Bone Imaging Modality Precision and Agreement Between DXA, PQCT, and HR-pQCT

Overview

Journal JBMR Plus

Publisher Oxford University Press

Date 2025 Jan 23

PMID 39845981

Authors

Jakub Mesinovic

Micheal O Breasail

Lauren A Burt

Cat Shore-Lorenti

Roger Zebaze

Camelia Q E Lim

Zihui Ling

Peter R Ebeling

David Scott

Ayse Zengin

Affiliations

Soon will be listed here.

Abstract

Quantifying precision error for DXA, peripheral QCT (pQCT), and HR-pQCT is crucial for monitoring longitudinal changes in body composition and musculoskeletal outcomes. Agreement and associations between bone variables assessed using pQCT and second-generation HR-pQCT are unclear. This study aimed to determine the precision of, and agreement and associations between, bone variables assessed via DXA, pQCT, and second-generation HR-pQCT. Thirty older adults (mean age: 64.2 8.0 yr; women: 67%) were recruited. DXA scans were performed at the total hip, lumbar spine, and whole body. Distal (4%) and proximal (30%/33%/66%) skeletal sites at the radius and tibia were scanned with pQCT and/or HR-pQCT. Root-mean-squared coefficients of variation (%CV) were calculated to define precision errors, and Bland-Altman plots assessed agreement between densitometric estimates. Pearson correlations and linear regression explored relationships between bone variables at different skeletal sites and proportional bias, respectively. Precision errors ranged between 0.55% and 1.6% for DXA, 0.40% and 4.8% for pQCT, and 0.13% and 30.7% for HR-pQCT. Systematic bias was identified between pQCT- and HR-pQCT-determined radius and tibia volumetric BMD (vBMD) estimates (all <.001). Proportional bias was not observed between vBMD measures at any skeletal site (all >.05). pQCT- and HR-pQCT-determined total, trabecular, and cortical vBMD and estimates of bone strength at the radius and tibia were strongly correlated (all <.05). Precision error was low for most bone variables and within the expected range for all imaging modalities. We observed significant systematic bias, but no proportional bias, between pQCT- and second-generation HR-pQCT-determined vBMD estimates at the radius and tibia. Nevertheless, measures of bone density and strength were strongly correlated at all skeletal sites. These findings suggest that although bone density and strength estimates from both imaging modalities are not interchangeable, they are strongly related and likely have similar fracture prediction capabilities.

References

Wong A . A comparison of peripheral imaging technologies for bone and muscle quantification: a technical review of image acquisition. J Musculoskelet Neuronal Interact. 2016; 16(4):265-282. PMC: 5259568. View

Lala D, Cheung A, Lynch C, Inglis D, Gordon C, Tomlinson G . Measuring apparent trabecular structure with pQCT: a comparison with HR-pQCT. J Clin Densitom. 2013; 17(1):47-53. DOI: 10.1016/j.jocd.2013.03.002. View

Engelke K, Stampa B, Timm W, Dardzinski B, de Papp A, Genant H . Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia. Osteoporos Int. 2011; 23(8):2151-8. DOI: 10.1007/s00198-011-1829-1. View

Mikolajewicz N, Bishop N, Burghardt A, Folkestad L, Hall A, Kozloff K . HR-pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res. 2019; 35(3):446-459. DOI: 10.1002/jbmr.3901. View

Chiba K, Okazaki N, Isobe Y, Miyazaki S, Yonekura A, Tomita M . Precision of 3D Registration Analysis for Longitudinal Study of Second-Generation HR-pQCT. J Clin Densitom. 2020; 24(2):319-329. DOI: 10.1016/j.jocd.2020.10.001. View

Paggiosi M, Eastell R, Walsh J . Precision of high-resolution peripheral quantitative computed tomography measurement variables: influence of gender, examination site, and age. Calcif Tissue Int. 2013; 94(2):191-201. DOI: 10.1007/s00223-013-9798-3. View

Whittier D, Boyd S, Burghardt A, Paccou J, Ghasem-Zadeh A, Chapurlat R . Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int. 2020; 31(9):1607-1627. PMC: 7429313. DOI: 10.1007/s00198-020-05438-5. View

Jorgenson B, Buie H, McErlain D, Sandino C, Boyd S . A comparison of methods for in vivo assessment of cortical porosity in the human appendicular skeleton. Bone. 2014; 73:167-75. DOI: 10.1016/j.bone.2014.11.023. View

Burrows M, Cooper D, Liu D, McKay H . Bone and muscle parameters of the tibia: agreement between the XCT 2000 and XCT 3000 instruments. J Clin Densitom. 2008; 12(2):186-94. DOI: 10.1016/j.jocd.2008.09.005. View

10.

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

11.

Macneil J, Boyd S . Improved reproducibility of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys. 2008; 30(6):792-9. DOI: 10.1016/j.medengphy.2007.11.003. View

12.

Sornay-Rendu E, Boutroy S, Duboeuf F, Chapurlat R . Bone Microarchitecture Assessed by HR-pQCT as Predictor of Fracture Risk in Postmenopausal Women: The OFELY Study. J Bone Miner Res. 2017; 32(6):1243-1251. DOI: 10.1002/jbmr.3105. View

13.

Hoiberg M, Rubin K, Hermann A, Brixen K, Abrahamsen B . Diagnostic devices for osteoporosis in the general population: A systematic review. Bone. 2016; 92:58-69. DOI: 10.1016/j.bone.2016.08.011. View

14.

Gluer C, Blake G, Lu Y, Blunt B, Jergas M, Genant H . Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int. 1995; 5(4):262-70. DOI: 10.1007/BF01774016. View

15.

Pauchard Y, Liphardt A, Macdonald H, Hanley D, Boyd S . Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone. 2012; 50(6):1304-10. DOI: 10.1016/j.bone.2012.03.003. View

16.

Lala D, Cheung A, Gordon C, Giangregorio L . Comparison of cortical bone measurements between pQCT and HR-pQCT. J Clin Densitom. 2012; 15(3):275-81. DOI: 10.1016/j.jocd.2012.01.005. View

17.

Braun M, Meta M, Schneider P, Reiners C . Clinical evaluation of a high-resolution new peripheral quantitative computerized tomography (pQCT) scanner for the bone densitometry at the lower limbs. Phys Med Biol. 1998; 43(8):2279-94. DOI: 10.1088/0031-9155/43/8/020. View

18.

Warden S, Fuchs R, Liu Z, Toloday K, Surowiec R, Moe S . Am I big boned? Bone length scaled reference data for HRpQCT measures of the radial and tibial diaphysis in White adults. Bone Rep. 2024; 20:101735. PMC: 10824696. DOI: 10.1016/j.bonr.2024.101735. View

19.

Hosseinitabatabaei S, Mikolajewicz N, Zimmermann E, Rummler M, Steyn B, Julien C . 3D Image Registration Marginally Improves the Precision of HR-pQCT Measurements Compared to Cross-Sectional-Area Registration in Adults With Osteogenesis Imperfecta. J Bone Miner Res. 2022; 37(5):908-924. DOI: 10.1002/jbmr.4541. View

20.

Ellouz R, Chapurlat R, van Rietbergen B, Christen P, Pialat J, Boutroy S . Challenges in longitudinal measurements with HR-pQCT: evaluation of a 3D registration method to improve bone microarchitecture and strength measurement reproducibility. Bone. 2014; 63:147-57. DOI: 10.1016/j.bone.2014.03.001. View