Bone Density Measurement

Ultrasound and dual X-ray absorptiometry densitometry in women with hip fracture.

Address
Sección Osteopat57ias Médicas, Hospital de Clínicas, Buenos Aires, Argentina.

Abstract

To assess the usefulness of the measurement of the os calcis by ultrasound, a method that probably reflects bone quality as well as density, we have studied 54 women with hip fracture of the proximal femur and a control group. Ultrasound evaluation of the os calcis [broadband ultrasound attenuation (BUA), speed of the sound (SOS), and a combined index ("stiffness")], and bone mineral density (BMD) determination over the proximal femur by dual X-ray absorptiometry (DXA) were performed. Weight, BMD, and ultrasound values in the hip fracture patients were significantly lower than controls (P < 0.001). The Z-scores for BUA and stiffness were not different than that for femoral neck, Ward's triangle or trochanteric BMD (between -1.7 and -1.5). The odds ratios determined by receiver-operating characteristics (ROC) analysis were greater at the femoral neck (25.1) and BUA (24.4). Intermediate values were found at stiffness (16.9), Ward's triangle (12.8), and trochanter (11.1), and lower values were obtained at SOS (4.2). In turn, patients with trochanteric hip fractures had a significantly lower femoral neck and Ward's triangle BMD, stiffness, and BUA than patients with cervical hip fractures. Comparing a subgroup of 30 women with hip fractures without vertebral fractures with an age-matched group of 87 women with osteoporotic vertebral fractures, both groups were of similar weight and BMD but all ultrasound values were significantly lower in the hip fractures compared with vertebral fracture patients (P < 0.05 - P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH Heading
Adult
Aged
Aged, 80 and over
Aging
Body Weight
Bone Density
Female
Human
Middle Age
Sensitivity and Specificity
Support, Non-U.S. Gov't

Address
Department of Endocrine Research, Lilly Research Laboratories, Indianapolis, IN 46285, USA.

Abstract

Comparative analysis of dual energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) with phantoms and rat bones showed that both are necessary to adequately quantitate ovariectomy induced bone changes, in vivo. Precision and accuracy analysis of a Hologic QDR 1000/W and a Stratec 960 QCT showed that the latter is a highly precise, modestly accurate device that is more suited to the analysis of small bones. Specifically, smaller error was achieved by threshold optimization for the QCT in the analysis of phantoms 1.04-9.6 mm in diameter, with precision comparable to or better than DXA. Additionally, the QCT measured significant differences between groups in proximal tibiae when DXA could not; and measured a larger difference between sham and ovariectomized controls which was suitable for analysis of the dose dependent effects of a pharmacological test compound, raloxifene. This may reflect the ability of the QCT to measure volumetric mineral density (VMD, mg/cc), compared to two dimensional analyses by DXA. However, QCT was not able to analyze vertebrae in vivo, a site of considerable clinical interest. Therefore, DXA is useful to analyze the axial skeleton in vivo, while the appendicular skeleton is better analyzed in vivo by QCT. By both techniques, a similar dose response was observed for raloxifene, with ED50 = 0.3 mg/kg for both axial and appendicular skeleton. Comparative analysis of rat L1-4 by the Hologic QDR 1000/W and Lunar DPXL showed 12-14% higher BMD and BMC values for the Hologic, which is the opposite relationship between these instruments to that observed clinically for this site.

MeSH Heading (Major)
Bone and Bones [*RA]
Densitometry, X-Ray
Ovary [*PH]
Tomography, X-Ray Computed

MeSH Heading
Analysis of Variance
Animal
Bone Density [PH]
Evaluation Studies
Female
Ovariectomy
Phantoms, Imaging
Random Allocation
Rats
Rats, Sprague-Dawley
Reproducibility of Results

Technical considerations of dual-energy X-ray absorptiometry-based bone mineral measurements for pediatric studies.

Abstract

Dual X-ray absorptiometry (DXA) measurements have been shown to provide useful information on bone mineral status in young pediatric subjects. The purpose of this study was to challenge this system under various conditions to determine the clinical and experimental parameters that may be encountered which could interfere with DXA-based bone mineral content (BMC) and bone mineral density (BMD) measurements. Variations in data acquisition, including the covering of step phantom (external calibration standard) with a cotton blanket or partial exclusion of step phantom in the scan field, tissue freezing, or the presence of small nonmetallic objects, did not significantly alter DXA BMC or BMD measurements. By contrast, the presence of movement artifact, radiographic contrast media, and nonmetallic orthopedic casts significantly interfered with DXA BMC and BMC measurements. Variability in operator-dependent analysis of DXA scans occurred with regional analysis of whole body scans for DXA BMC and BMD measurements (average coefficient of variation was 2.9% and 1%, respectively, depending on the region analyzed) but did not affect the total (whole body) result. A minor adjustment in the manual delineation of the step phantom during data analysis may result in almost a 30% difference in DXA BMC and BMD. We conclude that movement artifact, radiographic contrast media, nonmetallic or orthopedic cast, and variations in operator-dependent data analysis may interfere with DXA BMC and BMD measurement in young pediatric subjects. Therefore, appropriate care should be taken to reduce or eliminate such interference.

