Precision of Single vs Bilateral Hip Bone Mineral Density Scans

doi:10.1385/JCD:6:2:159

Journal of Clinical Densitometry

Volume 6, Issue 2, Summer 2003, Pages 159-162

https://doi.org/10.1385/JCD:6:2:159 Get rights and content

Abstract

This study was performed to determine and compare the precision of single and bilateral hip bone mineral density (BMD) measurements and to determine the precision of spinal and total body measurements by dual-energy X-ray absorptiometry (DXA). Precision (group root-mean-square average coefficient of variation) was determined in 6 subjects scanned six times each at the spine, both hips, and total body, with repositioning after each scan. Mean percentage coefficients of variance (%CVs) in BMD for single and bilateral hip scans were, respectively: 0.65% and 0.67% for the total hip, 1.16% and 1.03% for the trochanter, and 1.66% and 1.31% for the femoral neck, respectively. Mean %CV was 1.04% for spine BMD (L2–L4), 0.67% for total body BMD, 1.12% for total body bone mineral content (BMC), 0.94% for total body fat tissue, and 0.77% for total body nonfat soft tissue. We conclude that precision overall is excellent and that femoral neck precision can be improved with bilateral compared with the traditional single hip scans.

References (7)

P Szulc et al.
Cross-sectional assessment of age-related bone loss in men: the MINOS Study
Bone
(2000)
DM Black et al.
Axial and appendicular bone density predict fractures in older women
J Bone Miner Res
(1992)
JL Clasey et al.
Body composition by DEXA in older adults: accuracy and influence of scan mode
Med Sci Sports Exerc
(1997)

There are more references available in the full text version of this article.

Cited by (39)

