Document Detail


Device-specific thresholds to diagnose osteoporosis at the proximal femur: an approach to interpreting peripheral bone measurements in clinical practice.
MedLine Citation:
PMID:  16810454     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A single T score criterion cannot be universally applied to different peripheral bone measurement devices, since measurements in an identical population result in a tenfold difference in the prevalence of osteoporosis. The use of peripheral devices is increasing in clinical practice, despite the difficulties in interpreting results. We propose the use of two thresholds, which have either 95% sensitivity or 95% specificity, to identify (1) individuals who require treatment or (2) individuals who require no treatment, both based on a peripheral measurement alone, or (3) individuals who require additional central densitometry measurements. METHODS: We recruited 500 postmenopausal women, 100 premenopausal women and 279 women with proximal femoral, vertebral, distal forearm or proximal humeral fractures. All subjects underwent dual energy X-ray absorptiometry (DXA) measurements of the lumbar spine, total hip and distal forearm, quantitative computed tomography (QCT) of the distal forearm and quantitative ultrasound (QUS) of the heel (four devices), finger (two devices), radius and metatarsal. We identified the threshold for each device that identified women without osteoporosis with the same sensitivity (upper threshold set at 95%) as total hip DXA and women with osteoporosis with the same specificity (lower threshold set at 95%) as total hip DXA. Individuals between the two thresholds required additional examination by central densitometry. RESULTS: The correlation between devices varied from 0.173 (QUS finger) to 0.686 (DXA forearm) compared with total hip DXA (P<0.0001). The area under the curve (AUC) between devices varied from 0.604 (QUS finger) to 0.896 (DXA forearm) compared with total hip DXA (P<0.0001). In a population-based cohort (prevalence of osteoporosis 9.8%) the threshold approach appropriately identified between 26% (QUS heel) and 68% (DXA forearm) of subjects in whom a treatment decision could be made without additional central DXA with 95% certainty. In a fracture cohort (prevalence of osteoporosis 36%) between 16% (QUS finger) and 37% (QCT forearm) of subjects were appropriately identified. CONCLUSION: The threshold approach to interpreting peripheral bone measurements enables a substantial number of individuals with either normal bone mineral density (BMD) or osteoporosis to be selected and treated appropriately.
Authors:
J A Clowes; N F A Peel; R Eastell
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2006-06-30
Journal Detail:
Title:  Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA     Volume:  17     ISSN:  0937-941X     ISO Abbreviation:  Osteoporos Int     Publication Date:  2006  
Date Detail:
Created Date:  2006-08-15     Completed Date:  2007-06-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9100105     Medline TA:  Osteoporos Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1293-302     Citation Subset:  IM    
Affiliation:
Bone Metabolism Group, University of Sheffield, Sheffield, UK. j.a.clowes@sheffield.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Absorptiometry, Photon
Adult
Aged
Aged, 80 and over
Bone Density*
Calcaneus / ultrasonography
Female
Femur / physiopathology*
Forearm / physiopathology
Fractures, Bone / etiology
Hip Joint / physiopathology
Humans
Lumbar Vertebrae / physiopathology
Middle Aged
Osteoporosis, Postmenopausal / complications,  diagnosis*
Premenopause / physiology
Reference Values
Sensitivity and Specificity
Comments/Corrections
Comment In:
Osteoporos Int. 2007 Nov;18(11):1557-8; discussion 1559   [PMID:  17453316 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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