Osteoporosis International

, Volume 6, Issue 5, pp 407–415

Correlations of dual-energy X-ray absorptiometry, quantitative computed tomography, and single photon absorptiometry with spinal and non-spinal fractures

  • F. W. Lafferty
  • D. Y. Rowland
Original Article

Abstract

Controversy continues as to which method of measuring bone mineral density (BMD) best detects osteoporosis and best correlates with fractures of the spine, hip and elsewhere. To answer these questions the prevalence of fractures was carefully determined among 90 subjects (70 with osteoporosis, 6 with mild primary hyperparathyroidism, 1 with osteomalacia and 13 normals) and simultaneous measurements were made using spinal computed tomography (QCT), spinal anteroposterior (AP) and supine lateral dual X-ray absorptiometry (DXA), femoral neck and total hip DXA, and distal third radial DXA and single photon absorptiometry (SPA). The DXA measurements which had the greatest sensitivity in detecting osteoporosis (defined as a BMD lower than −2.5 SD of peak bone mass at age 30 years) were the supine lateral spine DXA (84%) and femoral neck DXA (75%); less sensitive were the DXA measurements of the distal third of the radius (61%) and AP spine (51%). DXA measurements of the femoral neck and distal third of the radius were more useful than spinal measurements in detecting the osteopenia of mild primary hyperparathyroidism. Vertebral compression fractures (VCF) correlated well with spinal QCT (r=−0.38) and lateral spine DXA (r=−0.41), but poorly with AP spine DXA (r=−0.17) and distal third radial DXA (r=−0.02). Non-spinal fractures correlated best with the distal third radial DXA (r=−0.42). In conclusion, spinal QCT, supine lateral spine DXA and femoral neck DXA are the best BMD methods to screen for osteoporosis, whereas AP spine DXA is a poor screening method in women over 60 years of age. Spinal QCT and lateral spine DXA correlate well with VCFs, whereas correlations of VCFs with AP spine DXA, femoral neck DXA and distal third radial DXA are poor.

Keywords

Bone densitometry Dual-energy absorptiometry Quantitative computed tomography Single photon absorptiometry Fractures Osteoporosis 

