Discrepancy of left and right hip bone mineral density (BMD) in Thai women: diagnostic agreement and misclassification
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To determine the diagnostic agreement and the degree of misclassification when using data from the left and right hips.
The cross-sectional study of 1,943 perimenopausal and postmenopausal Thai women, who had bone mineral density (BMD) measurements at the left (non-dominant) and right hips for the screening of low bone mass (LBM) or osteoporosis (OP) in the Department of Radiology, Faculty of Medicine, Chiang Mai University from September 2008 to August 2010 was performed. The kappa statistic was used to assess diagnostic agreement. The prevalence of LBM and OP and the percentage of misclassification were reported.
There was a significant correlation between the left and right BMD values for the femoral neck (FN) (r 2 = 0.83; p < 0.001) and the total hip (TH) (r 2 = 0.89; p < 0.001). The diagnostic agreement of the FN and TH regions was significant in all study groups ranging from 0.69 to 0.76 (p < 0.001). For the final diagnosis, which is based on the least T-score of the FN or TH regions, the diagnostic agreement was 0.73 for all women, 0.77 for perimenopausal women, 0.73 for postmenopausal women, 0.70 for postmenopausal women age less than 65 years and 0.71 for postmenopausal women age greater than or equal to 65 years. The percentage of misclassification for all women was 16.9 %, with 3.3 % being downgraded from normal to LBM and 3.4 % from LBM to OP.
Despite the fact that good diagnostic agreement was demonstrated in this study, a significant number of diagnostic discordance between left and right hips (16.9 %) was also observed. BMD measurements of both hips are recommended for diagnosing LBM and OP in clinical practice.
- Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9:1137–41. CrossRef
- Faulkner KG, Genant HK, McClung M. Bilateral comparison of femoral bone density and hip axis length from single and fan beam DXA scans. Calcif Tissue Int. 1995;56:26–31. CrossRef
- Bonnick SL, Nichols DL, Sanborn CF, Payne SG, Moen SM, Heiss CJ. Right and left proximal femur analyses: is there a need to do both? Calcif Tissue Int. 1996;58:307–10.
- Franck H, Munz M, Scherrer M. Bone mineral density of opposing hips using dual energy X-ray absorptiometry in single-beam and fan-beam design. Calcif Tissue Int. 1997;61:445–7. CrossRef
- Rao AD, Reddy S, Rao DS. Is there a difference between right and left femoral bone density? J Clin Densitom. 2000;3:57–61. CrossRef
- Lessig HJ, Meltzer MS, Siegel JA. The symmetry of hip bone mineral density. A dual photon absorptiometry approach. Clin Nucl Med. 1987;12:811–2. CrossRef
- Hall ML, Heavens J, Ell PJ. Variation between femurs as measured by dual energy X-ray absorptiometry (DEXA). Eur J Nucl Med. 1991;18:38–40. CrossRef
- Yang RS, Chieng PU, Tsai KS, Liu TK. Symmetry of bone mineral density in the hips is not affected by age. Nucl Med Commun. 1996;17:711–6. CrossRef
- Yang R, Tsai K, Chieng P, Liu T. Symmetry of bone mineral density at the proximal femur with emphasis on the effect of side dominance. Calcif Tissue Int. 1997;61:189–91. CrossRef
- Lipton RB, Liao Y, Cao G, Cooper RS, McGee D. Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 1993;138:826–39.
- Thurlow GA, Bowling DB, Cooper RM. ON and OFF activity gradients in the lateral geniculate nucleus of the cat: a combined 14C 2-deoxyglucose and d, l-2-amino-4-phosphonobutyric acid study. Vis Neurosci. 1993;10:1027–33. CrossRef
- Petley GW, Taylor PA, Murrills AJ, Dennison E, Pearson G, Cooper C. An investigation of the diagnostic value of bilateral femoral neck bone mineral density measurements. Osteoporos Int. 2000;11:675–9. CrossRef
- Wong JC, McEwan L, Lee N, Griffiths MR, Pocock NA. The diagnostic role of dual femur bone density measurement in low-impact fractures. Osteoporos Int. 2003;14:339–44. CrossRef
- Cooper C, O’Neill T, Silman A. The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone. 1993;14(Suppl 1):S89–97. CrossRef
- Wasnich RD. Vertebral fracture epidemiology. Bone. 1996;18:179S–83S. CrossRef
- Melton LJ 3rd. Epidemiology of spinal osteoporosis. Spine (Phila Pa 1976). 1997;22:2S–11S. CrossRef
- Jitapunkul S, Thamarpirat J, Chaiwanichsiri D, Boonhong J. Incidence of vertebral fractures in Thai women and men: a prospective population-based study. Geriatr Gerontol Int. 2008;8:251–8. CrossRef
- Cole R, Larson J. The effect of measurement of the contralateral hip if the spine is not included in the bone mineral density analysis. J Clin Densitom. 2006;9:210–6. CrossRef
- Discrepancy of left and right hip bone mineral density (BMD) in Thai women: diagnostic agreement and misclassification
Annals of Nuclear Medicine
Volume 26, Issue 10 , pp 787-793
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Bone mineral density
- Diagnostic agreement
- Industry Sectors
- Author Affiliations
- 1. Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 2. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- 3. Department of Orthopaedic, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 4. Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 5. Department of Orthopaedic, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- 6. Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand