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Skeletal Radiology

, Volume 47, Issue 8, pp 1111–1117 | Cite as

Peripheral DXA measurement around ankle joint to diagnose osteoporosis as assessed by central DXA measurement

  • Ki Hyuk Sung
  • Young Choi
  • Gyeong Hee Cho
  • Chin Youb Chung
  • Moon Seok ParkEmail author
  • Kyoung Min Lee
Scientific Article

Abstract

Objective

This study evaluated the correlation between central and peripheral bone mineral density (BMD) of the ankle joint, using dual-energy X-ray absorptiometry (DXA). We also investigated whether peripheral ankle BMD could be used to identify individuals who were diagnosed with osteoporosis, using central DXA.

Methods

We recruited 134 volunteers aged 20–90 years who agreed to participate in this study. Central BMD of the lumbar spine and left femur, and peripheral BMD of the medial malleolus, distal tibia, lateral malleolus, and talus were measured with DXA.

Results

Among the peripheral sites of the ankle, the highest and lowest BMD were observed in the talus and lateral malleolus, respectively. All peripheral DXA measurements of the ankle joint were significantly correlated with central DXA measurements. There was a good correlation (r: 0.656–0.725) between peripheral and central BMD for the older age group (> 50 years), but fair-to-good correlation (r: 0.263–0.654) for the younger age group (< 50 years). The cut-off values for peripheral BMD of the ankle joint between osteoporosis and non-osteoporosis were 0.548 g/cm2 (sensitivity, 89.0%; specificity, 69.0%) for the medial malleolus, 0.626 g/cm2 (sensitivity, 83.3%; specificity, 82.8%) for the distal tibia, 0.47 g/cm2 (sensitivity, 100.0%; specificity, 65.5%) for the lateral malleolus, and 0.973 g/cm2 (sensitivity, 72.2%; specificity, 83.6%) for the talus (p < 0.001).

Conclusions

This study showed good correlation between peripheral BMD around ankle joint and central BMD for older age group. Further study is required to use the ankle DXA as a valid clinical tool for the diagnosis of osteoporosis and fracture risk assessment.

Keywords

Osteoporosis Bone mineral density Dual-energy X-ray absorptiometry Peripheral Central Ankle joint 

Notes

Funding

This study was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (2017M3A9D8064200) and by SNUBH research fund (grant no. 13-2014-007).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

256_2018_2876_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)

