Aging Clinical and Experimental Research

, Volume 15, Issue 2, pp 131–135

Poor correlation of mid-femoral measurements by CT and hip measurements by DXA in the elderly

  • Dennis R. Taaffe
  • Thomas F. Lang
  • Tamara B. Harris
Original Articles
  • 22 Downloads

Abstract

Background and aims: Hip fracture is a devastating event in terms of outcome in the elderly, and the best predictor of hip fracture risk is hip bone density, usually measured by dual X-ray absorptiometry (DXA). However, bone density can also be ascertained from computerized tomography (CT) scans, and mid-thigh scans are frequently employed to assess the muscle and fat composition of the lower limb. Therefore, we examined if it was possible to predict hip bone density using mid-femoral bone density. Methods: Subjects were 803 ambulatory white and black women and men, aged 70–79 years, participating in the Health, Aging and Body Composition (Health ABC) Study. Bone mineral content (BMC, g) and volumetric bone mineral density (vBMD, mg/cm3) of the mid-femur were obtained by CT, whereas BMC and areal bone mineral density (aBMD, g/cm2) of the hip (femoral neck and trochanter) were derived from DXA. Results: In regression analyses stratified by race and sex, the coefficient of determination was low with mid-femoral BMC, explaining 6–27% of the variance in hip BMC, with a standard error of estimate (SEE) ranging from 16 to 22% of the mean. For midfemur vBMD, the variance explained in hip aBMD was 2–17% with a SEE ranging from 15 to 18%. Adjusting aBMD to approximate volumetric density did not improve the relationships. In addition, the utility of fracture prediction was examined. Forty-eight subjects had one or more fractures (various sites) during a mean follow-up of 4.07 years. In logistic regression analysis, there was no association between mid-femoral vBMD and fracture (all fractures), whereas a 1 SD increase in hip BMD was associated with reduced odds for fracture of ∼60%. Conclusions: These results do not support the use of CT-derived mid-femoral vBMD or BMC to predict DXA-measured hip bone mineral status, irrespective of race or sex in older adults. Further, in contrast to femoral neck and trochanter BMD, mid-femur vBMD was not able to predict fracture (all fractures).

Key words

Bone mineral density computerized tomography (CT) dual X-ray absorptiometry (DXA) elderly hip fracture mid-femur 

