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Adjustment of DXA BMD measurements for anthropometric factors and its impact on the diagnosis of osteoporosis

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Abstract

Summary

We compared the effect of anthropometric factors on osteoporosis diagnosis by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA) and found QCT spine volumetric bone mineral density (vBMD) was not associated with body weight, body mass index (BMI) or DXA anteroposterior spine thickness. In contrast, DXA spine and hip areal bone mineral density (aBMD) were strongly associated with all three factors. Adjustment of DXA aBMD measurements improved consistency with QCT vBMD.

Purpose

Although the diagnosis of osteoporosis using DXA T scores preferentially targets patients with BMI, there is evidence that obesity is not protective against fractures. The aim of this study was to compare the effect of anthropometric factors on osteoporosis diagnosis by QCT and DXA and investigate whether adjustment of DXA aBMD can achieve a more even distribution of diagnoses between slimmer and heavier individuals consistent with QCT.

Methods

The participants were 964 men and 682 women referred for low-dose chest CT and DXA examinations as part of their employers’ health check-up programs. QCT vBMD was measured in the L1–L2 vertebrae and DXA aBMD in the spine and hip. The prevalence of osteoporosis in each tertile of BMI in participants aged > 50 years was evaluated based on their QCT and DXA findings, and then re-evaluated after adjustment to the mean BMI in each sex. Similar investigations were performed for body weight and DXA anteroposterior (AP) spine thickness. The effect of the adjustment of DXA aBMD for anthropometric factors on the correlation with QCT vBMD was also examined.

Results

For spine QCT, correlations of age adjusted vBMD residuals against BMI were not statistically significant in men (P = 0.44) or women (P = 0.32). In contrast, slopes for aBMD residuals were all highly statistically significant (P < 0.001). There were similar findings for weight and AP spine thickness. Adjustment of DXA aBMD for anthropometric factors resulted in a more equal spread of diagnoses of osteoporosis and greater consistency with QCT.

Conclusion

Our study highlights differences between DXA and QCT in their correlation with anthropometric factors and its effect on the diagnosis of osteoporosis. Adjustment of DXA T scores for anthropometric factors gave greater consistency with QCT vBMD. Further studies are required into whether adjusting DXA aBMD for anthropometric factors has a beneficial impact on the discriminative or predictive power for vertebral fracture.

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Data availability

Data and material in this article are available by reasonable requests from the corresponding author.

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Funding

XGC received financial support from the Beijing Bureau of Health 215 program (grant number: 2009-2-03) and Beijing Natural Science Foundation project: 17L20188, the National Natural Science Foundation of China (Grant no. 81901718; 81771831). GMB acknowledges financial support from the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z].

Author information

Author notes

  1. Ling Wang, Limei Ran and Xiaojuan Zha contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China

    Ling Wang, Yandong Liu & Xiaoguang Cheng

  2. Department of Health Management, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China

    Limei Ran & Qing Shuang

  3. Department of Health Management, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, China

    Xiaojuan Zha & Yingying Yang

  4. Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Beijing, 100035, China

    Kaiping Zhao

  5. Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK

    Karen Hind

  6. School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK

    Glen M. Blake

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  1. Ling Wang
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Contributions

All authors contributed to the article and signed the authorship form affirming.

Corresponding author

Correspondence to Xiaoguang Cheng.

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The study was approved by the ethics committee of Beijing Jishuitan hospital.

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Each participant in the study gave written informed consent for their data to be used.

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Mindways QCT Pro and GE Lunar DXA were used in this study.

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Wang, L., Ran, L., Zha, X. et al. Adjustment of DXA BMD measurements for anthropometric factors and its impact on the diagnosis of osteoporosis. Arch Osteoporos 15, 155 (2020). https://doi.org/10.1007/s11657-020-00833-1

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