Discordance in diagnosis of osteoporosis using spine and femur bone densitometry: prevalence and related factors

Document Type: Original Article

Authors

Division of Nuclear Medicine & Radiology, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Introduction: This study was conducted to evaluate prevalence and risk factors for diagnostic discordance for osteoporosis due to different T-scores of lumbar spine and femoral neck.
Methods: In this cross sectional study demographic, anthropometric and risk factors for osteoporosis were derived from a database on 3,039 post-menopausal women who underwent bone densitometry for the first time in our department (Kurdistan Nuclear Medicine Center) from 2003 to 2010. DXA was performed on L2-L4 vertebrae and femoral neck for all cases. Major discordance (one site osteoporotic and the other normal) and minor discordance (difference between two site no more than one WHO diagnostic class) were determined. The association of related risk factors with discordance of interest was assessed.
 Results: Prevalence of osteoporosis and osteopenia in these post-menopausal women with mean age of 58.5 ±8.7 years, menopausal period of 11.2+9.4 years and mean BMI of 28+4.5 were 37.7% and 50.7%, respectively. Frequencies of minor and major discordances were 40.0% and 1.8%, respectively.

Conclusion: The minor discordance was a common finding; however, the major discordance is uncommon. The most important risk factors for major discordance were age, menopausal duration and BMI. There was no significant relationship between other risk factors (smoking and history of bone fracture) and diagnostic T-score discordances.

Keywords

Main Subjects


Maalouf G, Gannagé-Yared MH, Ezzedine J, Larijani B, Badawi S, Rached A, Zakroui L, Masri B, Azar E, Saba E, Nammari R, Adib G, Abou Samra H, Alrawi Z, Salman S, El Muntasser K, Tarseen R, El Kharousi W, Al-Lamki M, Alothman AN, Almarzook N, El Dessouki M, Sulaimani R, Saleh J, Suhaili AR, Khan A, Delmas P, Seeman E. Middle East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact. 2007 Apr-Jun;7(2):131-43.

Fujiwara S. Epidemiology of osteoporosis. Clin Calcium. 2005 Apr;15(4):577-82.

Derakhshan S, Salehi R. Prevalence of osteoporosis and related risk factors in Kurdish post-menopausal womens. Scientific J Kurdistan Univ Med Sci. 2006;11:59-67.

Woodson G. Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites. J Clin Densitom. 2000 Winter;3(4):319-24.

Leslie WD, Tsang JF, Caetano PA, Lix LM. Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program. J Bone Miner Res. 2007 Mar;22(3):476-83.

Mulder JE, Michaeli D, Flaster ER, Siris E. Comparison of bone mineral density of the phalanges, lumbar spine, hip, and forearm for the assessment of osteoporosis in postmenopausal women. J Clin Densitom. 2000 Winter;3(4):373-81.

Moayyeri A, Soltani A, Tabari NK, Sadatsafavi M, Hossein-Neghad A, Larijani B. Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocr Disord. 2005 Mar 11;5(1):3.

[O'Gradaigh D, Debiram I, Love S, Richards HK, Compston JE. A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int. 2003 Jan;14(1):13-8.

Mounach A, Abayi DA, Ghazi M, Ghozlani I, Nouijai A, Achemlal L, Bezza A, El Maghraoui A. Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Semin Arthritis Rheum. 2009 Jun;38(6):467-71.

El Maghraoui A, Mouinga Abayi DA, Ghozlani I, Mounach A, Nouijai A, Ghazi M, Achemlal L, Bezza A. Prevalence and risk factors of discordance in diagnosis of osteoporosis using spine and hip bone densitometry. Ann Rheum Dis. 2007 Feb;66(2):271-2.

Muraki S, Yamamoto S, Ishibashi H, Horiuchi T, Hosoi T, Orimo H, Nakamura K. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int. 2004 Sep;15(9):724-8.

[El Miedany YM, Mehanna AN, El Baddini MA. Altered bone mineral metabolism in patients with osteoarthritis. Joint Bone Spine. 2000;67(6):521-7.

Ichchou L, Allali F, Rostom S, Bennani L, Hmamouchi I, Abourazzak FZ, Khazzani H, El Mansouri L, Abouqal R, Hajjaj-Hassouni N. Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in post menopausal women. BMC Womens Health. 2010 Aug 8;10:25.

Garnero P, Sornay-Rendu E, Arlot M, Christiansen C, Delmas PD. Association between spine disc degeneration and type II collagen degradation in postmenopausal women: the OFELY study. Arthritis Rheum. 2004 Oct;50(10):3137-44.

Hashemipour S, Larijani B, Pazhouhi M, Bastan-Hagh MH, Soltani A, Javadi E, Adibi H, Shafaei AR, Baradar-Jalili R. Biochemichal parameters of bone in different levels of vitamin D deficiency. Iran South Med J. 2002;1:17-25.

Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001 Aug;22(4):477-501.

Jarupanich T. Prevalence and risk factors associated with osteoporosis in women attending menopause clinic at Hat Yai Regional Hospital. J Med Assoc Thai. 2007 May;90(5):865-9.

Heaney RP, Davies KM. Bone mineral density discordance and exploration of one of its causes. J Clin Densitom. 2011 Oct-Dec;14(4):428-33.

Munaisinghe RL, Botea V, Edelson GW. Association among age, height, weight, and body mass index with discordant regional bone mineral density. J Clin Densitom. 2002 Winter;5(4):369-73.

O'Gradaigh D, Debiram I, Love S, Richards HK, Compston JE. A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry. Osteoporos Int. 2003 Jan;14(1):13-8.

Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, Lo JC, Johnston JM, Cauley JA, Danielson ME, Neer RM. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. 2008 Mar;93(3):861-8.

Abrahamsen B, Stilgren LS, Hermann AP, Tofteng CL, Bärenholdt O, Vestergaard P, Brot C, Nielsen SP. Discordance between changes in bone mineral density measured at different skeletal sites in perimenopausal women--implications for assessment of bone loss and response to therapy: The Danish Osteoporosis Prevention Study. J Bone Miner Res. 2001 Jul;16(7):1212-9.

Gnudi S, Malavolta N. Comparison between T-score-based diagnosis of osteoporosis and specific skeletal site measurements: prognostic value for predicting fracture risk. J Clin Densitom. 2003 Fall;6(3):267-73.

Fink HA, Harrison SL, Taylor BC, Cummings SR, Schousboe JT, Kuskowski MA, Stone KL, Ensrud KE. Differences in site-specific fracture risk among older women with discordant results for osteoporosis at hip and spine: study of osteoporotic fractures. J Clin Densitom. 2008 Apr-Jun;11(2):250-9.

Crabtree NJ, Bebbington NA, Chapman DM, Wahid YS, Ayuk J, Boivin CM, Cooper MS, Gittoes NJ. Impact of UK National Guidelines based on FRAX®--comparison with current clinical practice. Clin Endocrinol (Oxf). 2010 Oct;73(4):452-6.

Leslie WD, Lix LM. Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: derivation and validation of a hybrid system. J Bone Miner Res. 2011 Mar;26(3):460-7.

Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA. Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int. 2011 Mar;22(3):839-47.