Most Cited Journal of Clinical Densitometry Articles
The most cited articles published since 2011, extracted from Scopus.
Correlations Between Trabecular Bone Score, Measured Using Anteroposterior Dual-Energy X-Ray Absorptiometry Acquisition, and 3-Dimensional Parameters of Bone Microarchitecture: An Experimental Study on Human Cadaver VertebraeDidier Hans | Nicole Barthe | Stephanie Boutroy | Laurent Pothuaud | Renaud Winzenrieth | Marc Antoine Krieg
Volume 14, Issue 3, July 2011, Pages 302-312
Developing a novel technique for the efficient, noninvasive clinical evaluation of bone microarchitecture remains both crucial and challenging. The trabecular bone score (TBS) is a new gray-level texture measurement that is applicable to dual-energy X-ray absorptiometry (DXA) images. Significant correlations between TBS and standard 3-dimensional (3D) parameters of bone microarchitecture have been obtained using a numerical simulation approach. The main objective of this study was to empirically evaluate such correlations in anteroposterior spine DXA images. Thirty dried human cadaver vertebrae were evaluated. Micro-computed tomography acquisitions of the bone pieces were obtained at an isotropic resolution of 93. μm. Standard parameters of bone microarchitecture were evaluated in a defined region within the vertebral body, excluding cortical bone. The bone pieces were measured on a Prodigy DXA system (GE Medical-Lunar, Madison, WI), using a custom-made positioning device and experimental setup. Significant correlations were detected between TBS and 3D parameters of bone microarchitecture, mostly independent of any correlation between TBS and bone mineral density (BMD). The greatest correlation was between TBS and connectivity density, with TBS explaining roughly 67.2% of the variance. Based on multivariate linear regression modeling, we have established a model to allow for the interpretation of the relationship between TBS and 3D bone microarchitecture parameters. This model indicates that TBS adds greater value and power of differentiation between samples with similar BMDs but different bone microarchitectures. It has been shown that it is possible to estimate bone microarchitecture status derived from DXA imaging using TBS. © 2011 The International Society for Clinical Densitometry.
Executive Summary of the 2013 International Society for Clinical Densitometry Position Development Conference on Bone DensitometryJohn T. Schousboe | John A. Shepherd | John P. Bilezikian | Sanford Baim
Volume 16, Issue 4, October 2013, Pages 455-466
The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) every 2-3yr to make recommendations for guidelines and standards in the field of musculoskeletal measurement and assessment. The recommendations pertain to clinically relevant issues regarding the acquisition, quality control, interpretation, and reporting of various aspects of musculoskeletal health metrics. Topics for consideration are developed by the ISCD Board of Directors and the Scientific Advisory Committee. For the 2013 PDC, body composition analysis was a central topic area for the first time and considered timely because of the scientific advances in measurement of fat and lean body mass by dual-energy X-ray absorptiometry (DXA). Indications for DXA and vertebral fracture assessment and use of reference data to calculate bone mineral density T-scores were also updated. Task Forces for each of these areas were assigned questions of relevance to a clinical audience and asked to conduct comprehensive literature reviews. Reports with proposed Position Statements were then presented to an international panel of experts. The Expert Panel included representatives of the International Osteoporosis Foundation, the American Society for Bone and Mineral Research, the National Osteoporosis Foundation, Osteoporosis Canada, and the North American Menopause Society. The PDC was held in Tampa, FL, contemporaneously with the Annual Meeting of the ISCD, March 21 through March 23, 2013. This report describes the methodology of the 2013 ISCD PDC and summarizes the results of the 2013 ISCD PDC for vertebral fracture assessment/DXA and National Health and Nutrition Survey (NHANES) Reference Database Task Forces. A separate article in this issue will summarize the results of the Body Composition Analysis Task Forces. © 2013.
Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. Executive Summary of the 2010 Position Development Conference on Interpretation and Use of FRAX® in Clinical PracticeDidier B. Hans | John A. Kanis | Sanford Baim | John P. Bilezikian | Neil Binkley | Jane A. Cauley | Juliet E. Compston | Cyrus Cooper | Bess Dawson-Hughes | Ghada El-Hajj Fuleihan | William D. Leslie | E. Michael Lewiecki | Marjorie M. Luckey | Eugene V. McCloskey | Socrates E. Papapoulos | Catalina Poiana | René Rizzoli
Volume 14, Issue 3, July 2011, Pages 171-180
The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX® Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX® in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX® in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX®. © 2011 The International Society for Clinical Densitometry.
Dual-energy x-ray absorptiometry interpretation and reporting in children and adolescents: The revised 2013 ISCD pediatric official positionsNicola J. Crabtree | Asma Arabi | Laura K. Bachrach | Mary Fewtrell | Ghada El-Hajj Fuleihan | Heidi H. Kecskemethy | Maciej Jaworski | Catherine M. Gordon
Volume 17, Issue 2, January 2014, Pages 225-242
The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference. © 2014 The International Society for Clinical Densitometry.
Normocalcemic Primary HyperparathyroidismNatalie E. Cusano | Shonni J. Silverberg | John P. Bilezikian
Volume 16, Issue 1, January 2013, Pages 33-39
Primary hyperparathyroidism, a common endocrine disorder, is traditionally defined by hypercalcemia and elevated levels of parathyroid hormone (PTH). A newer presentation of primary hyperparathyroidism has been described over the past decade, in which PTH is elevated but serum calcium is consistently normal, in the absence of secondary causes of hyperparathyroidism, such as renal disease or vitamin D deficiency. Recognition of this phenotype of primary hyperparathyroidism, normocalcemic primary hyperparathyroidism, supports a biphasic chronological time course in some individuals in which PTH levels are first elevated but serum calcium is normal, followed by the development of frank hypercalcemia. This review focuses on the available literature regarding this newly described phenotype of primary hyperparathyroidism. © 2013 The International Society for Clinical Densitometry.
Three-Dimensional (3D) microarchitecture correlations with 2d projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: Effects of resolution and noiseRenaud Winzenrieth | Franck Michelet | Didier Hans
Volume 16, Issue 3, July 2013, Pages 287-296
The aim of the present study is to determine the level of correlation between the 3-dimensional (3D) characteristics of trabecular bone microarchitecture, as evaluated using microcomputed tomography (μCT) reconstruction, and trabecular bone score (TBS), as evaluated using 2D projection images directly derived from 3D μCT reconstruction (TBSμCT). Moreover, we have evaluated the effects of image degradation (resolution and noise) and X-ray energy of projection on these correlations. Thirty human cadaveric vertebrae were acquired on a microscanner at an isotropic resolution of 93. μm. The 3D microarchitecture parameters were obtained using MicroView (GE Healthcare, Wauwatosa, MI). The 2D projections of these 3D models were generated using the Beer-Lambert law at different X-ray energies. Degradation of image resolution was simulated (from 93 to 1488. μm). Relationships between 3D microarchitecture parameters and TBSμCT at different resolutions were evaluated using linear regression analysis. Significant correlations were observed between TBSμCT and 3D microarchitecture parameters, regardless of the resolution. Correlations were detected that were strongly to intermediately positive for connectivity density (0.711≤r2≤0.752) and trabecular number (0.584≤r2≤0.648) and negative for trabecular space (-0.407 ≤r2≤-0.491), up to a pixel size of 1023μm. In addition, TBSμCT values were strongly correlated between each other (0.77≤r2≤0.96). Study results show that the correlations between TBSμCT at 93μm and 3D microarchitecture parameters are weakly impacted by the degradation of image resolution and the presence of noise. © 2013 The International Society for Clinical Densitometry.