Bilateral hip DXA Reporting: 2023 Official Positions of the International Society for Clinical Densitometry
2024, Journal of Clinical Densitometry
Introduction: This position development conference (PDC) Task Force examined the use and reporting of bilateral hip bone mineral density (BMD) measurements. This was deemed appropriate as increased availability of Dual-energy X-ray Absorptiometry (DXA) technology offering bilateral hip measurement resulted in more routine clinical use. The International Society for Clinical Densitometry Official Positions accept bilateral hip BMD measurement for clinical use but currently do not include recommendations for reporting those studies. Methods: Four key questions regarding bilateral hip reporting were proposed by the PDC Steering Committee. Relevant literature was identified using PubMed. Questions included whether bilateral hip measurements are appropriate for diagnostic classification or monitoring, as well as which bilateral hip regions of interest should be reported for diagnosis and monitoring. Additionally, the appropriate nomenclature for bilateral hip acquisition was defined. Results: The literature review demonstrated that bilateral hip measurement is appropriate and diagnostic classification should be based on the lowest T-score at the right or left side femoral neck or total hip; the mean T-score should not be used for diagnostic purposes. Mean bilateral total hip is preferred for BMD monitoring. The terms hip, or total hip were deemed appropriate nomenclature instead of femur or total proximal femur. Conclusion: Bilateral hip acquisition is clinically appropriate and reporting and nomenclature standards are offered herein when a bilateral hip study is acquired. In terms of future research, the impact of discordant hips on diagnosis and monitoring was identified as a significant knowledge gap.
Association between a Calcium-to-Magnesium Ratio and Osteoporosis among Puerto Rican Adults
2023, Journal of Nutrition
The ratio of calcium-to-magnesium intake (Ca:Mg) may be important for bone due to their competitive absorption. The Ca:Mg ratio has been related to health outcomes, but few studies have related it to bone.
The purpose of this analysis was to examine associations between the Ca:Mg intake with bone mineral density (BMD) and osteoporosis among Puerto Rican adults.
Adults, aged 47–79 y, from the Boston Puerto Rican Osteoporosis Study, with complete BMD and dietary data (n = 955) were included. BMD was assessed with dual-energy X-ray absorptiometry and diet by a food frequency questionnaire. Calcium and magnesium intakes from food were energy adjusted, and the Ca:Mg was calculated. Adjusted linear and logistic regression models were utilized for testing associations between Ca:Mg and bone outcomes.
Calcium intake was greater in the highest compared with lowest tertile, whereas magnesium intake was similar across tertiles. Mean BMD at hip sites was higher in the middle, compared with the lowest, tertile. Higher odds of osteoporosis were observed for the highest and lowest tertiles, compared with the middle tertile, after adjustment (T3 compared with T2 OR: 2.79; 95% CI: 1.47, 5.3; T1 compared with T2 OR: 2.01; 95% CI: 1.03, 3.92). Repeated analyses without supplement users (n = 432) led to stronger differences and ORs, but lost significance for some comparisons.
Dietary calcium and magnesium are important for bone, perhaps not independently. The Ca:Mg intake ratio appeared most protective within a range of 2.2–3.2, suggesting that a balance of these nutrients may be considered in recommendations for osteoporosis..
Cross-Calibration of Prodigy and Horizon A Densitometers and Precision of the Horizon A Densitometer
2021, Journal of Clinical Densitometry
Citation Excerpt :
Precision of this scanner tended to be slightly but not significantly better than the precision of their older Hologic Discovery scanner. The coefficients of variation of BMD measurements on our Horizon A were similar at the femoral neck and spine and slightly higher at the total hip, than values we reported earlier for our Prodigy (14). Abdominal thickness, within the range we studied, did not significantly influence precision or BMD values on the Horizon A scanner.
We performed this study to enable a reliable transition for clinical study participants and patients from a GE Lunar Prodigy to a Hologic Horizon A dual-energy X-ray absorptiometry (DXA) scanner and to assess the reproducibility of measurements made on the new DXA scanner. Forty-five older adults had one spine, hip, and total body scan on a Prodigy dual-energy X-ray absorptiometry (DXA) scanner and 2 spine, hip, and total body scans, with repositioning, on a new Hologic Horizon A DXA scanner. Linear regression models were used to derive cross calibration equations for each measure on the 2 scanners. Precision (group root-mean-square average coefficient of variation) of bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine (L1-L4), and total body fat, bone, and lean mass, appendicular lean mass, and trabecular bone score (TBS) was assessed using the International Society of Clinical Densitometry's (ISCD's) Advanced Precision Calculation Tool. Correlation coefficients for the BMD and body composition measures on the 2 scanners ranged from 0.94 to 0.99 (p<0.001). When compared with values on the Prodigy, mean BMD on the Horizon A was lower at each skeletal site (0.136 g/cm² lower at the femoral neck and 0.169 g/cm² lower at the lumbar spine (L1-4)), fat mass was 0.47 kg lower, and lean mass was 4.50 kg higher. Precision of the Horizon A scans was 1.60% for total hip, 1.94% for femoral neck, and 1.25% for spine (L1-4) BMD. Precision of TBS was 1.67%. Precision of total body fat mass was 2.16%, total body lean mass was 1.26%, appendicular lean mass was 1.97%, and total body bone mass was 1.12%. The differences in BMD and body composition values on the 2 scanners illustrate the importance of cross-calibration to account for these differences when transitioning clinical study participants and patients from one scanner to another.
Diet-derived fruit and vegetable metabolites show sex-specific inverse relationships to osteoporosis status
2021, Bone
Citation Excerpt :
BMD was assessed with DXA on a GE-Lunar Model Prodigy scanner (GE Lunar, Madison, WI, USA), with weekly calibration using an external standard (aluminum spine phantom; Lunar Radiation Corp). As reported previously, the root mean square precision was 1.31% and 1.04% for BMD of the femoral neck (FN) and lumbar spine (LS, L2–L4), respectively [26]. The DXA measures were completed using DXA acquisition software version 6.1 and analysis version 12.2.
The impact of nutrition on the metabolic profile of osteoporosis (OS) is unknown.
Identify biochemical factors driving the association of fruit and vegetable (FV) intakes with OS prevalence using an untargeted metabolomics approach.
Cross-sectional dietary, anthropometric and plasma metabolite data were examined from the Boston Puerto Rican Osteoporosis Study, n = 600 (46–79 yr).
