Selected Annotated Bibliography

Abstracted By Esther L. Smith and Dianne Rose

South Med J. 2002;95(6) 

In This Article

I. Diagnosis

  • Theodorou DJ, Theodorou SJ: Dual-energy x-ray absorptiometry in clinical practice: application and interpretation of scans beyond the numbers. Clin Imaging 2002; 26:43-49

Bone mineral density measurements by dual-energy x-ray absorptiometry (DXA) may be influenced by various artifacts and pathologic processes. Accurate interpretation of the scan findings requires careful analysis of these factors. This review of the published literature includes a discussion of incidental findings that can influence bone mineral density measurements and common pitfalls of DXA scan interpretation.

  • Abrahamsen B, Stilgren LS, Hermann AP, et al: Discordance between changes in bone mineral density measured at different skeletal sites in perimenopausal women - implications for assessment of bone loss and response to therapy: The Danish Osteoporosis Prevention Study. J Bone Miner Res 2001; 16:1212-1219

  • Adler RA, Funkhouser HL, Holt CM: Utility of heel ultrasound bone density in men. J Clin Densitom 2001; 4:225-230

  • Alonso CG, Curiel MD, Carranza FH, et al: Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter Project for Research in Osteoporosis. Osteoporos Int 2000; 11:714-720

  • Aoki TT, Grecu EO, Srinivas PR, et al: Prevalence of osteoporosis in women: variation with skeletal site of measurement of bone mineral density. Endocr Pract 2000; 6:127-131

  • Bergot C, Laval-Jeantet AM, Hutchinson K, et al: A comparison of spinal quantitative computed tomography with dual energy x-ray absorptiometry in European women with vertebral and nonvertebral fractures. Calcif Tissue Int 2001; 68:74-82

  • Berntsen GK, Fonnebo V, Tollan A, et al: Forearm bone mineral density by age in 7,620 men and women: the Tromso study, a population-based study. Am J Epidemiol 2001; 153:465-473

  • Blake GM, Fogelman I: Monitoring treatment for osteoporosis by using bone densitometry. Semin Nucl Med 2001; 31:212-222

  • Blake GM, Herd RJ, Patel R, et al: The effect of weight change on total body dual-energy x-ray absorptiometry: results from a clinical trial. Osteoporos Int 2000; 11:832-839

  • Boyanov M: Diagnostic discrepancies between two closely related forearm bone density measurement sites. J Clin Densitom 2001; 4:63-71

  • Cheng S, Njeh CF, Fan B, et al: Influence of region of interest and bone size on calcaneal BMD: implications for the accuracy of quantitative ultrasound assessments at the calcaneus. Br J Radiol 2002; 75:59-68

  • Coin A, Sergi G, Beninca P, et al: Bone mineral density and body composition in underweight and normal elderly subjects. Osteoporos Int 2000; 11:1043-1050

  • Crandall C: The role of serial bone mineral density testing for osteoporosis. J Womens Health Gend Based Med 2001; 10:887-895

  • Crandall C: When to measure BMD in patients being treated for osteoporosis. Postgrad Med 2001; 109:191-192

  • Dubois EF, van den Bergh JP, Smals AG, et al: Comparison of quantitative ultrasound parameters with dual energy x-ray absorptiometry in pre- and postmenopausal women. Neth J Med 2001; 58:62-70

  • Economides PA, Kaklamani VG, Karavas I, et al: Assessment of physician responses to abnormal results of bone densitometry studies. Endocr Pract 2000; 6:351-356

  • Ekman A, Michaelsson K, Petren-Mallmin M, et al: DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female hip fracture patients from controls: a comparison between four different methods. Osteoporos Int 2001; 12:185-191

  • Fordham JN, Chinn DJ, Kumar N: Identification of women with reduced bone density at the lumbar spine and femoral neck using BMD at the os calcis. Osteoporos Int 2000; 11:797-802

  • Gass R: The early preclinical diagnosis of osteoporosis measuring the pure trabecular bone density. Eur J Med Res 2001; 6:228-230

  • Greenspan SL, von Stetten E, Emond SK, et al: Instant vertebral assessment: a noninvasive dual x-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 2001; 4:373-380

  • Gurlek A, Baraktar M, Ariyurek M: Inappropriate reference range for peak bone mineral density in dual-energy x-ray absorptiometry: implications for the interpretation of T-scores. Osteoporos Int 2000; 11:809-813

  • Henry MJ, Pasco JA, Seeman E, et al: Assessment of fracture risk: value of random population-based samples - the Geelong Osteoporosis Study. J Clin Densitom 2001; 4:283-289

  • Karsh J: Diagnostic challenges in osteoporosis. indications for bone densitometry and establishing secondary causes. Can Fam Physician 2001; 47:1244-1250

  • Kirchengast S, Peterson B, Hauser G, et al: Body composition characteristics are associated with the bone density of the proximal femur end in middle- and old-aged women and men. Maturitas 2001; 39:133-145

