Discordance in Patient Classification Using T-Scores

Faulkner, Kenneth G.; Stetten, Eric von; Miller, Paul D.

doi:10.1385/jcd:2:3:343

Cited by 354 publications

(174 citation statements)

References 15 publications

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“…It was reported that lack of agreement between central and peripheral DEXA is a barrier to recommending peripheral DEXA scan methods. 28,29 In the same context, Wigderowitz et al 30 examined the extent to which patients with Colles' fractures have osteopenia. They measured BMD in the contralateral radius of 235 women ranging from 21 to 92 years in age presenting with Colles' fractures over a 2-year period.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

Abdelmohsen

2017

Journal of Chiropractic Medicine

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Objectives: The purpose of the current study was to compare central and peripheral bone mineral density at different regions including spine, hip, and wrist in postmenopausal women. Methods: Forty postmenopausal women participated in this study. Their mean age, body mass, height, and body mass index were 53.5 ± 2.75 y, 68.6 ± 8.68 kg, 167.8 ± 6.46 cm, and 24.31 ± 1.69 kg/m 2 , respectively. Bone mineral density (BMD) T-scores of spine, hip, and wrist regions were measured for all participants with a dual-energy X-ray absorptiometry scan. Results: All measured regions (spine, hip, and wrist) had low BMD T-scores. Bone mineral density of the wrist was significantly lower (-2.58 ± 2.18) than that of both spine (-1.79 ± 0.98) and hip (-1.69 ± 1.37). In addition, there were no statistically significant differences in BMD between the spine and hip. Conclusions: In this group of postmenopausal women, wrist BMD decreased more than spine and hip BMD. Both spine and hip BMD decreased by nearly the same percentage in postmenopausal women. Peripheral sites may be more representative of osteoporosis than central sites.

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Section: Discussionmentioning

confidence: 99%

Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

Abdelmohsen

2017

Journal of Chiropractic Medicine

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“…Faulkner and colleagues (12) showed discordance in patient classification using T-scores at different measurement sites. The percent of the population aged 60 with T-scores below −2.5 was 6% at total hip, 14% PA spine and 38% lateral spine.…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of Spine Bone Density in Elderly Women

Schneider

Bettencourt

Barrett‐Connor

2006

Journal of Clinical Densitometry

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It is common clinical practice to obtain bone mass measurement at both the hip and spine to evaluate for osteoporosis. With aging, degenerative changes in the lumbar spine may elevate the bone mineral density (BMD) results giving false assurances that the fracture risk at the spine is low. We examined the association of spine osteoarthritis and bone mineral density in 1082 community-dwelling ambulatory older women aged 50-96 years who participated in a 1992-1996 osteoporosis research clinic visit. Bone mineral density (BMD) was measured at the hip, PA and lateral lumbar spine using dual energy x-ray absorptiometry (DXA). Spine osteoarthritis was identified on the PA lumbar spine DXA images by a musculoskeletal radiologist. Forty percent of women had evidence of spine osteoarthritis (OA). Women with spine OA had mean age of 77.4 years (95% CI, 76.5-78.2), were significantly older than women without (mean age 66.8; 95% CI, 65.9-67.7), and were more likely to have prevalent radiographic fractures (14.2% vs. 9.5%, p< 0.05). Age-adjusted BMD at the femoral neck, total hip, PA spine, and lateral spine was significantly higher in women with spine OA. Women with spine OA were more likely to have osteoporosis by WHO classification at the femoral neck and total hip than those without spine OA, but less likely based on the PA spine site (14.4% vs 24.5%). Despite higher BMD levels, women with OA of the lumbar spine had higher prevalence of osteoporosis at the hip and radiographic vertebral fractures. In elderly women 65 years and older who are likely to have spine OA, DXA measurement of the spine may be not useful in assessing fracture risk and DXA of the hip is recommended for identification of osteoporosis.

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“…As T-score values from different skeletal sites often disagree, individual patients may be classified as having osteoporosis, low bone mass, or normal BMD depending on which skeletal site or sites are measured. (5,6,7,8) Clinicians may resolve this labeling dilemma by following International Society for Clinical Densitometry (ISCD) and American Society for Bone and Mineral Research (ASBMR) recommendations to classify patients on the basis of the skeletal site (total hip, femoral neck, or lumbar spine) with the lowest T-score. (9,10,11) Alternatively, the International Osteoporosis Foundation (IOF) has stated that because spine BMD does not enhance fracture prediction (any osteoporotic, hip, or spine) once hip BMD is known, only hip BMD should be measured.…”

Section: Introductionmentioning

confidence: 99%

Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: Study of Osteoporotic Fractures

Fink

Harrison

Taylor

et al. 2008

Journal of Clinical Densitometry

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To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy x-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score ≤-2.5 at femoral neck or total hip, and spine osteoporosis as T-score ≤-2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age and weight-adjusted increased risk for hip fracture (95%CI 2.4-3.6), and smaller increases in risk of nonhip nonspine (HR=1.6), clinical spine (OR=2.2), and radiographic spine fractures (OR=1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95%CI 2.1-3.8), and smaller increases in risk of clinical spine (OR=1.4), nonhip nonspine (HR=1.6), and hip fractures (HR=1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site-specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment.

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Discordance in Patient Classification Using T-Scores

Cited by 354 publications

References 15 publications

Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

Clinical Utility of Spine Bone Density in Elderly Women

Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: Study of Osteoporotic Fractures

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