Identification of Rheumatoid Arthritis Patients With Vertebral Fractures Using Bone Mineral Density and Trabecular Bone ScoreSophie Bréban | Karine Briot | Sami Kolta | Simon Paternotte | Mirieme Ghazi | Jacques Fechtenbaum | Christian Roux
Volume 15, Issue 3, July 2012, Pages 260-266
The aim of this study was to test bone mineral density (BMD), trabecular bone score (TBS), and their combination, for detection of rheumatoid arthritis (RA) patients with vertebral fractures (VFs). One hundred eighty-five women aged 56.0 ± 13.5. yr, with RA since 15.5 ± 9.9. yr were studied. Lumbar spine, total hip, and femoral neck BMD were assessed by dual-energy X-ray absorptiometry (DXA). TBS was calculated from anteroposterior image of lumbar spine BMD. VFs from T4 to L4 were evaluated using Vertebral Fracture Assessment software on DXA device. The proportions of patients with VF and T-scores ≤-2.5 were only 24.2%, 21.2%, and 33.3% at lumbar spine, total hip, and femoral neck, respectively. T-scores were significantly lower in patients with VF than in patients without VF, the largest difference being observed at femoral neck (p=0.0001). TBS was significantly lower in patients with VF vs without VF (p=0.0001). The areas under the curves were 0.621, 0.704, 0.703, 0.719, and 0.727 for lumbar spine BMD, TBS, lumbar spine BMD. +. TBS, total hip BMD, and femoral neck BMD, respectively. The threshold of 1.173 for TBS had the best sensitivity (63%) and specificity (74%). TBS measured at the lumbar spine has a better discrimination value than lumbar spine BMD, and similar to femoral neck BMD, for prediction of presence of VF in patients with RA. In RA subjects with osteopenia, the proportion of patients with VF was higher in the lowest tertile of TBS when compared with the highest tertile. In this population, at low risk according to BMD, TBS could help to detect patients with VF. © 2012 The International Society for Clinical Densitometry.
The 2011 IOM Report on Vitamin D and Calcium Requirements for North America: Clinical Implications for Providers Treating Patients With Low Bone Mineral DensityClifford J. Rosen | J. Christopher Gallagher
Volume 14, Issue 2, April 2011, Pages 79-84
Vitamin D is an essential nutrient for skeletal mineralization and maintenance of bone mass. Most healthy individuals can meet their vitamin D requirements through dietary means, modest supplementation and solar exposure for short periods of time. The serum level of 25OHD that determines adequacy is 20 ng/ml, which corresponds with consumption of 6-800 IU of vitamin D per day, according to the Institute of Medicine review. There is still debate about whether higher doses of vitamin D are required for treating patients with osteoporosis. © 2011 The International Society for Clinical Densitometry.
Fracture prediction and the definition of osteoporosis in children and adolescents: The ISCD 2013 pediatric official positionsNick Bishop | Paul Arundel | Emma Clark | Paul Dimitri | Joshua Farr | Graeme Jones | Outi Makitie | Craig F. Munns | Nick Shaw
Volume 17, Issue 2, January 2014, Pages 275-280
The ISCD 2007 Pediatric Official Positions define osteoporosis in children on the basis of fracture history and low bone density, adjusted as appropriate for age, gender, and body size. The task force on fracture prediction and osteoporosis definition has reviewed these positions and suggests modifications with respect to vertebral fracture and the definition of a significant fracture history and draws attention to the need to consider degree of trauma as a factor that may modify fracture risk prediction. © 2014 The International Society for Clinical Densitometry.
Official Positions for FRAX® Clinical Regarding Glucocorticoids: The impact of the Use of Glucocorticoids on the Estimate by FRAX® of the 10 Year Risk of Fracture. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®MEdward S. Leib | Kenneth G. Saag | Jonathan D. Adachi | Piet P. Geusens | Neil Binkley | Eugene V. McCloskey | Didier B. Hans
Volume 14, Issue 3, July 2011, Pages 212-219
Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX®). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX® is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX® may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX® calculations. © 2011 The International Society for Clinical Densitometry.