  • Link TM, Vieth V, Matheis J, et al: Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures. Eur Radiol 2002; 12:401-408

  • Lu Y, Genant HK, Shepherd J, et al: Classification of osteoporosis based on bone mineral densities. J Bone Miner Res 2001; 16:901-910

  • Maricic M, Chen Z: Bone densitometry. Clin Lab Med 2000; 20:469-488

  • Mulder JE, Michaeli D, Flaster ER, et al: Comparison of bone mineral density of the phalanges, lumbar spine, hip, and forearm for the assessment of osteoporosis in postmenopausal women. J Clin Densitom 2000; 3:373-381

  • Nguyen TV, Center JR, Eisman JA: Association between breast cancer and bone mineral density: the Dubbo Osteoporosis Epidemiology Study. Maturitas 2000; 36:27-34

  • Nolla JM, Gomez-Vaquero C, Fiter J, et al: Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures. Ann Rheum Dis 2002; 61:73-75

  • Nordin BE, Burnet RB, Fitzgerald S, et al: Bone densitometry in clinical practice: longitudinal measurements at three sites in postmenopausal women on five treatments. Climacteric 2001; 4:235-242

  • Petley GW, Taylor PA, Murrills AJ, et al: An investigation of the diagnostic value of bilateral femoral neck bone mineral density measurements. Osteoporos Int 2000; 11:675-679

  • Phillipov G, Seaborn CJ, Phillips PJ: Reproducibility of DXA: potential impact on serial measurements and misclassification of osteoporosis. Osteoporos Int 2001; 12:49-54

  • Pouilles JM, Tremollieres FA, Martinez S, et al: Ability of peripheral DXA measurements of the forearm to predict low axial bone mineral density at menopause. Osteoporos Int 2001; 12:71-76

  • Prevrhal S, Fuerst T, Fan B, et al: Quantitative ultrasound of the tibia depends on both cortical density and thickness. Osteoporos Int 2001; 12:28-34

  • Rea JA, Li J, Blake GM, et al: Visual assessment of vertebral deformity by x-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 2000; 11:660-668

  • Sahota O, Pearson D, Cawte SW, et al: Site-specific variation in the classification of osteoporosis, and the diagnostic reclassification using the lowest individual lumbar vertebra T-score compared with the L1-L4 mean, in early post-menopausal women. Osteoporos Int 2000; 11:852-857

  • Sim MF, Stone M, Johansen A, et al: Cost effectiveness analysis of BMD referral for DXA using ultrasound as a selective pre-screen in a group of women with low trauma Colles' fractures. Technol Health Care 2000; 8:277-284

  • Siris ES, Miller PD, Barrett-Connor E, et al: Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 2001; 286:2815-2822

  • Wachter NJ, Augat P, Mentzel M, et al: Predictive value of bone mineral density and morphology determined by peripheral quantitative computed tomography for cancellous bone strength of the proximal femur. Bone 2001; 28:133-139

  • Yao WJ, Wu CH, Wang ST, et al: Differential changes in regional bone mineral density in healthy Chinese: age-related and sex-dependent. Calcif Tissue Int 2001; 68:330-336 (Please see annotation under Special Groups - Ethnic.)

  • Midtby M, Magnus JH, Joakimsen RM: The Tromso Study: a population-based study on the variation in bone formation markers with age, gender, anthropometry and season in both men and women. Osteoporos Int 2001; 12:835-843

Menopause, body mass and seasonal changes affect the levels of bone alkaline phosphatase (S-BAP) and osteocalcin (S-OC) bone markers, which are important bone formation factors, and should be considered in the evaluation of bone loss. In order to make proper use of these bone markers, background information on how biological factors affect the level of bone turnover markers is crucial. Researchers evaluated the variations with height, weight, age, gender, and body mass index and season on a population cohort randomized from the 1994/1995 Tromso Study (n = 528 men and 605 women, aged 25 to 74 years). In men, S-BAP displayed no change with age. However, S-OC showed a decrease up to the age of 56 years with little change. Menopause was the chief factor influencing the variations in bone marker measurements in women, with the mean level of S-OC and S-BAP increasing by 21% and 41%, respectively. In both men and women, there was a negative trend in S-OC with body mass index. A 20% change in S-BAP levels was observed in postmenopausal women. Both S-BAP and S-OC levels varied in men in relation to the seasonal conditions of a far northern latitude.

  • Fassbender WJ, Balli M, Gortz B, et al: Sex steroids, biochemical markers, bone mineral density and histomorphometry in male osteoporosis patients. In Vivo 2000; 14:611-618

  • Lane NE, Sanchez S, Genant HK, et al: Short-term increases in bone turnover markers predict parathyroid hormone-induced spinal bone mineral density gains in postmenopausal women with glucocorticoid-induced osteoporosis. Osteoporos Int 2000; 11:434-442 (Please see annotation under Secondary Osteoporosis - