Order Critical Appraisal Assignment

Order Critical Appraisal Assignment
Association between bone indices assessed by DXA, HR‑pQCT and QCT scans in post‑menopausal women
Anne Kristine Amstrup1 · Niels Frederik Breum Jakobsen1 · Emil Moser1 · Tanja Sikjaer1 · Leif Mosekilde1 · Lars Rejnmark1
Received: 30 January 2015 / Accepted: 22 July 2015 / Published online: 21 August 2015 © The Japanese Society for Bone and Mineral Research and Springer Japan 2015
weak to moderate. Our data suggest that the various tech- niques measure different characteristics of the bone, and may therefore be used in addition to rather than as a replac- ment for imaging in clinical practice.
Keywords aBMD · vBMD · QCT · DXA · HR-pQCT
Osteoporosis is a metabolic disorder resulting from changes in bone mineral density, bone geometry and micro- structure that leads to an increased susceptibility to frac- tures. Currently, diagnosis of osteoporosis is based on areal bone mineral density (aBMD; g/cm2) values gained from 2D techniques (dual X-ray absorptiometry or DXA scans). However, aBMD has been shown to be only a partial pre- dictor of fracture risk [1, 2]. This may in part be due to the fact that 2D measures do not fully reflect the distribution of bone mass, including the relative contribution from cor- tical and trabecular bone or the microarchitecture of the bone matrix. For these aspects, imaging techniques such as quantitative computed tomography (QCT) and high- resolution pQCT (HR-pQCT) may present much better alternatives. QCT techniques enable measurements at cen- tral sites such as lumbar spine and hip [3] and are consid- ered to measure true volumetric BMD (vBMD; mg/cm3). HR-pQCT, an improved detector technique combined with beam acquisition originally designed for micro-computed tomography, permits in vivo assessment of trabecular and cortical architecture and vBMD at distal sites such as the tibia and radius [4]. In addition, these images can be used for microstructural finite element analysis (FEA) that inte- grates BMD with bone geometry and structure to estimate bone strength under various loading conditions [4].
Order Critical Appraisal Assignment
Abstract Quantitative computed tomography (QCT), high-resolution peripheral QCT (HR-pQCT) and dual X-ray absorptiometry (DXA) scans are commonly used when assessing bone mass and structure in patients with osteoporosis. Depending on the imaging technique and measuring site, different information on bone quality is obtained. How well these techniques correlate when assessing central as well as distal skeletal sites has not been carefully assessed to date. One hundred and twenty- five post-menopausal women aged 56–82 (mean 63) years were studied using DXA scans (spine, hip, whole body and forearm), including trabecular bone score (TBS), QCT scans (spine and hip) and HR-pQCT scans (distal radius and tibia). Central site measurements of areal bone mineral density (aBMD) by DXA and volumetric BMD (vBMD) by QCT correlated significantly at the hip (r = 0.74, p < 0.01). Distal site measurements of density at the radius as assessed by DXA and HR-pQCT were also associated (r = 0.74, p < 0.01). Correlations between distal and cen- tral site measurements of the hip and of the tibia and radius showed weak to moderate correlation between vBMD by HR-pQCT and QCT (r = −0.27 to 0.54). TBS correlated with QCT at the lumbar spine (r = 0.35) and to trabecu- lar indices of HR-pQCT at the radius and tibia (r = −0.16 to 0.31, p < 0.01). There was moderate to strong agree- ment between measuring techniques when assessing the same skeletal site. However, when assessing correlations between central and distal sites, the associations were only
* Anne Kristine Amstrup [email protected]
1 Osteoporosis Clinic, Department of Endocrinology and Internal Medicine (MEA), THG, Aarhus University Hospital, Tage-Hansens Gade 2, Aarhus C, 8000 Aarhus, Denmark

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