Official Positions for FRAX® Clinical Regarding International Differences. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®Jane A. Cauley | Ghada El-Hajj Fuleihan | Asma Arabi | Saeko Fujiwara | Sergio Ragi-Eis | Andrew Calderon | Siok Bee Chionh | Zhao Chen | Jeffrey R. Curtis | Michelle E. Danielson | David A. Hanley | Heikki Kroger | Annie W C Kung | Olga Lesnyak | Jeri Nieves | Wojciech Pluskiewicz | Rola El Rassi | Stuart Silverman | Anne Marie Schott | Rene Rizzoli | Marjorie Luckey
Volume 14, Issue 3, July 2011, Pages 240-262
Osteoporosis is a serious worldwide epidemic. Increased risk of fractures is the hallmark of the disease and is associated with increased morbidity, mortality and economic burden.FRAX® is a web-based tool developed by the Sheffield WHO Collaborating Center team, that integrates clinical risk factors, femoral neck BMD, country specific mortality and fracture data and calculates the 10 year fracture probability in order to help health care professionals identify patients who need treatment. However, only 31 countries have a FRAX® calculator at the time paper was accepted for publication. In the absence of a FRAX® model for a particular country, it has been suggested to use a surrogate country for which the epidemiology of osteoporosis most closely approximates the index country. More specific recommendations for clinicians in these countries are not available.In North America, concerns have also been raised regarding the assumptions used to construct the US ethnic specific FRAX® calculators with respect to the correction factors applied to derive fracture probabilities in Blacks, Asians and Hispanics in comparison to Whites. In addition, questions were raised about calculating fracture risk in other ethnic groups e.g., Native Americans and First Canadians.In order to provide additional guidance to clinicians, a FRAX® International Task Force was formed to address specific questions raised by physicians in countries without FRAX® calculators and seeking to integrate FRAX® into their clinical practice. The main questions that the task force tried to answer were the following:1.What is the evidence supporting ethnic and sex specific adjustments for fracture incidence rates in Blacks, Hispanics and Asians-2.What data exist for other groups, e.g., Native Americans, First Nations Canadians-3.Are there secular changes in fracture rates-4.What are the requirements for the construction of a FRAX® calculator? And what are the desirable/optimal characteristics of the data-5.What do I do if my country does not have a FRAX® calculator? The Task Force members conducted appropriate literature reviews and developed preliminary statements that were discussed and graded by a panel of experts at the ISCD-IOF joint conference. The statements approved by the panel of experts are discussed in the current paper. © 2011.
Official Positions for FRAX® Clinical Regarding Falls and Frailty: Can Falls and Frailty be Used in FRAX®?. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®Tahir Masud | Neil Binkley | Steven Boonen | Marian T. Hannan
Volume 14, Issue 3, July 2011, Pages 194-204
Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal. © 2011 The International Society for Clinical Densitometry.
Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in womenDiane Krueger | Ellen Fidler | Jessie Libber | Bérengère Aubry-Rozier | Didier Hans | Neil Binkley
Volume 17, Issue 1, January 2014, Pages 60-65
Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis and assess fracture risk. However, DXA cannot evaluate trabecular microarchitecture. This study used a novel software program (TBS iNsight; Med-Imaps, Geneva, Switzerland) to estimate bone texture (trabecular bone score [TBS]) from standard spine DXA images. We hypothesized that TBS assessment would differentiate women with low trauma fracture from those without. In this study, TBS was performed blinded to fracture status on existing research DXA lumbar spine (LS) images from 429 women. Mean participant age was 71.3 yr, and 158 had prior fractures. The correlation between LS BMD and TBS was low (r = 0.28), suggesting these parameters reflect different bone properties. Age- and body mass index-adjusted odds ratios (ORs) ranged from 1.36 to 1.63 for LS or hip BMD in discriminating women with low trauma nonvertebral and vertebral fractures. TBS demonstrated ORs from 2.46 to 2.49 for these respective fractures; these remained significant after lowest BMD T-score adjustment (OR = 2.38 and 2.44). Seventy-three percent of all fractures occurred in women without osteoporosis (BMD T-score > -2.5); 72% of these women had a TBS score below the median, thereby appropriately classified them as being at increased risk. In conclusion, TBS assessment enhances DXA by evaluating trabecular pattern and identifying individuals with vertebral or low trauma fracture. TBS identifies 66-70% of women with fracture who were not classified with osteoporosis by BMD alone. © 2014 The International Society for Clinical Densitometry.