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References

  1. 1.
    Melton LJ III. How many women have osteoporosis? J Bone Miner Res 1995; 10: 175–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B. Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 1999; 10: 73–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 2000; 11: 460–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Genant HK, Glüer CC, Lotz JC. Gender differences in bone density, skeletal geometry, and fracture biomechanics. Radiology 1994; 190: 636–40.PubMedGoogle Scholar
  5. 5.
    Mazess RB, Barden HS. Interrelationships among bone density sites in normal young women. Bone Miner 1990; 11: 347–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Nordin BEC, Chatterton BE, Schultz CG, Need AG, Horowitz M. Regional bone mineral density interrelationships in normal and osteoporotic postmenopausal women. J Bone Miner Res 1996; 11: 849–56.PubMedCrossRefGoogle Scholar
  7. 7.
    Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993; 341: 72–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol 1988; 64: 1038–44.PubMedGoogle Scholar
  9. 9.
    Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Ohkawa S, Odamaki M, Yoneyama T, Hibi I, Miiyaji K, Kumagai H. Standardized thigh muscle area measured by computed axial tomography as an alternate muscle mass index for nutritional assessment of hemodialysis patients. Am J Clin Nutr 2000; 71: 485–90.PubMedGoogle Scholar
  11. 11.
    Cann CE. Quantitative CT for determination of bone mineral density. A review. Radiology 1988; 166: 509–22.Google Scholar
  12. 12.
    Greenspan SL, Myers ER, Maitland LA, Kido TH, Krasnow MB, Hayes WC. Trochanteric bone mineral density is associated with type of hip fracture in the elderly. J Bone Miner Res 1994; 9: 1889–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Kalender WA, Felsenberg D, Genant HK, Fischer M, Dequeker J, Reeve J. The European Spine Phantom — a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 1995; 20: 83–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Kröger H, Hunt M, Reeve J. Bone density reduction in various measurement sites in men and women with osteoporotic fractures of spine and hip: the European Quantitation of Osteo-porosis Study. Calcif Tissue Int 1999; 64: 191–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Prevrhal S, Engelke K, Kalender WA. Accuracy limits for the determination of cortical width and density: the influence of object size and CT imaging parameters. Phys Med Biol 1999; 44: 751–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Reid IR, Plank LD, Evans MC. Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 1992; 75: 779–82.PubMedCrossRefGoogle Scholar
  17. 17.
    Katzman DK, Bachrach LK, Carter DR, Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991; 73: 1332–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Boonen S, Cheng X, Nicholson PH, Verbeke G, Broos P, Dequeker J. The accuracy of peripheral skeletal assessment at the radius in estimating femoral bone density as measured by dual-energy X-ray absorptiometry: a comparative study of singlephoton absorptiometry and computed tomography. J Intern Med 1997; 242: 323–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Grampp S, Lang P, Jergas M, et al. Assessment of the skeletal status by peripheral quantitative computed tomography of the forearm: short-term precision in vivo and comparison to dual X-ray absorptiometry. J Bone Miner Res 1995; 10: 1566–76.PubMedCrossRefGoogle Scholar
  20. 20.
    Mundy GR. Bone remodeling. In Favus MJ, Ed. Primer on the metabolic bone diseases and disorders of mineral metabolism, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 1999; 30–8.Google Scholar
  21. 21.
    Laval-Jeantet AM, Bergot C, Carroll R, Garcia-Schaefer F. Cortical bone senescence and mineral bone density of the humerus. Calcif Tissue Int 1983; 35: 268–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Seeman E. From density to structure: growing up and growing old on the surfaces of bone. J Bone Miner Res 1997; 12: 509–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Silverman SL, Madison RE. Decreased incidence of hip fracture in Hispanics, Asians, and Blacks: California hospital discharge data. Am J Public Health 1988; 78: 1482–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Kellie SE, Brody JA. Sex-specific and race-specific hip fracture rates. Am J Public Health 1990; 80: 326–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Griffin MR, Ray WA, Fought RL, Melton LJ III. Black-white differences in fracture rates. Am J Epidemiol 1992; 136: 1378–85.PubMedGoogle Scholar
  26. 26.
    Hinton RY, Smith GS. The association of age, race, and sex with the location of proximal femoral fractures in the elderly. J Bone Joint Surg 1993; 75: 752–9.PubMedGoogle Scholar
  27. 27.
    Marshall D, Johnell O, Edel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312: 1254–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Augat P, Fan B, Lane NE, et al. Assessment of bone mineral at appendicular sites in females with fractures of the proximal femur. Bone 1998; 22: 395–402.PubMedCrossRefGoogle Scholar
  29. 29.
    Formica CA, Nieves JW, Cosman F, Garrett P, Lindsay R. Comparative assessment of bone mineral measurements using dual X-ray absorptiometry and peripheral quantitative computed tomography. Osteoporos Int 1998; 8: 460–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Kalender WA. Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 1992; 2: 82–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2003

Authors and Affiliations

  • Dennis R. Taaffe
    • 1
    • 2
  • Thomas F. Lang
    • 3
  • Tamara B. Harris
    • 1
  1. 1.Epidemiology, Demography and Biometry ProgramNational Institute on AgingBethesdaUSA
  2. 2.School of Human Movement Studies, Faculty of Health SciencesUniversity of QueenslandSt. LuciaAustralia
  3. 3.Department of RadiologyUniversity of CaliforniaSan FranciscoUSA

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