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Patient variables impact lumbar spine dual energy X-ray absorptiometry precision

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Abstract

Introduction

Changes in bone mineral density are used to monitor osteoporosis therapy. To determine whether a change in bone mass is clinically significant, the precision of bone mineral density measurements must be known.

Methods

We therefore measured the impact of vertebral body exclusion on dual energy X-ray absorptiometry (DXA) precision. At one university and one Veterans Affairs DXA center, three radiology technologists each scanned 30 participants twice, with repositioning between scans, to estimate DXA precision. Three International Society for Clinical Densitometry-certified physicians reviewed all lumbar spinal scans to note the presence of focal structural defects. We calculated precision for subsets of vertebrae, and for virtual samples of patients with and without physician-identified vertebral focal structural defects. We graphed the reciprocal of least significant change versus bone area to determine the dependence of precision on interpreted scan area.

Results

Within each sample, greater interpretable bone area improved precision. The contribution of interpreted bone area to precision differed among the samples, ranging from 57 to 94%. Greater population bone mineral density heterogeneity and presence of focal structural defects each decreased precision.

Conclusion

All bone densitometry centers must determine precision using a sample representative of their served populations. Failure to do so may lead to incorrect determination of least significant change. Population heterogeneity, vertebral body exclusion and presence of focal structural defects each decreases precision.

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Acknowledgements

We thank Jeff Franz for providing us documentation regarding the design of the GE LUNAR database and assistance with conversion of dates from the OLE auto format. RDB gratefully acknowledges support provided by DAMD17-00-1-0071. The US Army Medical Research and Materiel Command, Ft. Detrick, MD, is the awarding and administering acquisition office. The views expressed do not necessarily reflect the position or policy of the US government and no official endorsement should be inferred. This material is based upon work supported in part by the Office of Research and Development, Medical Research Service, Department of Veterans Affairs (VA Merit Award) and was conducted in the Geriatrics, Research, Education and Clinical Center at the William S. Middleton Veterans’ Hospital. This paper is Madison GRECC manuscript 2005-004. KEH gratefully acknowledges support provided by the National Institutes of Health, award K23 AR050995-01. MKD gratefully acknowledges support provided by the National Institutes of Health, awards R01-AR27032-24 and R01-DK65830-01. Funding agencies played no role in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. None of the authors has a conflict of interest bearing on the work reported here. RDB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Osteoporosis Clinical Center and Research Program, University of Wisconsin, Madison, WI, USA

    R. D. Blank, D. G. Malone, R. C. Christian, N. L. Vallarta-Ast, D. C. Krueger, M. K. Drezner, N. C. Binkley & K. E. Hansen

  2. Endocrinology, Diabetes and Metabolism Section, Department of Medicine, University of Wisconsin, Madison, WI, USA

    R. D. Blank, R. C. Christian, M. K. Drezner, N. C. Binkley & K. E. Hansen

  3. GRECC, William S. Middleton Veterans Hospital, Madison, WI, USA

    R. D. Blank & M. K. Drezner

  4. Rheumatology Section, Department of Medicine, University of Wisconsin, Madison, WI, USA

    D. G. Malone & K. E. Hansen

  5. Department of Radiology, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

    N. L. Vallarta-Ast

  6. Geriatrics Section, Department of Medicine, University of Wisconsin, Madison, WI, USA

    N. C. Binkley

Authors
  1. R. D. Blank
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  2. D. G. Malone
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  3. R. C. Christian
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  4. N. L. Vallarta-Ast
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  5. D. C. Krueger
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  6. M. K. Drezner
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  7. N. C. Binkley
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  8. K. E. Hansen
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Corresponding author

Correspondence to R. D. Blank.

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Blank, R.D., Malone, D.G., Christian, R.C. et al. Patient variables impact lumbar spine dual energy X-ray absorptiometry precision. Osteoporos Int 17, 768–774 (2006). https://doi.org/10.1007/s00198-005-0050-5

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  • DOI: https://doi.org/10.1007/s00198-005-0050-5

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