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The effect of patient positioning on measurements of bone mineral density of the proximal femur: a simulation study using computed tomographic images

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Abstract

Summary

The patient’s position may affect the bone mineral density (BMD) measurements; however, the extent of this effect is undefined. This CT image-based simulation study quantified changes in BMD induced by hip flexion, adduction, and rotations to recommend appropriate patient positioning when acquiring dual-energy x-ray absorptiometry images.

Purpose

Several studies have analyzed the effect of hip rotation on the measurement of bone mineral density (BMD) of the proximal femur by dual-energy x-ray absorptiometry (DXA). However, as the effects of hip flexion and abduction on BMD measurements remain uncertain, a computational simulation study using CT images was performed in this study.

Methods

Hip CT images of 120 patients (33 men and 87 women; mean age, 82.1 ± 9.4 years) were used for analysis. Digitally reconstructed radiographs of the proximal femur region were generated from CT images to calculate the BMD of the proximal femur region. BMD at the neutral position was quantified, and the percent changes in BMD when hip internal rotation was altered from −30° to 15°, when hip flexion was altered from 0° to 30°, and when hip abduction was altered from –15° to 30° were quantified. Analyses were automatically performed with a 1° increment in each direction using computer programming.

Results

The alteration of hip angles in each direction affected BMD measurements, with the largest changes found for hip flexion (maximum change of 17.7% at 30° flexion) and the smallest changes found for hip rotation (maximum change of 2.2% at 15° internal rotation). The BMD measurements increased by 0.34% for each 1° of hip abduction, and the maximum change was 12.3% at 30° abduction.

Conclusion

This simulation study quantified the amount of BMD change induced by altering the hip position. Based on these results, we recommend that patients be positioned carefully when acquiring DXA images.

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Data availability

Data used for this study can be made available by submitting on reasonable request to the corresponding author. Codes and models used in this study are available at https://github.com/keisuke-uemura/proximal_femur_BMD_measurement.

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Acknowledgements

We thank Dr. Tatsuya Kitaura for his help in the acquisition of data.

Funding

This study was supported by the Japan Osteoporosis Foundation Grant for Bone Research and the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (KAKENHI) (grant numbers 19H01176, 20H04550, and 21K16655).

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Authors and Affiliations

  1. Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Keisuke Uemura, Masaki Takao & Kazuma Takashima

  2. Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan

    Yoshito Otake & Yoshinobu Sato

  3. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Hidetoshi Hamada, Wataru Ando & Nobuhiko Sugano

Authors
  1. Keisuke Uemura
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  2. Masaki Takao
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  8. Nobuhiko Sugano
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Contributions

Keisuke Uemura: conceptualization, methodology, code writing, validation, formal analysis, data curation, writing–original draft and review and editing, visualization, funding acquisition. Masaki Takao: writing–review and editing, supervision. Yoshito Otake: resources, methodology, writing–review and editing, supervision, funding acquisition. Kazuma Takashima: writing–review and editing. Hidetoshi Hamada: writing–review and editing. Wataru Ando: writing–review and editing. Yoshinobu Sato: resources, writing–review and editing, supervision, funding acquisition. Nobuhiko Sugano: writing–review and editing, supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Keisuke Uemura.

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Ethical approval

All procedures performed in this study were performed according to the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

This study was approved by the Institutional Review Board of each participating institution, and informed consent was obtained from all patients in the form of opt-out.

Conflicts of interest

None.

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Uemura, K., Takao, M., Otake, Y. et al. The effect of patient positioning on measurements of bone mineral density of the proximal femur: a simulation study using computed tomographic images. Arch Osteoporos 18, 35 (2023). https://doi.org/10.1007/s11657-023-01225-x

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