The effects of standardization and reference values on patient classification for spine and femur dual-energy X-ray absorptiometry

被引:49
作者
Simmons, A
Simpson, DE
ODoherty, MJ
Barrington, S
Coakley, AJ
机构
[1] MAUDSLEY HOSP & INST PSYCHIAT,DEPT NEUROIMAGING,LONDON SE5 8AZ,ENGLAND
[2] KENT & CANTERBURY HOSP,E KENT OSTEOPOROSIS SCREENING & RES UNIT,CANTERBURY,KENT,ENGLAND
关键词
BMD; dual-energy X-ray absorptiometry; normal range; osteoporosis; standardized bone mineral density;
D O I
10.1007/BF01622289
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The effect of two methods for standardizing dual-energy X-ray absorptiometry (DXA) measurements on patient classification by the T-score has been determined for a group of over 2000 patients. The methods proposed by the international DXA Standardization Committee and the European Community's COMAC-BME group were used in conjunction with young reference data from the major DXA manufacturers, the COMAC-BME group and the third US National Health and Nutrition Examination Survey (NHANES III). The two standardization techniques produced dissimilar classifications as measured by the kappa statistic (kappa = 0.34-0.90), especially for the femoral neck, with up to 24.3% of patients reclassified from osteopenic to normal and 18.6% reclassified from osteoporotic to osteopenic when the standardization method was changed, Considering the effects of both reference data and standardization techniques together, there was a wide variation of patient classification, with the number of patients classified as osteoporotic varying from 9.6% to 21.1% for the postero-anterior spine L2-4 region and from 2.3% to 27.6% for the femoral neck, The agreement between different classifications ranged widely. from very poor to excellent (kappa = 0.02-0.98). The creation of standardized reference data must be an important priority in order to harmonize patient management using standardized BMD measurements. The choice of standardization technique, however, must be addressed in light of the results presented here.
引用
收藏
页码:200 / 206
页数:7
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