Skip to main content

Advertisement

SpringerLink
Log in

Total Body, Spine, and Femur Dual X-ray Absorptiometry in Spinal Osteoporosis

  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the ability of dual x-ray absorptiometry (DXA) to discriminate between normal and osteoporotic patients. A total of 152 postmenopausal women entered the study: 73 (aged 61.2 ± 8 years) had established postmenopausal osteoporosis with one or more vertebral crushes on lateral X-ray of spine, and 79 (aged 59.3 ± 7.8 years) had no vertebral fractures. Measurements of bone mineral content (BMC) in grams, bone mineral density (BMD) in g/cm2 and body composition (lean and fat mass in grams) of total body, lumbar spine (L2-L4), and femur (neck, trochanter, Ward’s triangle) were carried out with a LUNAR DPX densitometer. In all sites, BMD values of osteoporotic patients were significantly lower than those of the control subjects. The higher Z-score was found for total body density (−2.14) followed by L2-L4 (−2.0), femoral neck (−1.93), Ward’s triangle (−1.69), and trochanter (−1.4). Only the trochanter Z-score was significantly different compared with the other sites. A fracture threshold was determined for each site from osteoporotic patients and normal controls: with a sensitivity set at 90%, the best specificity was obtained at the lumbar spine and total body sites (89% and 84%, respectively). BMD values were highly related to lean and fat body mass, but bone loss with age was unrelated to soft tissue change. In conclusion, BMD measurements at different skeletal sites enable detection of spinal osteoporosis although sensitivity for femoral areas was less with respect to total body and L2-L4 BMD values.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Genant HK, Block JE, Steiger P, Glueer C, Ettinger B, Harris ST (1989) Appropriate use of bone densitometry. Radiology. 170:817–822

    Article  CAS  PubMed  Google Scholar 

  2. Mazess RB (1990) Bone densitometry of the axial skeleton. Orthop Clin North Am 21(1):51–63

    Article  CAS  PubMed  Google Scholar 

  3. Mazess RB, Peppier WW, Chesnut CH, Nelp WB, Cohn SH, Zanzi I (1981) Total body mineral and lean body mass by dualphoton absorptiometry. II. Comparison with total body calcium by neutron activation analysis. Calcif Tissue Int. 33:361–363

    Article  CAS  PubMed  Google Scholar 

  4. Nuti R, Righi G, Martini G, Turchetti V, Lepore C, Caniggia A (1987) Methods and clinical applications of total body absorptiometry. J Nucl Med Allied Sci. 31:213–221

    CAS  PubMed  Google Scholar 

  5. Kelly TL, Slovik DM, Schoenfeld DA, Neer RM (1988) Quantitative digital radiography versus dual photon absorptiometry of the lumbar spine. J Clin Endocrinol Metab. 67:839–844

    Article  CAS  PubMed  Google Scholar 

  6. Mazess RB, Collich B, Trempe J, Barden H, Hansen J (1989) Performance evaluation of a dual-energy X-ray bone densitometer. Calcif Tissue Int. 44:228–232

    Article  CAS  PubMed  Google Scholar 

  7. Cullum ID, Ell PJ, Ryder JP (1989) X-ray dual photon absorptiometry: a new method for the measurement of bone density. Br J Radiol. 62:587–592

    Article  CAS  PubMed  Google Scholar 

  8. Sorenson JA, Hanson JA, Mazess RB (1988) Precision and accuracy of dual-energy X-ray absorptiometry. J Bone Miner Res 3:S126

    Google Scholar 

  9. Pacifici R, Rupich R, Vered I, Fischer KC, Griffin M, Susman N, Avioli LV (1988) Dual energy radiography (DER): a preliminary comparative study. Calcif Tissue Int. 43:189–191

    Article  CAS  PubMed  Google Scholar 

  10. Eastell R, Wahner HW, O’Fallen WM, Amadio PC, Melton LJ III, Riggs BL (1989) Unequal decrease in bone density of lumbar spine and ultradistal radius in Colle’s and vertebral fracture syndromes. J Clin Invest. 83:168–174

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Need AG, Nordin BEC (1990) Which bone to measure? Osteoporosis Int. 1:3–6

    Article  CAS  Google Scholar 

  12. Mazess RB, Barden H, Ettinger M, Schultz E (1988) Bone density of the radius, spine and proximal femur in osteoporosis. J Bone Miner Res 3(1): 13–18

    Article  CAS  PubMed  Google Scholar 

  13. Mazess RB, Peppier WW, Chesney RW, Lang TA, Lindgren U, Smith E (1984) Does bone measurement on the radius indicate skeletal status? J Nucl Med. 25:281–288

    CAS  PubMed  Google Scholar 

  14. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. Lancet. 341:72–75

    Article  CAS  PubMed  Google Scholar 

  15. Feyerabend AJ, Lear JL (1993) Regional variations in bone mineral density as assessed with dual-energy photon absorptiometry and dual X-ray absorptiometry. Radiology. 186:467–469

    Article  CAS  PubMed  Google Scholar 

  16. Cummings SR, Black D, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P, Vogt TM (1990) Appendicular bone density and age predict hip fracture in women. JAMA. 263:665–668

