Spinal bone mineral assessment in postmenopausal women: A comparison between dual X-ray absorptiometry and quantitative computed tomography

被引:126
作者
Yu, W
Gluer, CC
Grampp, S
Jergas, M
Fuerst, T
Wu, CY
Lu, Y
Fan, B
Genant, HK
机构
[1] UNIV CALIF SAN FRANCISCO,DEPT RADIOL,MUSCULOSKELETAL SECT,SAN FRANCISCO,CA 94143
[2] UNIV CALIF SAN FRANCISCO,OSTEOPOROSIS RES GRP,SAN FRANCISCO,CA 94143
关键词
bone mineral density (BMD); dual X-ray absorptiometry (DXA); fracture risk; postmenopause; quantitative computed tomography (QCT);
D O I
10.1007/BF01626604
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We compared quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA) with respect to their ability to discriminate subjects with and without prevalent vertebral fractures. In 240 post-menopausal women (mean age 63.7 +/- 6.9 years) lateral spine radiographs (T4-L4) were reviewed for the presence of vertebral fracture. Using a semiquantitative technique to grade the severity of vertebral deformities, we classified fractures as mild, moderate or severe (grade 1 to 3, respectively). Postero-anterior DXA (PA-DXA) and lateral DXA (L-DXA) measurements (L2-4) as well as QCT measurements of the lumbar spine (T12-L3 or L1-14) were obtained in all women. Seventy-two women were diagnosed with at least one fracture, and of these 40 were graded as mild. Comparing normal women with fractured women, we found the area under the receiver operating characteristics (ROC) curves to be greatest for QCT (0.81), followed by L-DXA (0.72) and PA-DXA (0.65). The differences among all three techniques were significant. Comparing the normal women with women having only mild fractures, the areas under the ROC curves were 0.79, 0.73 and 0.63 for QCT, L-DXA. and PA-DXA, respectively. Significant differences existed between QCT and PA-DXA as well as between L-DXA and PA-DXA. Logistic regression analysis also revealed the highest age-adjusted odds ratios for QCT (3.67; 2.25-5.97) while L-DXA and PA-DXA showed substantially lower odds ratios (2.00; 1.39-2.87, and 1.54; 1.11-2.15, respectively). We conclude that low bone density as measured by QCT, PA-DXA or L-DXA is significantly associated with the prevalence of vertebral fractures. Of the methods studied, QCT of trabecular bone offered the best discriminatory capability. L-DXA proved to be superior to PA-DXA in its diagnostic sensitivity, particularly in women with mild fracture. Mild vertebral fractures are associated with decreased spinal bone density and may be regarded as osteoporotic deformities.
引用
收藏
页码:433 / 439
页数:7
相关论文
共 34 条
[1]   BONE-DENSITY MEASUREMENTS [J].
ALHAVA, EM .
CALCIFIED TISSUE INTERNATIONAL, 1991, 49 :S21-S23
[2]  
BLACK DM, 1991, J BONE MINER RES S1, V6, pS300
[3]   BONE COMPRESSIVE STRENGTH - INFLUENCE OF DENSITY AND STRAIN RATE [J].
CARTER, DR ;
HAYES, WC .
SCIENCE, 1976, 194 (4270) :1174-1176
[4]   BONE-DENSITY AT VARIOUS SITES FOR PREDICTION OF HIP-FRACTURES [J].
CUMMINGS, SR ;
BLACK, DM ;
NEVITT, MC ;
BROWNER, W ;
CAULEY, J ;
ENSRUD, K ;
GENANT, HK ;
PALERMO, L ;
SCOTT, J ;
VOGT, TM .
LANCET, 1993, 341 (8837) :72-75
[5]   CROSS-CALIBRATION OF LIQUID AND SOLID QCT CALIBRATION STANDARDS - CORRECTIONS TO THE UCSF NORMATIVE DATA [J].
FAULKNER, KG ;
GLUER, CC ;
GRAMPP, S ;
GENANT, HK .
OSTEOPOROSIS INTERNATIONAL, 1993, 3 (01) :36-42
[6]  
FAULKNER KG, 1990, QUANTITATIVE COMPUTE
[7]   A COMPARISON OF LATERAL VERSUS ANTERIOR-POSTERIOR SPINE DUAL-ENERGY X-RAY ABSORPTIOMETRY FOR THE DIAGNOSIS OF OSTEOPENIA [J].
FINKELSTEIN, JS ;
CLEARY, RL ;
BUTLER, JP ;
ANTONELLI, R ;
MITLAK, BH ;
DERASKA, DJ ;
ZAMORAQUEZADA, JC ;
NEER, RM .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1994, 78 (03) :724-730
[8]   MEASUREMENT OF SPINE DENSITY IN NORMAL AND OSTEOPOROTIC SUBJECTS USING COMPUTED-TOMOGRAPHY - RELATIONSHIP OF SPINE DENSITY TO FRACTURE THRESHOLD AND FRACTURE INDEX [J].
GALLAGHER, C ;
GOLDGAR, D ;
MAHONEY, P ;
MCGILL, J .
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 1985, 9 (03) :634-635
[9]  
GARTON MJ, 1994, CLIN RADIOL, V118, P22
[10]   VERTEBRAL FRACTURE ASSESSMENT USING A SEMIQUANTITATIVE TECHNIQUE [J].
GENANT, HK ;
WU, CY ;
VANKUIJK, C ;
NEVITT, MC .
JOURNAL OF BONE AND MINERAL RESEARCH, 1993, 8 (09) :1137-1148