, Volume 4, Issue 2, pp 110-116

Dual-energy X-ray absorptiometry of the spine in anteroposterior and lateral projections

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Dual-energy X-ray absorptiometry (DXA) of the lumbar spine provides an estimation of the bone mineral content (BMC) corrected by the projected area of the spine and expressed in g/cm2. This two-dimensional estimate of the bone mineral density (BMD) is influenced by the skeletal size, assessed by the subject's height. In order to obtain an estimate of the volumetric BMD, we measured BMC with a new DXA device (Sophos L-XRA) equipped with 24 detectors and a rotating arm, thus allowing scanning of the lumbar spine in both an anteroposterior (AP) projection and a lateral (LAT) projection with the patient in a supine position. Comparison between the results obtained on the third (L3) and fourth (L4) lumbar vertebrae with automatic or manual analysis showed that the best precision was obtained with the lateral measurement of L3 alone with an automatic soft tissue baseline determination. Results were expressed in g/cm2 and in g/cm3 (by dividing the g/cm2 value by the width (AP area divided by the height of the vertebra) of L3), and were compared with those obtained by conventional AP scanning of L2–4 (g/cm2). The in vivo precision error evaluated by triplicate measurements on 10 controls was 17 mg/cm2 (1.96%) and 5.2 mg/cm3 (2.31%) for LAT L3 as compared with 13 mg/cm2 (1.15%) for AP L2–4. Volumetric BMD (g/cm3) measurement, assessed in vitro on a calibrated hydroxyapatite phantom, and the absolute values obtained in normal women were similar to those obtained by quantitative computed tomography (QCT). In 39 healthy adults (27±4 years) BMD expressed in g/cm2 was correlated with height (r=0.36 for AP L2–4 andr=0.39 for LAT L3;p<0.05 for both) but not with LAT L3 BMD expressed in g/cm3 (r=0.02; NS). The age-related bone loss between 30 and 80 years of age, derived from the normal values for 101 healthy women (age range 19–73 years) was 36% for AP L2–4, 52% for LAT L3 (g/cm2) and 60% for LAT L3 (g/cm3). In a group of 22 women with untreated postmenopausal vertebral osteoporosis (one or more non-traumatic vertebral crush fractures) the mean decrease in BMD, expressed as a percentage of the age-adjusted normal value, was more pronounced (p<0.001) for LAT L3 BMD (−21% in g/cm2,Z-score −1.08; −22% in g/cm3,Z-score −0.94) than for AP L2–4 BMD (−9%,Z-score −0.66). We conclude that: 1) BMD measurement restricted to the vertebral body of L3 can be achieved with a low precision error with this new DXA device; 2) it allows an estimate of the volumetric density (g/cm3) which does not seem to be influenced by skeletal size; 3) lateral BMD appears to be more sensitive than conventional AP scanning for assessing age-related bone loss and should be useful in the investigation of trabecular osteoporosis.