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The Clinical Role of Bone Density Scans in the Diagnosis and Treatment of Osteoporosis

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Osteoporosis

Part of the book series: Contemporary Endocrinology ((COE))

Summary

Dual energy X-ray absorptiometry (DXA) measurements of hip and spine bone mineral density (BMD) have an important role in the evaluation of individuals at risk of osteoporosis and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organisation (WHO) T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies and the ability to monitor response to treatment. This chapter discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.

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References

  1. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761–1767.

    Article  PubMed  Google Scholar 

  2. Bone health and osteoporosis: a report of the Surgeon General. Issued October 2004. Available online at http://www.surgeongeneral.gov/library/bonehealth.

  3. Kanis JA, Black D, Cooper C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 2002;13:527–536.

    Article  CAS  PubMed  Google Scholar 

  4. Ray NF, Chan JK, Thamer M, Melton LJ. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997:12:24–35.

    Article  CAS  PubMed  Google Scholar 

  5. Melton LJ, Gabriel SE, Crowson CS, Tostesen ANA, Johnell O, Kanis JA. Cost-equivalence of different osteoporotic fractures. Osteoporos Int 2003;14:383–388.

    Article  PubMed  Google Scholar 

  6. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon M, Melton LJ. Population based study of survival after osteoporotic fractures. Am J Epidemiol 1993;137:1001–1005.

    CAS  PubMed  Google Scholar 

  7. Centre JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fractures in men and women: an observational study. Lancet 1999;353:878–882.

    Article  Google Scholar 

  8. Genant HK, Engelke K, Fuerst T, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 1996;11:707–730.

    Article  CAS  PubMed  Google Scholar 

  9. Storm T, Thamsborg G, Steiniche T, Genant HK, Sorensen OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 1990;322:1265–1271.

    Article  CAS  PubMed  Google Scholar 

  10. WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: technical report series 843. Geneva: WHO, 1994.

    Google Scholar 

  11. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of the effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996;348:1535–1541.

    Article  CAS  PubMed  Google Scholar 

  12. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998;280:2077–2082.

    Article  CAS  PubMed  Google Scholar 

  13. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis. JAMA 1999;282:1344–1352.

    Article  CAS  PubMed  Google Scholar 

  14. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate treatment on hip fracture risk in elderly women. N Engl J Med 2001;344:333–340.

    Article  CAS  PubMed  Google Scholar 

  15. Chesnut CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004;19:1241–1249.

    Article  CAS  Google Scholar 

  16. Black DM, Boonen S, Cauley J, et al. Effect of once-yearly infusion of zolendronic acid 5 mg on spine and hip fracture reduction in postmenopausal women with osteoporosis: the HORIZON pivotal fracture trial. J Bone Miner Res 2006;21(Suppl 1):S16.

    Google Scholar 

  17. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomised clinical trial. JAMA 1999;282:637–645.

    Article  CAS  PubMed  Google Scholar 

  18. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1–34) fragment on spine and non-spine fractures and bone mineral density in postmenopausal osteoporosis. N Engl J Med 2001;344:1434–1441.

    Article  CAS  PubMed  Google Scholar 

  19. Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004;350:459–468.

    Article  CAS  PubMed  Google Scholar 

  20. Reginster JY, Seeman E, De Vernejoul MC, et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: TROPOS study. J Clin Endocrinol Metab 2005;90:2816–2822.

    Article  CAS  PubMed  Google Scholar 

  21. Seeman E, Vellas B, Benhamou C, et al. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res 2006;21:1113–1120.

    Article  CAS  PubMed  Google Scholar 

  22. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D, On behalf of the European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and treatment of osteoporosis. Osteoporos Int 1997;7:390–406.

    Article  CAS  PubMed  Google Scholar 

  23. Anon. Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporos Int 1998;8(Suppl 4):S7–S80.

    Google Scholar 

  24. Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporos Int 1999;10:259–264.

    Article  CAS  PubMed  Google Scholar 

  25. Kanis JA, Gluer CC, For the Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 2000;11: 192–202.

    Article  CAS  PubMed  Google Scholar 

  26. Official positions of the International Society for Clinical Densitometry: updated 2005. Available online at http://www.iscd.org/visitors/positions/official.cfm.

  27. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254–1259.

    CAS  PubMed  Google Scholar 

  28. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005;20:1185–1194.

    Article  PubMed  Google Scholar 

  29. Stone KL, Seeley DG, Lui L-Y, 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;18:1947–1954.

    Article  PubMed  Google Scholar 

  30. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med 1998;338:736–746.

    Article  CAS  PubMed  Google Scholar 

  31. Gluer C-C. Monitoring skeletal change by radiological techniques. J Bone Miner Res 1999;14:1952–1962.

    Article  CAS  PubMed  Google Scholar 

  32. Fogeman I, Blake GM. Different approaches to bone densitometry. J Nucl Med 2000;41:2015–2025.

    Google Scholar 

  33. Guglielmi G, Lang TF. Quantitative computed tomography. Semin Musculoskelet Radiol 2002;6:219–227.

    Article  PubMed  Google Scholar 

  34. Lang TF, Guglielmi G, Van Kuijk C, De Serio A, Cammisa M, Genant HK. Measurement of vertebral bone mineral density at the spine and proximal femur by volumetric quantitative computed tomograph and dual-energy X-ray absorptiometry in elderly women with and without vertebral fractures. Bone 2002;30:247–250.