2013 pediatric position development conference: EXECUTIVE summary and reflectionsCatherine M. Gordon | Mary B. Leonard | Babette S. Zemel
Volume 17, Issue 2, January 2014, Pages 219-224
The International Society for Clinical Densitometry (ISCD) convened its second Pediatric Position Development Conference (PDC) on October 2-3, 2013 in Baltimore, MD. The conference was co-sponsored by the American Society for Bone and Mineral Research (ASBMR) and was held immediately before their annual meeting. The aim of a PDC is to make recommendations for standards in the field of bone densitometry. The recommendations address issues such as quality control, data acquisition and analysis, and the interpretation and reporting of bone densitometric results. In 2007, ISCD convened its first Pediatric PDC to address issues specific to skeletal health assessments in children and adolescents. The 2013 Pediatric PDC focused on advances in the field since that initial conference that would lead to revisions of the original positions. Topics for consideration were developed by the ISCD and its Scientific Advisory Committee. Clinically relevant questions related to each topic were assigned to task forces for a comprehensive review of the medical literature and subsequent presentation of reports to an international panel of experts. Expert panelists included representatives from both the ISCD and ASBMR. The recommendations of the PDC Expert Panel were subsequently reviewed by the ISCD Board of Directors and positions accepted by majority vote. The approved recommendations became the Official Positions of the ISCD. The positions are to be submitted to the ASBMR for its consideration for endorsement. Topics considered at the Pediatric PDC included fracture prediction and definition of osteoporosis, dual-energy X-ray absorptiometry assessment in chronic diseases that may affect the skeleton, dual-energy X-ray absorptiometry interpretation and reporting, quantitative computed tomography measurements, and densitometry in infants and young children. We discuss potential implications of the new recommendations and factors leading to a change in the wording of these positions, considering the science that has evolved over the past 6. yr. © 2014 The International Society for Clinical Densitometry.
Official Positions for FRAX® Bone Mineral Density and FRAX® Simplification. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®E. Michael Lewiecki | Juliet E. Compston | Paul D. Miller | Jonathan D. Adachi | Judith E. Adams | William D. Leslie | John A. Kanis | Alireza Moayyeri | Robert A. Adler | Didier B. Hans | David L. Kendler | Adolfo Diez-Perez | Marc Antoine Krieg | Basel K. Masri | Roman R. Lorenc | Douglas C. Bauer | Glen M. Blake | Robert G. Josse | Patricia Clark | Aliya A. Khan
Volume 14, Issue 3, July 2011, Pages 226-236
Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues. © 2011 The International Society for Clinical Densitometry.
Official Positions for FRAX® Clinical Regarding Biochemical Markers. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®Eugene V. McCloskey | Samuel Vasikaran | Cyrus Cooper
Volume 14, Issue 3, July 2011, Pages 220-222
The best indirect evidence that increased bone turnover contributes to fracture risk is the fact that most of the proven therapies for osteoporosis are inhibitors of bone turnover. The evidence base that we can use biochemical markers of bone turnover in the assessment of fracture risk is somewhat less convincing. This relates to natural variability in the markers, problems with the assays, disparity in the statistical analyses of relevant studies and the independence of their contribution to fracture risk. More research is clearly required to address these deficiencies before biochemical markers might contribute a useful independent risk factor for inclusion in FRAX®. © 2011.
Serum uric acid levels in relation to bone-related phenotypes in men and womenChanika Sritara | Boonsong Ongphiphadhanakul | Laor Chailurkit | Sukit Yamwong | Wipa Ratanachaiwong | Piyamitr Sritara
Volume 16, Issue 3, July 2013, Pages 336-340
Serum uric acid levels have recently been found to be associated with bone mineral density (BMD) in elderly males. The purpose of the present study was to investigate the relationship between bone-related phenotypes and serum uric acid levels in young and middle-aged males and females. Subjects consisted of 1320 males and 485 females aged 25-54. yr. Bone densitometry and quantitative ultrasonometry (QUS) were performed on each subject. Serum uric acid and biochemical markers of bone turnover were measured in fasting serum samples. When adjusted for covariates including age, body weight, and serum creatinine in multiple linear regression models, it was found that there was a positive association between uric acid levels and BMD in males at the lumbar spine (p< 0.05). The association between uric acid levels and BMD was found in females after controlling for age, body weight, and serum creatinine at the femoral neck, but in the opposite direction (p< 0.05). Uric acid levels were related to the stiffness index (SI) as assessed by QUS in males, independent of age, body weight, and serum creatinine (p< 0.05). No association between uric acid and SI in females was found. The present study demonstrated a positive association in males between serum uric acid levels and BMD, and SI from QUS, suggesting a beneficial influence of uric acid on both the quantity and quality of bone in males. © 2013 The International Society for Clinical Densitometry.
