed with Qualeffo 41 Questionnaire for quality of life and with Hamilton Anxiety Rating Scale for anxiety. Results: Quality of life was low in both groups, but in the group of women with osteoporosis was lower than in the group of men with osteoporosis. The mean anxiety value was higher in the group of women with osteoporosis than in the group of men with osteoporosis. Conclusion: Osteoporosis itself has an impact on patient’s quality of life, women and men. It also has an impact on psychological wellbeing. Our study underline the need for developing future strategies for coping with anxiety as a part of mental wellbeing and health related quality of life in patients, women and men also, with osteoporosis. By including physical exercises and healthy habits in everyone’s life we could help improving not only osteoporosis, but also psychological wellbeing and quality of life. Disclosure of Interest: None Declared
P119 LIFTING DISABLED PATIENTS ONTO THE DENSITOMETER WITH A CEILING-LIFT: EFFECT OF THE SLING ON MEASUREMENTS OF BMD H. Rosen*, A. O. Malabanan, L. G. Whittaker, E. A. McNamara; Endocrine/ Medicine, Beth Israel Deaconess Medical Center, Boston, United States Aims: Lifting quadriplegic patients onto a densitometer manually is dangerous for both the patient and densitometry staff, and using an overhead lift is the preferred method of transfer. The overhead lift system commonly in use (LikorallÔ 242 S overhead lift system, Batesville, IN) requires the use of a sling underneath the patient, so the sling is then underneath the patient as BMD is measured. The aim of this study is to determine whether this sling affects the BMD measurement. Methods: Measurements were done on a Hologic Discovery A (Bedford, MA). The spine phantom was measured 30 times by itself, and 30 times with the standard sling (Liko Soft Original high-backed sling, model 20) placed underneath it, and 16 times with the disposable sling (LikoÒ Solo HighBack sling, model 25) placed underneath. We report the meanSD for the area, BMC, and BMD for the spine phantom alone, and with the different slings underneath. The significance of the difference between groups was assessed using the Mann-Whitney test, and significance of the difference of the variance among groups was assessed using the F-test of the equality of two variances.
Fracture Site Hip Measure Site & Parameter Femoral Neck Total Femur
SMD (95% CI) Total vBMD DXA BMD Total vBMD DXA BMD
0.90 ( 1.36, 0.84 ( 1.28, 0.91 ( 1.39,
0.43)
0.91 1.16 1.01 0.80 0.90
0.68) 0.96) 0.71) 0.51) 0.41)
AUROC (95% CI)
0.45) 0.40)
Lumbar Spine
Any Assessed Site SMD (95% CI)
0.71 (0.38, 0.93) 0.73 (0.40, 0.94)
0.94 0.83 1.01 0.74
( ( ( (
1.26, 1.07, 1.28, 0.92,
0.74 0.81 0.77 0.72 0.73
0.87 1.09 0.93 0.78 0.90
( ( ( ( (
1.08, 1.25, 1.21, 0.98, 1.39,
Spine Total vBMD Trabecular vBMD Cortical vBMD DXA BMD DXA BMD (lateral)
( ( ( ( (
1.15, 1.37, 1.32, 1.09, 1.39,
(0.66, (0.77, (0.64, (0.63, (0.33,
0.82) 0.85) 0.89) 0.80) 0.96)
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
AUROC (95% CI)
0.61) 0.75 0.58) 0.72 0.73) 0.76 0.56) 0.70 Any Assessed Site 0.65) 0.73 0.92) 0.80 0.65) 0.75 0.58) 0.71 0.41) 0.74
(0.53, (0.64, (0.57, (0.65,
0.92) 0.79) 0.91) 0.75)
(0.66, (0.76, (0.64, (0.64, (0.34,
0.79) 0.83) 0.86) 0.77) 0.96)
Volume 17, 2014
409
Conclusion: For the purposes of opportunistic osteoporosis screening at routine post-contrast abdominopelvic CT scans, a simple offset correction of -0.3 T-score units for femoral neck BMD assessment appears to be appropriate. This simple additive measure could greatly enhance osteoporosis screening since it can be applied regardless of the clinical indication for CT scanning. Disclosure of Interest: A. Maciejewski: None Declared, T. Ziemlewicz: None Declared, N. Binkley: None Declared, A. Brett Salary from: Mindways Software, Inc., Stock owner of: Mindways Software, Inc., K. Brown Salary from: Mindways Software, Inc., Stock owner of: Mindways Software, Inc., P. Pickhardt Consultant for: Mindways Software, Inc.