    Article  CAS  PubMed  Google Scholar 

  35. Blake GM, Fogelman I. Clinical use of instruments that measure peripheral bone mass. Curr Opin Endocrinol Diab 2002;9:502–511.

    Article  Google Scholar 

  36. Stewart A, Reid DM. Quantitative ultrasound in osteoporosis. Semin Musculoskelet Radiol 2002;6:229–232.

    Article  PubMed  Google Scholar 

  37. Lu Y, Genant HK, Shepherd J, et al. Classification of osteoporosis based on bone mineral densities. J Bone Miner Res 2001;16:901–910.

    Article  CAS  PubMed  Google Scholar 

  38. Faulkner KG, Von Stetton E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom 1999;2:343–350.

    Article  CAS  PubMed  Google Scholar 

  39. Blake GM, Fogelman I. Peripheral or central densitometry: does it matter which technique we use? J Clin Densitom 2001;4:83–96.

    Article  CAS  PubMed  Google Scholar 

  40. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998;8:468–489.

    Article  CAS  PubMed  Google Scholar 

  41. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. Lancet 1993;341:72–75.

    Article  CAS  PubMed  Google Scholar 

  42. Black DM, Palermo L, Bauer D. How well does bone mass predict long-term risk of hip fracture? Osteoporosis Int 2000;11(Suppl 2):S59.

    Google Scholar 

  43. Orwoll ES, Marshall LM, Chan BK, et al. Measures of hip structure are important determinants of hip fracture risk independent of BMD. J Bone Miner Res 2006;20(Suppl 1):S35.

    Google Scholar 

  44. Hans D, Dargent-Molina P, Schott AM, et al. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996;348:511–514.

    Article  CAS  PubMed  Google Scholar 

  45. Bauer DC, Gluer C-C, Cauley JA, et al. Broadband ultrasonic attenuation predicts fractures strongly and independently of densitometry in older women. Arch Intern Med 1997;157:629–634.

    Article  CAS  PubMed  Google Scholar 

  46. Pluijm SMF, Graafmans WC, Bouter LM, Lips P. Ultrasound measurements for the prediction of osteoporotic fractures in elderly people. Osteoporos Int 1999;9:550–556.

    Article  CAS  PubMed  Google Scholar 

  47. Woodhouse A, Black DM. BMD at various sites for the prediction of hip fracture: a meta-analysis. J Bone Miner Res 2000;15(Suppl 2):S145.

    Google Scholar 

  48. Bauer DC, Palermo L, Black DM, Hillier TA, Cauley JA. A prospective study of dry calcaneal quantitative ultrasound and fracture risk in older women: the Study of Osteoporotic Fractures. J Bone Miner Res 2001;16(Suppl 1):S166.

    Google Scholar 

  49. Miller PD, Siris ES, Barrett-Connor E, et al. Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 2002;17:2222–2230.

    Article  PubMed  Google Scholar 

  50. Hans D, Schott A-M, Duboeuf F, Durosier C, Meunier PJ. Does follow-up duration influence the ultrasound and DXA prediction of hip fracture? The EPIDOS prospective study. Bone 2004;35:357–363.

    Article  CAS  PubMed  Google Scholar 

  51. Durosier C, Hans D, Kreig M-A, Schott A-M. Prediction and discrimination of osteoporotic hip fracture in postmenopausal women. J Clin Densitom 2006;9:475–495.

    Article  PubMed  Google Scholar 

  52. Barr RJ, Adebajo A, Fraser WD, et al. Can peripheral DXA measurements be used to predict fractures in elderly women living in the community? Osteoporos Int 2005;16:1177–1183.

    Article  CAS  PubMed  Google Scholar 

  53. Delmas PD. How does antiresorptive therapy decrease the risk of fracture in women with osteoporosis? Bone 2000:27;1–3.

    Article  PubMed  Google Scholar 

  54. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001;285:320–323.

    Article  CAS  PubMed  Google Scholar 

  55. Melton L, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int 1999;10:214–221.

    Article  PubMed  Google Scholar 

  56. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137–1148.

    Article  CAS  PubMed  Google Scholar 

  57. Rea JA, Li J, Blake GM, et al. Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 2000;11:660–668.

    Article  CAS  PubMed  Google Scholar 

  58. Rea JA, Chen MB, Li J, et al. Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 2000;15:564–574.

    Article  CAS  PubMed  Google Scholar 

  59. Faulkner KG, Roberts LA, McClung MR. Discrepancies in normative data between Lunar and Hologic DXA systems. Osteoporosis Int 1996;6:432–436.