Skeletal Effects of Primary Hyperparathyroidism: Bone Mineral Density and Fracture RiskE. Michael Lewiecki | Paul D. Miller
Volume 16, Issue 1, January 2013, Pages 28-32
Parathyroid hormone (PTH) is associated with anabolic and catabolic skeletal effects that vary according to the kinetics of serum levels and the type of bone. The anabolic effects are manifested in patients with a periodic rapid transient rise in serum PTH, as seen with daily subcutaneous injection of PTH(1-34) and PTH(1-84) in the treatment of osteoporosis. These patients have an increase in bone mineral density (BMD), particularly at skeletal sites with a high trabecular component, such as the lumbar spine, and a reduction in fracture risk. The catabolic effects are typified in patients with primary hyperparathyroidism (PHPT) who have chronic persistently elevated PTH levels. Patients with long-standing PHPT have a reduction in BMD, particularly at predominately cortical skeletal sites, such as the one-third radius, with relative preservation of BMD at the lumbar spine. Some but not all studies have reported an increase in fracture risk with PHPT. Because many patients with PHPT are postmenopausal women at risk for osteoporosis owing to estrogen deficiency, BMD and fracture risk may be a result of multiple factors with variable effects on bone remodeling. The skeletal effects of normocalcemic PHPT have not yet been fully characterized, but may not be the same as hypercalcemic PHPT. © 2013 The International Society for Clinical Densitometry.
Official Positions for FRAX ® Clinical Regarding Rheumatoid Arthritis. From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX ®Susan B. Broy | S. Bobo Tanner
Volume 14, Issue 3, July 2011, Pages 184-189
Rheumatoid arthritis is the only secondary cause of osteoporosis that is considered independent of bone density in the FRAX ® algorithm. Although input for rheumatoid arthritis in FRAX ® is a dichotomous variable, intuitively, one would expect that more severe or active disease would be associated with a greater risk for fracture. We reviewed the literature to determine if specific disease parameters or medication use could be used to better characterize fracture risk in individuals with rheumatoid arthritis. Although many studies document a correlation between various parameters of disease activity or severity and decreased bone density, fewer have associated these variables with fracture risk. We reviewed these studies in detail and concluded that disability measures such as HAQ (Health Assessment Questionnaire) and functional class do correlate with clinical fractures but not morphometric vertebral fractures. One large study found a strong correlation with duration of disease and fracture risk but additional studies are needed to confirm this. There was little evidence to correlate other measures of disease such as DAS (disease activity score), VAS (visual analogue scale), acute phase reactants, use of non-glucocorticoid medications and increased fracture risk. We concluded that FRAX ® calculations may underestimate fracture probability in patients with impaired functional status from rheumatoid arthritis but that this could not be quantified at this time. At this time, other disease measures cannot be used for fracture prediction. However only a few, mostly small studies addressed other disease parameters and further research is needed. Additional questions for future research are suggested. © 2011 The International Society for Clinical Densitometry.
Secondary and Tertiary HyperparathyroidismSophie A. Jamal | Paul D. Miller
Volume 16, Issue 1, January 2013, Pages 64-68
We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up. © 2013 The International Society for Clinical Densitometry.
The Official Positions of the International Society for Clinical Densitometry: Acquisition of Dual-Energy X-Ray Absorptiometry Body Composition and Considerations Regarding Analysis and Repeatability of MeasuresThomas N. Hangartner | Sarah Warner | Pierre Braillon | Larry Jankowski | John Shepherd
Volume 16, Issue 4, October 2013, Pages 520-536
In preparation for the International Society for Clinical Densitometry Position Development Conference of 2013 in Tampa, Florida, Task Force 2 was created as 1 of 3 task forces in the area of body composition assessment by dual-energy X-ray absorptiometry (DXA). The assignment was to review the literature, summarize the relevant findings, and formulate positions covering (1) accuracy and precision assessment, (2) acquisition of DXA body composition measures in patients, and (3) considerations regarding analysis and repeatability of measures. There were 6 primary questions proposed to the task force by the International Society for Clinical Densitometry board and expert panel. Based on a series of systematic reviews, 14 new positions were developed, which are intended to augment and define good clinical practice in quantitative assessment of body composition by DXA. © 2013 The International Society for Clinical Densitometry.