    Article  CAS  PubMed  Google Scholar 

  17. Wasnich RD, Ross PD, Heilbrun LK, Vogel JM (1989) A comparison of single and multi-site BMC measurements for assessment of spine fracture probability. J Nucl Med 30:1166

    CAS  PubMed  Google Scholar 

  18. Hui SL, Slemenda CW, Johnston CC (1989) Baseline measurements of bone mass predicts fracture in white women. Am Coll Physicians. 111:335–361

    Google Scholar 

  19. Riis BJ, Christiansen C (1988) Measurement of spinal or peripheral bone mass to estimate early postmenopausal bone loss? Am J Med. 84:646–653

    Article  CAS  PubMed  Google Scholar 

  20. Eastell R, Cedel SL, Wahner W, Riggs BL, Melton LJ III (1991) Classification of vertebral fractures. J Bone Miner Res. 6:207–215

    Article  CAS  PubMed  Google Scholar 

  21. Mazess RB, Wahner HW (1988) Nuclear medicine and densitometry. In: Riggs BL, Melton LJ (eds) Osteoporosis: etiology, diagnosis, and management. Raven Press, New York, pp 251–295

    Google Scholar 

  22. Gundry CR, Miller CW, Ramos E, Moscona A, Stein JA, Mazess RB, Sartoris DJ, Resnick D (1990) Dual-energy radiographic absorptiometry of the lumbar spine: clinical experience with two different systems. Radiology. 174:539–541

    Article  CAS  PubMed  Google Scholar 

  23. Gluer CC, Steiger P, Selvidge R, Elliesen-Kliefoth K, Hayashi C, Genant HK (1990) Comparative assessment of dual-photon absorptiometry and dual-energy radiography. Radiology. 174:223–228

    Article  CAS  PubMed  Google Scholar 

  24. Svendsen OL, Marslew U, Hassager C, Christiansen C (1992) Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems. Eur J Nucl Med. 19:41–46

    Article  CAS  PubMed  Google Scholar 

  25. Nuti R, Martini G, Righi G, Frediani B, Turchetti V (1991) Comparison of total-body measurements by dual-energy X-ray absorptiometry and dual-photon absorptiometry. J Bone Miner Res. 7:681–687

    Google Scholar 

  26. Mazess RB, Barden HS, Bisek JP, Hanson J (1990) Dual-energy X-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. Am J Clin Nutr. 51:1106–1112

    Article  CAS  PubMed  Google Scholar 

  27. Martini G, Frediani B, Núti R (1992) Metodi di misura del tes-suto adiposo nel corpo intero: utilità della densitometria “total body” a raggi x. Min Med. 83:181–185

    CAS  Google Scholar 

  28. Genant HK, Faulkner KG, Gluer CC (1991) Measurement of bone mineral density: current status. Am J Med 91(5B):49–53

    Article  Google Scholar 

  29. Mazess RB, Barden HS, Vetter J, Ettinger M (1989) Advances in noninvasive bone measurements. Ann Biomed Eng. 17:177–181

    Article  CAS  PubMed  Google Scholar 

  30. Ho CP, Kim RW, Schäffler MB, Sartoris DJ (1990) Accuracy of dual energy radiographic absorptiometry of the lumbar spine: cadaver study. Radiology. 176:171–173

    Article  CAS  PubMed  Google Scholar 

  31. Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, Johnson KA, Melton LJ III (1982) Changes in bone mineral density of the proximal femur and spine with ageing. Differences between the postmenopausal and senile osteoporotic syndromes. J Clin Invest. 70:716–723

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Mazess RB, Barden HS (1990) Interrelationships among bone densitometry sites in normal young women. Bone Miner. 11:347–356

    Article  CAS  PubMed  Google Scholar 

  33. Gotfredsen A, Nilas L, Podenphant J, Hadberg A, Christiansen C (1989) Regional bone mineral in healthy and osteoporotic women: a cross-sectional study. Scand J Clin Lab Invest. 49:739–749

    Article  CAS  PubMed  Google Scholar 

  34. Nuti R, Martini G (1992) Measurements of bone mineral density by DXA total body absorptiometry in different skeletal sites in postmenopausal osteoporosis. Bone. 13:173–178

    Article  CAS  PubMed  Google Scholar 

  35. Nuti R, Martini G (1993) Effects of age and menopause on bone density of entire skeleton in healthy and osteoporotic women. Osteoporosis Int. 3:59–65

    Article  CAS  Google Scholar 

  36. Krolner B, Nielsen PS (1982) Bone mineral content of the lumbar spine in normal and osteoporotic women: cross-sectional and longitudinal studies. Clin Sci. 62:329–336

    Article  CAS  Google Scholar 

  37. Meltzer M, Lessig HJ, Siegel JA (1989) Bone mineral density and fracture in postmenopausal women. Calcif Tissue Int. 45:142–145

    Article  CAS  PubMed  Google Scholar 

  38. Gotfredsen A, Podenphant J, Nilas L, Christiansen C (1989) Discriminative ability of total body bone mineral measured by dual photon absorptiometry. Scand J Clin Lab Invest. 49:125–134