    Article  CAS  Google Scholar 

  60. Hanson J. Standardization of femur BMD. J Bone Miner Res 1997;12:1316–1317.

    Article  CAS  PubMed  Google Scholar 

  61. Blake GM, Chinn DJ, Steel SA, et al. A list of device specific thresholds for the clinical interpretation of peripheral X-ray absorptiometry examinations. Osteoporos Int 2005;16:2149–2156.

    Article  CAS  PubMed  Google Scholar 

  62. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359:1929–1936.

    Article  PubMed  Google Scholar 

  63. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int 2005;16:581–589.

    Article  PubMed  Google Scholar 

  64. De Laet C, Oden A, Johansson H, Johnell O, Jonsson B, Kanis JA. The impact of the use of multiple risk factors for fracture on case-finding strategies: a mathematical approach. Osteoporos Int 2005;16:313–318.

    Article  PubMed  Google Scholar 

  65. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001;12:989–995.

    Article  CAS  PubMed  Google Scholar 

  66. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004;35:375–382.

    Article  CAS  PubMed  Google Scholar 

  67. Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 2004;19:893–899.

    Article  PubMed  Google Scholar 

  68. Kanis JA, Johansson H, Oden A, et al. A family history of fracture and fracture risk: a meta-analysis. Bone 2004;35:1029–1037.

    Article  CAS  PubMed  Google Scholar 

  69. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int 2005;16:155–162.

    Article  CAS  PubMed  Google Scholar 

  70. Kanis JA, Johansson H, Johnell O, et al. Alcohol intake as a risk factor for fracture. Osteoporos Int 2005;16:737–742.

    Article  PubMed  Google Scholar 

  71. De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 2005;16:1330–1338.

    Article  PubMed  Google Scholar 

  72. Kanis JA, Johnell O, Oden A, et al. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int 2006;17:527–534.

    Article  CAS  PubMed  Google Scholar 

  73. Blake GM, Patel R, Knapp KM, Fogelman I. Does the combination of two BMD measurements improve fracture discrimination? J Bone Miner Res 2003;18:1955–1963.

    Article  PubMed  Google Scholar 

  74. Johansson H, Oden A, Johnell O, et al. Optimisation of BMD measurements to identify high risk groups for treatment – a test analysis. J Bone Miner Res 2004;19:906–913.

    Article  PubMed  Google Scholar 

  75. Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A. The burden of osteoporotic fractures: a method of setting intervention thresholds. Osteoporos Int 2001;12:417–427.

    Article  CAS  PubMed  Google Scholar 

  76. Borgstrom F, Johnell O, Kanis JA, et al. At what hip fracture risk is it cost effective to treat? International intervention thresholds for the treatment of osteoporosis. Osteoporos Int 2006;17:1459–1471.

    Article  CAS  PubMed  Google Scholar 

  77. Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jonsson B. Intervention thresholds for osteoporosis in the UK. Bone 2005;36:22–32.

    Article  PubMed  Google Scholar 

  78. Zethraeus N, Borgstrom F, Strom O, Kanis JA. Cost-effectiveness of the treatment and prevention of osteoporosis – a review of the literature and a reference model. Osteoporos Int 2007;18:9–23.

    Article  CAS  PubMed  Google Scholar 

  79. Kanis JA, Borgstrom F, Johnell O, Oden A, Sykes D, Jonsson B. 2005 Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 16:15–25.

    Article  CAS  PubMed  Google Scholar 

  80. Borgstrom F, Carisson A, Sintonen H, et al. Cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective. Osteoporos Int 2006;17:996–1007.

    Article  CAS  PubMed  Google Scholar 

  81. Borgstrom F, Jonsson B, Strom O, Kanis JA. An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting based on the results of the SOTI and TROPOS trials. Osteoporos Int 2006;17:1781–1793.

    Article  CAS  PubMed  Google Scholar 

  82. Patel R, Blake GM, Rymer J, Fogelman I. Long-term precision of DXA scanning assessed over seven years in forty postmenopausal women. Osteoporos Int 2000;11;68–75.

    Article  PubMed  Google Scholar 

  83. Faulkner KG. Bone densitometry: choosing the proper site to measure. J Clin Densitom 1998;1:279–285.

    Article  CAS  PubMed  Google Scholar 

  84. Blake GM, Herd RJM, Fogelman I. A longitudinal study of supine lateral DXA of the lumbar spine: a comparison with posteroanterior spine, hip and total body DXA. Osteoporos Int 1996;6:462–470.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Imaging Sciences, King’s College London Osteoporosis Unit, Guy’s Hospital, London, UK

    Glen M. Blake PhD

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  1. Glen M. Blake PhD
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  1. Section of Endocrinology, McGuire Veterans Affairs Medical Center, Broad Rock Blvd. 1201, Richmond, 23249, U.S.A.

    Robert A. Adler

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Blake, G.M. (2010). The Clinical Role of Bone Density Scans in the Diagnosis and Treatment of Osteoporosis. In: Adler, R. (eds) Osteoporosis. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-459-9_4

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  • DOI: https://doi.org/10.1007/978-1-59745-459-9_4

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