P117 IS CENTRAL QUANTITATIVE COMPUTED TOMOGRAPHY (QCT) SUPERIOR TO DUAL ENERGY X-RAY ABSORPTIOMETRY (DXA) FOR FRACTURE RISK ASSESSMENT IN POSTMENOPAUSAL WOMEN? A SYSTEMATIC REVIEW AND META-ANALYSIS I. Polidoulis1, A. Tisseverasinghe2,*, G. Tomlinson2, A. M. Cheung2; 1 Departments of Family and Community Medicine, 2Department of Medicine, University of Toronto, Toronto, Canada Aims: Unlike DXA, QCT can assess volumetric BMD (vBMD) and bone strength can be estimated using finite element analysis. Whether these QCT features translate to improved fracture risk assessment is unclear. This study was undertaken to ascertain if QCT-based bone parameters were superior to DXA measurements for determining fracture risk in postmenopausal women. Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for studies published until October 31, 2013, inclusive, comparing QCT-derived bone measurements at the spine or hip between fractured post-menopausal women and nonfractured female controls. Two authors independently selected and reviewed articles, and abstracted data. Discrepancies were resolved by consensus with a third author. We also assessed bias using the QUADAS-2 tool in a similar manner. For bone measures reported in O1 study, the standardized mean difference (SMD) between fractured and non-fractured groups was calculated. ROC curves were plotted for parameters reported in 3 studies, and area under the ROC (AUROC) was calculated. Results: Of 6791 search results, 44 met our inclusion criteria. All but one were cross-sectional studies comparing fractured and nonfractured postmenopausal women. Key results are displayed in Table. The AUROC for spinal trabecular vBMD (0.81 for spine fracture and 0.80 for any assessed fracture) are higher than that for DXA measures (range 0.70-0.74), but with overlapping 95% CIs. There were inadequate numbers of studies to determine AUROC for trabecular or cortical vBMD of femoral neck or total femur. The AUROC for total vBMD at these sites were comparable to DXA BMD for any incident fracture. Conclusion: QCT is comparable to DXA in fracture risk assessment in postmenopausal women. Spinal trabecular vBMD by QCT may be superior to DXA. Disclosure of Interest: None Declared
P118 ANXIETY AND QUALITY OF LIFE IN PATIENTS WITH OSTEOPOROSIS D. M. Farcas1,2,*, F. Marc2,3, C. Suteu2,4, I. Gasparik5, V. Marc2; 1Physical Rehabilitation, Faculty of Medicine, 2ASPOR, 3Internal Medicine, 4 Occupational Medicine, Faculty of Medicine, Oradea, 5ASPOR, Targu Mures, Romania Aims: To assess quality of life and anxiety in patients women and men with osteoporosis from Bihor county, Romania. Methods: We studied patients with osteoporosis; first group consisted in 25 women, second group of 25 men. All the patients were recruited from ambulatory system Bihor county, Romania. The mean age in the group of women was 63.245.31 and in the group of men was of 69.924.49. Educational levels were similar in both groups. The inclusion criteria were: fulfilling the WHO criteria for osteoporosis, complying with the principles of medical ethics. The exclusion criteria were: severe diseases, noncompliance. They were evaluated for osteoporosis by DXA method. All of the subjects completed ‘‘the 1 minute test’’ to assess their risk factors for osteoporosis. All the patients