Precision of GE Lunar iDXA for the Measurement of Total and Regional Body Composition in Nonobese AdultsMegan P. Rothney | Francois Pierre Martin | Yi Xia | Maurice Beaumont | Cynthia Davis | David Ergun | Laurent Fay | Fiona Ginty | Sunil Kochhar | Wynn Wacker | Serge Rezzi
Volume 15, Issue 4, October 2012, Pages 399-404
Dual-energy X-ray absorptiometry (DXA) is a well-accepted technique for measuring body composition. Knowledge of measurement precision is critical for monitoring of changes in bone mineral content (BMC), and fat and lean masses. The purpose of this study was to characterize in vivo precision of total body and regional body composition parameters using the GE Lunar iDXA (GE Healthcare Lunar, Madison, WI) system in a sample of nonobese subjects. We also evaluated the difference between expert and automatic region-of-interest (ROI) analysis on body composition precision. To this end, 2 total body scans were performed on each subject with repositioning between scans. Total body precision for BMC, fat and lean mass were 0.5%, 1.0%, and 0.5% coefficient of variation (CV), respectively. Regional body composition precision error was less than 2.5% CV for all regions except arms. Precision error was higher for the arms (CV: BMC 1.5%; fat mass 2.8%; lean mass 1.6%), likely owing to the placement of arms relative to torso leading to differences in ROI. There was a significant correlation between auto ROI and expert ROI (r>. 0.99). Small, but statistically significant differences were found between auto and manual ROI. Differences were small in total body, leg, trunk, and android and gynoid regions (0.004-2.8%), but larger in arm region (3.0-6.3%). Total body and regional precision for iDXA are small and it is suggested that iDXA may be useful for monitoring changes in body composition during longitudinal trials. © 2012 The International Society for Clinical Densitometry.
Obesity Increases Precision Errors in Dual-Energy X-Ray Absorptiometry MeasurementsKaren M. Knapp | Joanne R. Welsman | Susan J. Hopkins | Ignac Fogelman | Glen M. Blake
Volume 15, Issue 3, July 2012, Pages 315-319
The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9kg/m 2 were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (<25kg/m 2) (n=48), overweight (25-30kg/m 2) (n=26), and obese (>30kg/m 2) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated. © 2012 The International Society for Clinical Densitometry.
Bone health in children and adolescents with chronic diseases that may affect the skeleton: The 2013 ISCD pediatric official positionsMaria Luisa Bianchi | Mary B. Leonard | Susanne Bechtold | Wolfgang Högler | M. Zulf Mughal | Eckhart Schönau | Francisco A. Sylvester | Maria Vogiatzi | Marry M. van den Heuvel-Eibrink | Leanne Ward
Volume 17, Issue 2, January 2014, Pages 281-294
The aim of this Task Force was to review the use of dual-energy X-ray absorptiometry (DXA) in children and adolescents with underlying chronic diseases that pose risk factors for compromised bone health, such as inflammation, glucocorticoid therapy, or decreased mobility. The Task Force systematically analyzed more than 270 studies, with an emphasis on those published in the interval since the original 2007 Position Statements. Important developments over this period included prospective cohort studies demonstrating that DXA measures of areal bone mineral density (aBMD) predicted incident fractures and the development of robust reference data and strategies to adjust for bone size in children with growth impairment. In this report, we summarize the current literature on the relationship between DXA-based aBMD and both fracture (vertebral and non-vertebral) outcomes and non-fracture risk factors (e.g., disease characteristics, ambulatory status, and glucocorticoid exposure) in children with chronic illnesses. Most publications described the aBMD profile of children with underlying diseases, as well as the cross-sectional or longitudinal relationship between aBMD and clinically relevant non-fracture outcomes. Studies that addressed the relationship between aBMD and prevalent or incident fractures in children with chronic illnesses are now emerging. In view of these updated data, this report provides guidelines for the use of DXA-based aBMD in this setting. The initial recommendation that DXA is part of a comprehensive skeletal healthy assessment in patients with increased risk of fracture is unchanged. Although the prior guidelines recommended DXA assessment in children with chronic diseases at the time of clinical presentation with ongoing monitoring, this revised Position Statement focuses on the performance of DXA when the patient may benefit from interventions to decrease their elevated risk of a clinically significant fracture and when the DXA results will influence that management. © 2014 The International Society for Clinical Densitometry.
Asymptomatic Primary HyperparathyroidismShonni J. Silverberg | Marcella D. Walker | John P. Bilezikian
Volume 16, Issue 1, January 2013, Pages 14-21
The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term " asymptomatic primary hyperparathyroidism" was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease. © 2013 .