Bone mineral density was assessed by DXA. OS was defined by clinical standards. A culturally adapted FFQ assessed usual dietary intake. Principal components analysis (PCA) of 42 FV items created 6 factors. Metabolomic profiles derived from plasma samples were assessed on a commercial platform. Differences in levels of 525 plasma metabolites between disease groups (OS vs no-OS) were compared using logistic regression; and associations with FV intakes by multivariable linear regression, adjusted for covariates. Metabolites significantly associated with OS status or with total FV intake were analyzed for enrichment in various biological pathways using Mbrole 2.0, MetaboAnalyst, and Reactome, using FDR correction of P-values. Correlation coefficients were calculated as Spearman's rho rank correlations, followed by hierarchical clustering of the resulting correlation coefficients using PCA FV factors and sex-specific sets of OS-associated metabolites.
High FV intake was inversely related to OS prevalence (Odds Ratio = 0.73; 95% CI = 0.57, 0.94; P = 0.01). Several biological processes affiliated with the FV-associating metabolites, including caffeine metabolism, carnitines and fatty acids, and glycerophospholipids. Important processes identified with OS-associated metabolites were steroid hormone biosynthesis in women and branched-chain amino acid metabolism in men. Factors derived from PCA were correlated with the OS-associated metabolites, with high intake of dark leafy greens and berries/melons appearing protective in both sexes.
These data warrant investigation into whether increasing intakes of dark leafy greens, berries and melons causally affect bone turnover and BMD among middle-aged and older adults at risk for osteoporosis via sex-specific metabolic pathways, and how gene-diet interactions alter these sex-specific metabolomic-osteoporosis links.
ClinicalTrials.gov Identifier: NCT01231958.
Dietary Approaches to Stop Hypertension, Mediterranean, and Alternative Healthy Eating indices are associated with bone health among Puerto Rican adults from the Boston Puerto Rican Osteoporosis Study
2020, American Journal of Clinical Nutrition
Conflicting results on associations between dietary quality and bone have been noted across populations, and this has been understudied in Puerto Ricans, a population at higher risk of osteoporosis than previously appreciated.
To compare cross-sectional associations between 3 dietary quality indices [Dietary Approaches to Stop Hypertension (DASH), Alternative Health Eating Index (AHEI-2010), and Mediterranean Diet Score (MeDS)] with bone outcomes.
Participants (n = 865–896) from the Boston Puerto Rican Osteoporosis Study (BPROS) with complete bone and dietary data were included. Indices were calculated from validated food frequency data. Bone mineral density (BMD) was measured using DXA. Associations between dietary indices (z-scores) and their individual components with BMD and osteoporosis were tested with ANCOVA and logistic regression, respectively, at the lumbar spine and femoral neck, stratified by male, premenopausal women, and postmenopausal women.
Participants were 59.9 y ± 7.6 y and mostly female (71%). Among postmenopausal women not taking estrogen, DASH (score: 11–38) was associated with higher trochanter (0.026 ± 0.006 g/cm², P <0.001), femoral neck (0.022 ± 0.006 g/cm², P <0.001), total hip (0.029 ± 0.006 g/cm², P <0.001), and lumbar spine BMD (0.025 ± 0.007 g/cm², P = 0.001). AHEI (score: 25–86) was also associated with spine and all hip sites (P <0.02), whereas MeDS (0–9) was associated only with total hip (P = 0.01) and trochanter BMD (P = 0.007) in postmenopausal women. All indices were associated with a lower likelihood of osteoporosis (OR from 0.54 to 0.75). None of the results were significant for men or premenopausal women.
Although all appeared protective, DASH was more positively associated with BMD than AHEI or MeDS in postmenopausal women not taking estrogen. Methodological differences across scores suggest that a bone-specific index that builds on existing indices and that can be used to address dietary differences across cultural and ethnic minority populations should be considered.
Dietary fat increases vitamin d-3 absorption
2015, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
Total body fat tissue mass, a potential storage site for vitamin D, was assessed on the first study visit by a GE Lunar Prodigy dual x-ray absorptiometry scanner with acquisition software version 6.1 (2002) and analysis version 12.2 (2008). The precision of this measure in our laboratory is 0.94%.17 Intake of calcium, macronutrients, and total energy during the past 3 months was assessed on the first study visit with use of a validated Fred Hutchinson food frequency questionnaire.18
The plasma 25-hydroxyvitamin D response to supplementation with vitamin D varies widely, but vitamin D absorption differences based on diet composition is poorly understood.
We tested the hypotheses that absorption of vitamin D-3 is greater when the supplement is taken with a meal containing fat than with a fat-free meal and that absorption is greater when the fat in the meal has a higher monounsaturated-to-polyunsaturated fatty acid ratio (MUFA:PUFA).
Open, three-group, single-dose vitamin D-3 comparative absorption experiment.
Our 1-day study was conducted in 50 healthy older men and women who were randomly assigned to one of three meal groups: fat-free meal, and a meal with 30% of calories as fat with a low (1:4) and one with a high (4:1) MUFA:PUFA. After a 12-hour fast, all subjects took a single 50,000 IU vitamin D-3 supplement with their test breakfast meal.
Plasma vitamin D-3 was measured by liquid chromatography–mass spectrometry before and 10, 12 (the expected peak), and 14 hours after the dose.
Means were compared with two-tailed t tests for independent samples. Group differences in vitamin D-3 absorption across the measurement time points were examined by analysis of variance with the repeated measures subcommand of the general linear models procedure.
The mean peak (12-hour) plasma vitamin D-3 level after the dose was 32% (95% CI 11% to 52%) greater in subjects consuming fat-containing compared with fat-free meals (P=0.003). Absorption did not differ significantly at any time point in the high and low MUFA and PUFA groups.
The presence of fat in a meal with which a vitamin D-3 supplement is taken significantly enhances absorption of the supplement, but the MUFA:PUFA of the fat in that meal does not influence its absorption.

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Original ArticlePrecision of Single vs Bilateral Hip Bone Mineral Density Scans

Abstract

Bone

Axial and appendicular bone density predict fractures in older women

J Bone Miner Res

Body composition by DEXA in older adults: accuracy and influence of scan mode

Med Sci Sports Exerc

Original Article
Precision of Single vs Bilateral Hip Bone Mineral Density Scans