Impact of Spinal Degenerative Changes on the Evaluation of Bone Mineral Density with Dual Energy X-Ray Absorptiometry (DXA)

Rand, Th.; Seidl, G; Kainberger, Franz; Resch, Alexandra; Hittmair, Karl; Schneider, Barbara; Glüer, Claus C.; Imhof, Herwig

doi:10.1007/s002239900258

Cited by 165 publications

(94 citation statements)

References 17 publications

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“…It has been long understood that spinal BMD measurements in older people using DXA technology, are subject to variation due to both difficulties in interpreting images, and inherent additional bone mineral being present where the spine may be degenerate, have calcification of the aorta projected over it or anatomical variation with scoliosis in addition to other normal variants such as absent or additional vertebrae [15].…”

Section: Discussionmentioning

confidence: 99%

Static and mobile DXA scanner in-vivo cross-calibration study

2013

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Cross calibration of DXA scanning equipment with phantom subjects has been recommended for assessing agreement between devices co-located within DXA scanning services.This study evaluated in-vivo and in-vitro cross calibration of a static and a mobile DXA scanner within the same service in their individual clinical settings. 50 individuals from a volunteer group were recruited to take part in this study and had DXA measurements made on two GE Lunar Prodigy Advance (GE Lunar, Bedford, UK) scanners.Results in this study showed that the scanners agreed, with no statistically significant differences in BMD measurements made at the same site on the individual devices used in this study. The in-vivo cross calibration of the instruments was a useful experience, which demonstrated closely calibrated systems and raised the profile of the bone densitometry service within the hospital.3 Introduction Central dual energy x-ray absorptiometry (DXA) of the spine and hip is the current preferred method for the diagnosis of osteoporosis [1]. DXA scanners have good long term precision due to stable calibration and effective instrument quality control procedures to detect long term drift [1]. However, the results from DXA scanners produced by different manufacturers and even the same make of scanner made by the same manufacturer cannot be directly compared due to potential differences in calibration [2]. When introducing additional or replacing DXA scanners it is therefore recommended to perform cross calibration whether the new machine is from the same manufacturer or not [3]. While cross calibration between two machines of the same manufacturer and using the same manufacture's phantom has been reported to have good agreement of 0.2%, in vivo measurements may differ by more than 2%[4] The increased errors in-vivo can be partly attributed to the increased precision errors introduced by virtue of scanning an individual who has in-homogeneity within their tissue, meaning that the x-ray photons may not pass though the same structures on both scans. Precision errors within DXA are also important for the characterisation of it's ability to assess bone mineral density and detect longitudinal change. Monitoring measurement errors within a service is also dependant on QA systems to detect scanner changes [5]. When introducing a new scanner, it is recommended to undertake a cross-calibration of the scanners within a service. The optimum technique for undertaking a cross-calibration study of DXA scanners is to use in-vivo measurements since this is how DXA scanners are used in clinical practice [4,6].In 2009, a GE Lunar Prodigy DXA scanner (GE Healthcare, Bedford, UK) was purchased and commissioned to operate in a mobile vehicle, alongside the existing static GE Lunar Prodigy within the Healthy Bones Service at Derriford Hospital (Plymouth UK). While it is not good practice to make longitudinal measurements of

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Section: Discussionmentioning

confidence: 99%

Static and mobile DXA scanner in-vivo cross-calibration study

2013

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“…6,8,[14][15][16] Studies analyzing the intensity of osteophytes have shown that the greater the intensity of this abnormality, the higher the increase in bone mineral density is. 3 It is clear that osteophytes can lead to an apparent increase in bone mineral density, although it is not clear whether this increase is associated with a decrease in fractures.…”

Section: Discussionmentioning

confidence: 99%

Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis

et al. 2002

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CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6%, osteophytes in 33.3% and calcifications of the aorta in 30.2%. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively), despite the fractured vertebrae having greater bone mineral density (P < 0.02). Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04). Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01). CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry results should be carried out together with the interpretation of a simple lumbar spine x-ray in elderly women.

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“…6 Degenerative factors such as, osteophytes, osteochondrosis, scoliosis and vascular calcification are increased from 35% to 80% in the 55 to 70 years age group. 7 It has been accepted generally that conditions of osteoporosis and osteoarthritis are different diseases, possibly resulting from different pathomechanisms. Several investigators have examined the coexistence of osteoporosis and spondylosis in the spine and have reported an inverse relation between decreased bone mineral density (BMD) and intervertebral disc degeneration.…”

Section: Methodsmentioning

confidence: 99%