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References

  1. 1.
    Cameron JF, Sorenson J. Measurement of bone mineral in vivo: an improved method. Science 1963;142:250–2.Google Scholar
  2. 2.
    Roos B. Dual photon absorptiometry in lumbar vertebrae. Göteborg, Sweden: Academisk Avhaling, 1974:264–90.Google Scholar
  3. 3.
    Cann CE, Genant HK. Precise measurements of vertebral mineral content using computed tomography. J Comput Assist Tomogr 1980;4:493–500.Google Scholar
  4. 4.
    Brody WR, Butt G, Hall A, Macovsky A. A method for selective tissue and bone visualization using dual energy scanned projection radiography. Med Phys 1981;8:353–7.Google Scholar
  5. 5.
    Genant HK, Grampp S, Glüer CC, et al. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 1994;9:1503–14.Google Scholar
  6. 6.
    Awbrey BJ, Jacobsen PC, Grubb SA, et al. Bone density in women: a modified procedure for measurement of distal radial density. J Orthop Res 1984;2:314–21.Google Scholar
  7. 7.
    Kalendar WH, Felsenberg D, Louis O, et al. Reference values for trabecular and cortical bone density in single and dual energy quantitative computed tomography. Eur J Radiol 1989;9:75–80.Google Scholar
  8. 8.
    Rupich R, Griffin MG, Pacifici R, Avioli LV, Susman N. Lateral dual-energy radiography: artifact error from rib and pelvic bone. J Bone Miner Res 1992;7:97–101.Google Scholar
  9. 9.
    Jergas M, Brietenseher M, Gluer CC, Black D, Lang P, Grampp S, Engelke K, Genant HK. Which vertebrae should be assessed using lateral dual-energy X-ray absorptiometry of the lumbar spine? Osteoporosis Int 1995;5:196–204.Google Scholar
  10. 10.
    Fuleihan GE, Testa MA, Angell JE, Porrino N, Leboff MS. Reproducibility of DXA absorptiometry: a model for bone loss estimates. J Bone Miner Res 1995;10:1004–14.Google Scholar
  11. 11.
    Bjarnason K, Hassager C, Ravn P, Christiansen C. Early post-menopausal diminution of forearm and spinal bone mineral density: a cross-sectional study. Osteoporosis Int 1995;5:35–8.Google Scholar
  12. 12.
    Leboff MS, El-Hajj, Fuleiham G, Angell JE, Chung S, Curtis K. Dual-energy x-ray absorptiometry of the forearm: reproducibility and correlation with single-photon absorptiometry. J Bone Miner Res 1992;7:841–6.Google Scholar
  13. 13.
    SPSS, Inc. SPSS user's guide, 2nd ed. New York: McGraw-Hill, 1986:639–43.Google Scholar
  14. 14.
    Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research. New York: Van Nostrand Reinhold, 1982:221–2.Google Scholar
  15. 15.
    Slosman DO, Rissoli R, Donath A, Bonjour JP. Vertebral bone mineral density measured laterally by dual X-ray absorptiometry. Osteoporosis Int 1990;1:23–9.Google Scholar
  16. 16.
    Centor RM. A visicalc program for estimating the area under a Receiver Operating Characteristic (ROC) curve. Med Decis Making 1985;5:139–48.Google Scholar
  17. 17.
    Hanley JA, McNeil BJ. A method of comparing the areas under Receiver Operating Characteristic curves derived from the same cases. Radiology 1983;148:839–43.Google Scholar
  18. 18.
    Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137–41.Google Scholar
  19. 19.
    Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 1991;114:919–23.Google Scholar
  20. 20.
    Parfitt AM. Interpretation of bone densitometry measurements: disadvantages of a percentage scale and a discussion of some alternatives. J Bone Miner Res 1990;5:537–40.Google Scholar
  21. 21.
    Silverberg SJ, Gertenberg F, Jacobs TP, et al. Longitudinal measurements of bone density and biochemical indices in untreated primary hyperparathyroidism. J Clin Endocrinol Metab 1995;80:723–8.Google Scholar
  22. 22.
    Davis JW, Ross PD, Wasnich RD. Evidence for both generalized and regional low bone mass among elderly women. J Bone Miner Res 1994;9:305–9.Google Scholar
  23. 23.
    Orwal! EF, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 1990;70:1202–7.Google Scholar
  24. 24.
    Reid IR, Evans MC, Ames R, Wattie DJ. The influence of osteophytes and aortic calcification on spinal mineral density in postmenopausal women. J Clin Endocrinol Metab 1991;72:1372–4.Google Scholar
  25. 25.
    Cann CE, Genant HK, Kolb FO, Ettinger B. Quantitative computed tomography for prediction of vertebral fracture risk. Bone 1985;6:1–7.Google Scholar
  26. 26.
    Odvina CV, Wergedal JE, Libanati CR, Schulz EE, Baylink DJ. Relationship between trabecular vertebral bone density and fractures: a quantitative definition of spinal osteoporosis. Metabolism 1988;37:221–8.Google Scholar