References

  1. 1.
    Patel R, Blake GM, Fogelman I. Peripheral and central measurements of bone mineral density are equally strongly associated with clinical risk factors for osteoporosis. Calcif Tissue Int. 2007;80(2):89–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Caliri A, De Filippis L, Bagnato GL, Bagnato GF. Osteoporotic fractures: mortality and quality of life. Panminerva Med. 2007;49(1):21–7.PubMedGoogle Scholar
  3. 3.
    Boonen S, Singer AJ. Osteoporosis management: impact of fracture type on cost and quality of life in patients at risk for fracture I. Curr Med Res Opin. 2008;24(6):1781–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006;194(2 Suppl):S3–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Hans DB, Shepherd JA, Schwartz EN, Reid DM, Blake GM, Fordham JN, et al. Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD official positions. J Clin Densitom. 2008;11(1):188–206.CrossRefPubMedGoogle Scholar
  6. 6.
    Miller PD, Njeh CF, Jankowski LG, Lenchik L. International Society for Clinical Densitometry Position Development P, scientific advisory C. What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis? J Clin Densitom. 2002;5(Suppl):S39–45.CrossRefPubMedGoogle Scholar
  7. 7.
    Pacheco EM, Harrison EJ, Ward KA, Lunt M, Adams JE. Detection of osteoporosis by dual energy X-ray absorptiometry (DXA) of the calcaneus: is the WHO criterion applicable? Calcif Tissue Int. 2002;70(6):475–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Picard D, Brown JP, Rosenthall L, Couturier M, Levesque J, Dumont M, et al. Ability of peripheral DXA measurement to diagnose osteoporosis as assessed by central DXA measurement. J Clin Densitom. 2004;7(1):111–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Kung AW, Wu CH, Itabashi A, Lee JK, Park HM, Zhao Y, et al. International Society for Clinical Densitometry official positions: Asia-Pacific region consensus. J Clin Densitom. 2010;13(4):346–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Greenfield DM, Eastell R. Risk factors for ankle fracture. Osteoporos Int. 2001;12(2):97–103.CrossRefPubMedGoogle Scholar
  11. 11.
    Ingle BM, Eastell R. Site-specific bone measurements in patients with ankle fracture. Osteoporos Int. 2002;13(4):342–7.CrossRefPubMedGoogle Scholar
  12. 12.
    McLellan AR, Gallacher SJ, Fraser M, McQuillian C. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int. 2003;14(12):1028–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee KM, Chung CY, Kwon SS, Won SH, Lee SY, Chung MK, et al. Ankle fractures have features of an osteoporotic fracture. Osteoporos Int. 2013;24(11):2819–25.CrossRefPubMedGoogle Scholar
  14. 14.
    Biver E, Durosier C, Chevalley T, Herrmann FR, Ferrari S, Rizzoli R. Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations. Osteoporos Int. 2015;26(8):2147–55.CrossRefPubMedGoogle Scholar
  15. 15.
    Yoo JH, Moon SH, Ha YC, Lee DY, Gong HS, Park SY, et al. Osteoporotic fracture: 2015 position statement of the Korean Society for Bone and Mineral Research. J Bone Metab. 2015;22(4):175–81.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren–Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016;474(8):1886–93.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    osteoporosis TWsgo. Assessment of fracture risk and its application to screening for post-menopausal osteoporosis. Geneva: World Health Organization; 1994.Google Scholar
  18. 18.
    Mulder JE, Michaeli D, Flaster ER, Siris E. Comparison of bone mineral density of the phalanges, lumbar spine, hip, and forearm for the assessment of osteoporosis in postmenopausal women. J Clin Densitom. 2000;3(4):373–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Tenne M, McGuigan F, Besjakov J, Gerdhem P, Akesson K. Degenerative changes at the lumbar spine—implications for bone mineral density measurement in elderly women. Osteoporos Int. 2013;24(4):1419–28.CrossRefPubMedGoogle Scholar
  20. 20.
    Grams AE, Rehwald R, Bartsch A, Honold S, Freyschlag CF, Knoflach M, et al. Correlation between degenerative spine disease and bone marrow density: a retrospective investigation. BMC Med Imaging. 2016;16:17.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Oh JH, Song BW, Lee YS. Measurement of volumetric bone mineral density in proximal humerus using quantitative computed tomography in patients with unilateral rotator cuff tear. J Shoulder Elb Surg. 2014;23(7):993–1002.CrossRefGoogle Scholar
  22. 22.
    Lee SY, Kwon SS, Kim HS, Yoo JH, Kim J, Kim JY, et al. Reliability and validity of lower extremity computed tomography as a screening tool for osteoporosis. Osteoporos Int. 2015;26(4):1387–94.CrossRefPubMedGoogle Scholar
  23. 23.
    Melton LJ 3rd, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. 1998;13(12):1915–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Nyquist F, Gardsell P, Sernbo I, Jeppsson JO, Johnell O. Assessment of sex hormones and bone mineral density in relation to occurrence of fracture in men: a prospective population-based study. Bone. 1998;22(2):147–51.CrossRefPubMedGoogle Scholar
  25. 25.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001;286(22):2815–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Cheng S, Suominen H, Sakari-Rantala R, Laukkanen P, Avikainen V, Heikkinen E. Calcaneal bone mineral density predicts fracture occurrence: a five-year follow-up study in elderly people. J Bone Miner Res. 1997;12(7):1075–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. 2003;18(11):1947–54.CrossRefPubMedGoogle Scholar
  28. 28.
    Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am. 2003;85-A(5):820–4.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Ki Hyuk Sung
    • 1
  • Young Choi
    • 2
  • Gyeong Hee Cho
    • 1
  • Chin Youb Chung
    • 1
  • Moon Seok Park
    • 1
    Email author
  • Kyoung Min Lee
    • 1
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnamSouth Korea
  2. 2.Department of Orthopaedic SurgeryKosin University Gaspel HospitalBusanSouth Korea

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