    Article  CAS  PubMed  Google Scholar 

  39. Reinbold WD, Genant HK, Reiser NJ, Harris ST, Ettinger B (1986) Bone mineral content in early-postmenopausal and postmenopausal osteoporotic women: comparison of measurement methods. Radiology. 160:469–478

    Article  CAS  PubMed  Google Scholar 

  40. Ott SM, Kilcoyne RF, Chesnut CH III (1988) Comparisons among methods of measuring bone mass and relationship to severity of vertebral fractures in osteoporosis. J Clin Endocrinol Metab. 66:501–507

    Article  CAS  PubMed  Google Scholar 

  41. Heuck AF, Block J, Glueer C-C, Steiger P, Genant HK (1989) Mild versus definite osteoporosis: comparison of bone densitometry techniques using different statistical models. J Bone Miner Res. 4:891–900

    Article  CAS  PubMed  Google Scholar 

  42. Mautalen C, Vega E, Ghiringhelli G, Fromm G (1990) Bone diminution of osteoporotic females at different skeletal sites. Calcif Tissue Int. 46:217–221

    Article  CAS  PubMed  Google Scholar 

  43. Van Berkum FNR, Birkenhager JC, Van Veen LCP, Zeelenberg J, Birkenhäger-Fenkel DH, Troverbach WT, Stijnen T, Pols HAP (1989) Noninvasive axial and peripheral assessment of bone mineral content: a comparison between osteoporotic women and normal subjects. J Bone Miner Res. 4:679–685

    Article  PubMed  Google Scholar 

  44. Pouilles JM, Tremollieres F, Todorovsky N, Ribot C (1991) Precision and sensitivity of dual-energy X-ray absorptiometry in spinal osteoporosis. J Bone Miner Res. 9:997–1002

    Google Scholar 

  45. Pacifici R, Rupich R, Griffin M, Chines A, Susman N, Avioli LV (1990) Dual energy radiography versus quantitative computer tomography for the diagnosis of osteoporosis. J Clin Endocrinol Metab. 70:705–710

    Article  CAS  PubMed  Google Scholar 

  46. Ryan PJ, Blake GM, Fogelman I (1992) Fracture thresholds in osteoporosis: implications for hormone replacement treatment. Ann Rheum Dis. 51:1063–1065

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Griffin MG, Rupich RC, Avioli LV, Pacifici R (1991) A comparison of dual energy radiography measurements at the lumbar spine and proximal femur for the diagnosis of osteoporosis. J Clin Endocrinol Metab. 73:1164–1169

    Article  CAS  PubMed  Google Scholar 

  48. Overgaard K, Hansen MA, Riis BJ, Christiansen C (1992) Discriminatory ability of bone mass measurements (SPA and DEX A) for fractures in elderly postmenopausal women. Calcif Tissue Int. 50:30–35

    Article  CAS  PubMed  Google Scholar 

  49. Rico H, Revilla M, Hernandez ER, Villa LF, Alvarez del Buergo M (1992) Is pelvic bone mineral content assessed through dual energy X-ray absorptiometry an appropriate anatomical area for bone mass estimation in women? Clin Rheum. 11:508–511

    Article  CAS  Google Scholar 

  50. Aloia JF, McGowan D, Erens E, Miele G (1992) Hip fracture patients have generalized osteopenia with a preferential deficit in the femur. Osteoporosis Int. 2:88–93

    Article  CAS  Google Scholar 

  51. Duboeuf F, Brailion P, Chapuy MC, Haond P, Hardovin C, Meary MF, Delmas PD, Meunier PJ (1991) 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. 1:242–249

    Article  CAS  Google Scholar 

  52. Seldin DW, Esser PP, Alderson PO (1988) Comparison of bone density measurements from different skeletal sites. J Nucl Med. 29:168–173

    CAS  PubMed  Google Scholar 

  53. Lindsay R, Cosman F, Herrington BS, Himmelstein S (1992) Bone mass and body composition in normal women. J Bone Miner Res. 7:55–63

    Article  CAS  PubMed  Google Scholar 

  54. Lindsay R, Coutts JRT, Hart DM (1977) The effect of endogenous oestrogen on plasma and urinary calcium and phosphate in oophorectomized women. Clin Endocrinol (Oxf). 6:87–93

    Article  CAS  Google Scholar 

  55. Ribot C, Tremolleries F, Pouilles JM, Louvet JP, Guiraud R (1988) Influence of the menopause and aging on spinal density in French women. Bone Miner. 5:89–97

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Internal Medicine, Chair of Therapy, University of Siena, P.zza della Selva, 7, 53100, Siena, Italy

    Ranuccio Nuti, Giuseppe Martini & Carlo Gennari

Authors
  1. Ranuccio Nuti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Gennari
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nuti, R., Martini, G. & Gennari, C. Total Body, Spine, and Femur Dual X-ray Absorptiometry in Spinal Osteoporosis. Calcif Tissue Int 53, 388–393 (1993). https://doi.org/10.1007/BF03549781

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03549781

Keywords

Search

Navigation