  27. 27.
    Overgaard K, Hansen MA, Riis BJ, Christiansen C. Discriminatory ability of bone mass measurements (SPA and DEXA) for fractures in elderly postmenopausal women. Calcif Tissue Int 1992;50:30–5.Google Scholar
  28. 28.
    Yu N, Glüer CC, Gramp S, et al. Spine bone mineral assessment in postmenopausal women: a comparison between dual x-ray absorptiometry and quantitative computed tomography. Osteoporosis Int 1995;5:433–9.Google Scholar
  29. 29.
    Smith-Bindman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991;6:25–34.Google Scholar
  30. 30.
    Nelson DA, Kleerekoper M, Peterson EL. Reversal of vertebral deformities in osteoporosis: measurement error or “rebound”? J Bone Miner Res 1994;9:977–82.Google Scholar
  31. 31.
    National Osteoporosis Foundation Working Group in Vertebral Fractures. J Bone Miner Res 1995;10:518–23.Google Scholar
  32. 32.
    Spector TD, McCloskey EV, Doyle DV, Kanis JA. Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford study. J Bone Miner Res 1993;8:817–22.Google Scholar
  33. 33.
    Ryan PJ, Blake GM, Herd R, Parker J, Fogelman I. Distribution of bone mineral density in the lumbar spine in health and osteoporosis. Osteoporosis Int 1994;4:67–71.Google Scholar
  34. 34.
    Finkelstein JS, Cleary RL, Butler JP, et al. A comparison of lateral versus anterior-posterior spine dual energy x-ray absorptiometry for the diagnosis of osteopenia. J Clin Endocrinol Metab 1994;78:724–30.Google Scholar
  35. 35.
    Guglielmi G, Grimston SK, Fischer KC, Pacifici R. Osteoporosis: diagnosis with lateral and posteroanterior dual x-ray absorptiometry compared with quantitative CT. Radiology 1994;192:845–50.Google Scholar
  36. 36.
    Bjarnson K, Nilas L, Hassager C, Christiansen C. Dual energy x-ray absorptiometry of the spine-decubitus lateral versus anteroposterior projection in osteoporotic women: comparison to single energy x-ray absorptiometry of the forearm. Bone 1995;16:255–60.Google Scholar
  37. 37.
    Duboeuf F, Braillon P, Chapuy MC, et al. Bone mineral density of the hip measured with dual-energy x-ray absorptiometry in normal elderly women and in patients with hip fracture. Osteoporosis Int 1991;1:242–9.Google Scholar
  38. 38.
    Ott SM, Kilcoyne RF, Chestnut CH III. Ability of four different techniques of measuring bone mass to diagnose vertebral fractures in postmenopausal women. J Bone Miner Res 1987;2:201–10.Google Scholar
  39. 39.
    Eastell R, Wahner HW, O'Fallen WM. Amadio PC, Melton J, Riggs BL. Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles' and vertebral fracture syndromes. J Clin Invest 1989;83:168–74.Google Scholar
  40. 40.
    Mazess RB, Barden H, Ettinger M, Schultz E. Bone density of the radius, spine, and proximal femur in osteoporosis. J Bone Miner Res 1988;3:13–8.Google Scholar
  41. 41.
    Riggs BL, Washner HW, Seeman E, et al. Changes in bone mineral density of the proximal femur and spine with aging. J Clin Invest 1982;70:716–23.Google Scholar
  42. 42.
    Nilas L, Podenphant J, Riis BJ, Gotfradsen A, Christiansen C. Usefulness of regional bone measurements in patients with osteoporotic fractures of the spine and distal forearm. J Nucl Med 1987;28:960–5.Google Scholar
  43. 43.
    Need AG, Nordin BEC. Which bone to measure? Osteoporosis Int 1990;1:3–6.Google Scholar
  44. 44.
    Pacifici R, Rupich R, Griffin M, Chenes A, Susman N, Avioli LV. Dual energy radiography versus quantitative computed tomography for the diagnosis of osteoporosis. J Clin Enocrinol Metab 1990;70:705–10.Google Scholar
  45. 45.
    Duboeuf F, Pommet R, Meunier PJ, Delmas PD. Dual-energy X-ray absorptiometry of the spine in anteroposterior and lateral projections. Osteoporosis Int 1994;4:110–6.Google Scholar
  46. 46.
    Cummings SR, Black DB. Should perimenopausal women be screened for osteoporosis? Ann Intern Med 1986;104:817–23.Google Scholar
  47. 47.
    Weinstein RS, New KD, Sappington LJ. Dual-energy x-ray absorptiometry versus single photon absorptiometry of the radius. Calcif Tissue Int 1991;49:313–6.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1996

Authors and Affiliations

  • F. W. Lafferty
    • 1
  • D. Y. Rowland
    • 2
  1. 1.Department of MedicineUniversity Hospitals of ClevelandUSA
  2. 2.Department of Epidemiology and BiostatisticsCase Western Reserve School of MedicineClevelandUSA
  3. 3.University Suburban Health CenterClevelandUSA

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