MeSH Heading
Analysis of Variance
Animal
Animals, Newborn
Calibration
Human
Infant
Infant, Newborn
Linear Models
Movement
Phantoms, Imaging
Reference Standards
Reproducibility of Results
Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S.
Swine

Reliability of in vivo neutron activation analysis for measuring body composition: comparisons with tracer dilution and dual-energy x-ray absorptiometry [see comments]

Address
Department of Medicine, St. Lukes-Roosevelt Hospital, New York, NY 10025, USA.

Abstract

In vivo neutron activation (IVNA) analysis has the capacity to measure several total body elements in human subjects. Although it has been considered a criterion method for the past 3 decades, the reliability of IVNA analysis has been tested only in phantom calibrations. In 5 male weight-stable patients with AIDS, total body N, Ca, Cl, Na, P, and C were measured three times in 16 weeks at Brookhaven National Laboratory. With tracer dilution methods for total body water (TBW) by 3H2O and for extracellular water (ECW) by 35SO4 and NaBr, and dual-energy x-ray absorptiometry (DXA), total body calcium (TBCa) and fat percentage were measured within 2 weeks of IVNA measurements. For comparison, tracer dilution for TBW by D2O and ECW by NaBr, plus DXA measurements, were performed three times in 5 weight-stable healthy volunteers. The reliability of the IVNA technique was very high in patients with AIDS; it ranged from 0.99 for total body chloride (TBCI) to 0.84 for total body phosphorus (TBP), and it agreed with phantom calibration results in the literature. The reliability for measuring fat percentage and TBCa by DXA was similar in patients with AIDS and in healthy volunteers. Tracer dilution for measuring TBW by 3H2O in patients with AIDS and by D2O in healthy volunteers had a reliability score similar to those found with IVNA and DXA. The reliability scores for measuring ECW in patients with AIDS by 35SO4 and NaBr, 0.66 and 0.68, respectively, were the lowest among all measurements, whereas the reliability score for NaBr in healthy volunteers was 0.96, as with the other measurements.

MeSH Heading (Major)
Body Composition
Densitometry, X-Ray
Neutron Activation Analysis [*SN]
Radioisotope Dilution Technique

MeSH Heading
Acquired Immunodeficiency Syndrome
Adult
Body Water
Bromides [AN]
Calcium [AN]
Comparative Study
Deuterium
Extracellular Space
Human
Male
Sodium Compounds [AN]
Sulfates
Sulfur Radioisotopes [DU]
Support, U.S. Gov't, P.H.S.
Tritium

CAS Registry/EC Number
0 (Bromides)
0 (Sodium Compounds)
0 (Sulfates)
0 (Sulfur Radioisotopes)
10028-17-8 (Tritium)
7440-70-2 (Calcium)
7647-15-6 (sodium bromide)
7782-39-0 (Deuterium)

Abstract

Osteoporosis, an age-related condition, is classified into primary and secondary types. Primary osteoporosis encompasses the postmenopausal and senile types; secondary osteoporosis occurs "secondary" to endocrine and renal diseases. Subjects affected by osteoporosis have an overall reduced bone mass and become highly susceptible to bone fractures. Dual energy x-ray absorptiometry is the method most often used to determine the risk for osteoporotic fractures. In the past decade, a number of studies have suggested a possible correlation between systemic osteoporosis and alveolar bone loss in periodontal disease pathogenesis. It appears that a clear correlation between periodontal health and the general mineral status of the skeleton is still lacking. This review addresses the pathogenesis of osteoporosis and emphasizes the multifactorial nature of bone loss. The current concepts in alveolar bone loss resulting from osteoporosis and its implications as a risk factor in periodontal disease development are also presented.

MeSH Heading
Aged
Calcitriol [PH]
Cytokines [PH]
Female
Human
Male
Middle Age
Osteoporosis, Postmenopausal [CO]
Tooth Loss [ET]

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Figure 1. Example of a DXA image of the hip, including femoral neck.	Figure 2. Example of a DXA image of the lumbar spine.