Differences in Precision in Bone Mineral Density Measured by SXA and DXA: the NOREPOS Study

Overview

Journal Eur J Epidemiol

Specialty Public Health

Date 2008 Jul 3

PMID 18594994

Citations 12

Authors

Lisa Forsen

Gro K Rosvold Berntsen

Haakon E Meyer

Grethe S Tell

Vinjar Fonnebo

Affiliations

Soon will be listed here.

Abstract

The aims were to compare the precision (reliability) in single X-ray (SXA) and dual X-ray (DXA) absorptiometry, and to compare smallest detectable difference (SDD). An additional aim was to examine determinants for precision in bone mineral density (BMD). BMD was measured by SXA (DTX-100, Osteometer) in the forearm and by DXA (Lunar Expert) in the forearm and in the hip. Two measurements were performed at each site/method, and 195 of 207 participants had complete datasets. Participants were aged 47-49 and 71-74 years. The precision was estimated by Root Mean Square Standard Deviation (RMS SD) with 95% Confidence Interval (95%CI) and the corresponding coefficients of variation (CV%). Determinants (age, gender, BMD) were analysed by multiple linear regression with log (SD) and log (CV) as dependent variables. RMS SD tended to be largest in older women and in those with low BMD. RMS SD for SXA and DXA forearm was 4.6 (4.2-5.1) and 6.8 (6.1-7.4) and the corresponding CVs 1.0% and 1.4%. RMS SD for DXA hip was 11.0 (9.9-12.0) with CV 1.2%. To detect a 3% change in BMD one would need two repeated measurements by DXA in the distal forearm at each of two consultations, but only one measurement by SXA in the distal forearm and also only one measurement by DXA in the hip. Precision differed by type of densitometer affecting the number of repeated measurements needed to detect a given BMD difference.

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References

Meyer H, Berntsen G, Sogaard A, Langhammer A, Schei B, Fonnebo V . Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol. 2004; 160(11):1039-46. DOI: 10.1093/aje/kwh337. View

Alver K, Meyer H, Falch J, Sogaard A . Bone mineral density in ethnic Norwegians and Pakistani immigrants living in Oslo--The Oslo Health Study. Osteoporos Int. 2004; 16(6):623-30. DOI: 10.1007/s00198-004-1722-2. View

Sievanen H, Backstrom M, Kuusela A, Ikonen R, Maki M . Dual energy x-ray absorptiometry of the forearm in preterm and term infants: evaluation of the methodology. Pediatr Res. 1999; 45(1):100-5. DOI: 10.1203/00006450-199901000-00017. View

Baim S, Wilson C, Lewiecki E, Luckey M, Downs Jr R, Lentle B . Precision assessment and radiation safety for dual-energy X-ray absorptiometry: position paper of the International Society for Clinical Densitometry. J Clin Densitom. 2005; 8(4):371-8. DOI: 10.1385/jcd:8:4:371. View

Faulkner K, McClung M . Quality control of DXA instruments in multicenter trials. Osteoporos Int. 1995; 5(4):218-27. DOI: 10.1007/BF01774010. View

Sievanen H, Kannus P, Oja P, Vuori I . Precision of dual energy x-ray absorptiometry in the upper extremities. Bone Miner. 1993; 20(3):235-43. DOI: 10.1016/s0169-6009(08)80004-9. View

Eckert P, Casez J, Thiebaud D, Schnyder P, Burckhardt P . Bone densitometry of the forearm: comparison of single-photon and dual-energy X-ray absorptiometry. Bone. 1996; 18(6):575-9. DOI: 10.1016/8756-3282(96)00082-8. View

Sievanen H, Oja P, Vuori I . Precision of dual-energy x-ray absorptiometry in determining bone mineral density and content of various skeletal sites. J Nucl Med. 1992; 33(6):1137-42. View

Berntsen G, Fonnebo V, Tollan A, Sogaard A, Magnus J . Forearm bone mineral density by age in 7,620 men and women: the Tromsø study, a population-based study. Am J Epidemiol. 2001; 153(5):465-73. DOI: 10.1093/aje/153.5.465. View

10.

Kelly T, Crane G, Baran D . Single X-ray absorptiometry of the forearm: precision, correlation, and reference data. Calcif Tissue Int. 1994; 54(3):212-8. DOI: 10.1007/BF00301681. View

11.

Siris E, Miller P, Barrett-Connor E, Faulkner K, Wehren L, Abbott T . Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001; 286(22):2815-22. DOI: 10.1001/jama.286.22.2815. View

12.

LeBoff M, Fuleihan G, Angell J, Chung S, Curtis K . Dual-energy x-ray absorptiometry of the forearm: reproducibility and correlation with single-photon absorptiometry. J Bone Miner Res. 1992; 7(7):841-6. DOI: 10.1002/jbmr.5650070714. View

13.

Emaus N, Berntsen G, Joakimsen R, Fonnebo V . Longitudinal changes in forearm bone mineral density in women and men aged 45-84 years: the Tromso Study, a population-based study. Am J Epidemiol. 2006; 163(5):441-9. DOI: 10.1093/aje/kwj055. View

14.

Borg J, Mollgaard A, Riis B . Single X-ray absorptiometry: performance characteristics and comparison with single photon absorptiometry. Osteoporos Int. 1995; 5(5):377-81. DOI: 10.1007/BF01622260. View

15.

Ravn P, Overgaard K, Huang C, Ross P, Green D, McClung M . Comparison of bone densitometry of the phalanges, distal forearm and axial skeleton in early postmenopausal women participating in the EPIC Study. Osteoporos Int. 1996; 6(4):308-13. DOI: 10.1007/BF01623390. View

16.

Lodder M, Lems W, Ader H, Marthinsen A, van Coeverden S, Lips P . Reproducibility of bone mineral density measurement in daily practice. Ann Rheum Dis. 2004; 63(3):285-9. PMC: 1754906. DOI: 10.1136/ard.2002.005678. View

17.

Ravaud P, Reny J, Giraudeau B, Porcher R, Dougados M, Roux C . Individual smallest detectable difference in bone mineral density measurements. J Bone Miner Res. 1999; 14(8):1449-56. DOI: 10.1359/jbmr.1999.14.8.1449. View

18.

Marshall D, Johnell O, Wedel H . Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312(7041):1254-9. PMC: 2351094. DOI: 10.1136/bmj.312.7041.1254. View

19.

Berntsen G, Tollan A, Magnus J, Sogaard A, Ringberg T, Fonnebo V . The Tromsø Study: artifacts in forearm bone densitometry--prevalence and effect. Osteoporos Int. 1999; 10(5):425-32. DOI: 10.1007/s001980050249. View

20.

Gjesdal C, Aanderud S, Haga H, Brun J, Tell G . Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values. Osteoporos Int. 2004; 15(7):525-34. DOI: 10.1007/s00198-003-1573-2. View