Impact of bone mineral measurements on osteoporosis

Guidelines for the diagnosis of osteoporosis by densitometric methods

BACKGROUND

Osteoporosis is a major health hazard for postmenopausal women and elderly people. Local, national, and international organizations developed clinical practice guidelines for the diagnosis and management of osteoporosis and the prevention of osteoporotic fractures. Low bone mineral density (BMD) is the most important risk factor for fragility fractures. Bone densitometry is the best method to measure BMD in an individual. Many risk factors contribute to the development of osteoporosis and increase the fracture risk independently from BMD. Guidelines must be comprehensive, factual, simple to implement, and should provide the clinician, patients, governments, and payers with the best evidence available.

OBJECTIVES

The objectives of this article were to review national and international guidelines to establish a congruent set of parameters that may aid the clinician in the decision-making process for the diagnosis of osteoporosis.

DATA SOURCES

An online search of several databases provided 18 guidelines for this review. Comparison among the guidelines was made on 10 different aspects: format, focus, significance of hip and vertebral body fractures, primary diagnostic considerations, BMD measurement technology, interpretation, reporting and follow-up, equipment reliability and quality control, risk factors considered, and methodologic quality of the guidelines. Tables were created for easier comparison on the aspects covered and supported by each guideline.

RESULTS

None of the guidelines reviewed fulfills all the requirements of good clinical practice guidelines.

CONCLUSIONS

Further works should finally provide all those interested with a more complete and thorough set of guidelines based on the best evidence available.

Fractal signature analysis of macroradiographs measures trabecular organization in lumbar vertebrae of postmenopausal women

High definition macroradiography was used to provide an image of the detailed structural organization of the cancellous bone in human lumbar vertebrae. The fractal signature analysis (FSA) method was used to quantify the horizontal and vertical trabecular organization recorded within the image. Comparison of the FSA of the postero-anterior and lateral macroradiographs in postmortem lumbar vertebrae showed that neither the superimposition of the neural arch nor the radiographic angle affected the trabecular measurement within the vertebral body. FSA analysis of the trabecular structure measured from the macroradiographs of lumbar vertebrae in two groups of postmenopausal women, with high and low bone mineral density (BMD), showed that the large vertical trabecular structures correlated with the women's body weight (P < 0.01-0.03) and body mass index (P < 0.005-0.05), the fine horizontal structures correlated with the women's age (P < 0.005-0.05), and fine vertical trabecular structures were significantly greater (P < 0.005-0.05) in the low compared with the high BMD group.

Serum collagenase-like peptidase activity correlated with bone mineral density. A study of 102 elderly women

To clarify the relationship between collagenase-like peptidase (CL-peptidase) and bone metabolism, serum CL-peptidase activity and bone mineral density (BMD) in the lumbar spine, measured by dual energy X-ray absorptiometry (DEXA), were determined in 102 women with a mean age of 70 (41-94) years. The serum activity of CL-peptidase increased slightly with age up to the 8th decade, and then decreased. Next, we classified the subjects into the following 2 groups by age: a postmenopausal group 50-69 years, and an elderly group over 70 years. In the younger group serum CL-peptidase activity did not correlate with BMD, while in the elderly it did. Our result suggests that serum CL-peptidase activity may reflect bone resorption in elderly women.

Future diagnostic methods. A brief look at new technologies and their potential application to equine diagnosis

We live in an age in which highly sophisticated computerized equipment and imaging methods are becoming increasingly available. Demand from clients requires that we as veterinary professionals keep our eyes on the future potential of these technologies for diagnosis and treatment. This article briefly reviews some of the techniques that are just around the corner for the progressive equine practitioner.

Intersite comparison of the Hologic QDR-1000 dual energy X-ray bone densitometer

We have compared results from 13 Hologic QDR-1000 bone densitometers: (i) by performing spine and hip scans on two normal volunteers; (ii) by acquiring sets of 10 sequential scans on a Hologic anthropomorphic spine phantom. For each QDR-1000 site visited a set of spine phantom scans was also acquired on a QDR-1000 at Guy's Hospital to serve as a control study. All scans were analysed using the Hologic scan comparison software. Radiographers at each site were asked to perform their own independent analysis of the scans of the two volunteers. The precision of the bone mineral density (BMD), bone mineral content (BMC) and projected area (Area) results for a set of 10 phantom scans was 0.11%, 0.14% and 0.12% respectively. The coefficient of variation (CV) between sites for the sets of phantom scans was 0.58% for BMD, 0.71% for BMC and 0.35% for Area. In comparison, CVs for the phantom scans acquired on a single QDR-1000 were 0.23%, 0.23% and 0.09% respectively. The CV for the BMD results on the two volunteers obtained using the scan comparison software averaged 1.4% for the spine and 2.1% for the femoral neck. The CV for the results obtained by site radiographers averaged 2.2% for the spine and 3.7% for the femoral neck. Significant differences in the technique used for hip analysis were found.

CONCLUSIONS

(i) differences in calibration between systems were generally less than 1%; (ii) variations in results resulting from differences in analytical technique were more significant than those resulting from differences in calibration.