were assessed with Qualeffo 41 Questionnaire for quality of life and with Hamilton Anxiety Rating Scale for anxiety. Results: Quality of life was low in both groups, but in the group of women with osteoporosis was lower than in the group of men with osteoporosis. The mean anxiety value was higher in the group of women with osteoporosis than in the group of men with osteoporosis. Conclusion: Osteoporosis itself has an impact on patient’s quality of life, women and men. It also has an impact on psychological wellbeing. Our study underline the need for developing future strategies for coping with anxiety as a part of mental wellbeing and health related quality of life in patients, women and men also, with osteoporosis. By including physical exercises and healthy habits in everyone’s life we could help improving not only osteoporosis, but also psychological wellbeing and quality of life. Disclosure of Interest: None Declared
P119 LIFTING DISABLED PATIENTS ONTO THE DENSITOMETER WITH A CEILING-LIFT: EFFECT OF THE SLING ON MEASUREMENTS OF BMD H. Rosen*, A. O. Malabanan, L. G. Whittaker, E. A. McNamara; Endocrine/ Medicine, Beth Israel Deaconess Medical Center, Boston, United States Aims: Lifting quadriplegic patients onto a densitometer manually is dangerous for both the patient and densitometry staff, and using an overhead lift is the preferred method of transfer. The overhead lift system commonly in use (LikorallÔ 242 S overhead lift system, Batesville, IN) requires the use of a sling underneath the patient, so the sling is then underneath the patient as BMD is measured. The aim of this study is to determine whether this sling affects the BMD measurement. Methods: Measurements were done on a Hologic Discovery A (Bedford, MA). The spine phantom was measured 30 times by itself, and 30 times with the standard sling (Liko Soft Original high-backed sling, model 20) placed underneath it, and 16 times with the disposable sling (LikoÒ Solo HighBack sling, model 25) placed underneath. We report the meanSD for the area, BMC, and BMD for the spine phantom alone, and with the different slings underneath. The significance of the difference between groups was assessed using the Mann-Whitney test, and significance of the difference of the variance among groups was assessed using the F-test of the equality of two variances.
Fracture Site Hip Measure Site & Parameter Femoral Neck Total Femur
SMD (95% CI) Total vBMD DXA BMD Total vBMD DXA BMD
0.90 ( 1.36, 0.84 ( 1.28, 0.91 ( 1.39,
0.43)
0.91 1.16 1.01 0.80 0.90
0.68) 0.96) 0.71) 0.51) 0.41)
AUROC (95% CI)
0.45) 0.40)
Lumbar Spine
Any Assessed Site SMD (95% CI)
0.71 (0.38, 0.93) 0.73 (0.40, 0.94)
0.94 0.83 1.01 0.74
( ( ( (
1.26, 1.07, 1.28, 0.92,
0.74 0.81 0.77 0.72 0.73
0.87 1.09 0.93 0.78 0.90
( ( ( ( (
1.08, 1.25, 1.21, 0.98, 1.39,
Spine Total vBMD Trabecular vBMD Cortical vBMD DXA BMD DXA BMD (lateral)
( ( ( ( (
1.15, 1.37, 1.32, 1.09, 1.39,
(0.66, (0.77, (0.64, (0.63, (0.33,
0.82) 0.85) 0.89) 0.80) 0.96)
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
AUROC (95% CI)
0.61) 0.75 0.58) 0.72 0.73) 0.76 0.56) 0.70 Any Assessed Site 0.65) 0.73 0.92) 0.80 0.65) 0.75 0.58) 0.71 0.41) 0.74
(0.53, (0.64, (0.57, (0.65,
0.92) 0.79) 0.91) 0.75)
(0.66, (0.76, (0.64, (0.64, (0.34,
0.79) 0.83) 0.86) 0.77) 0.96)
Volume 17, 2014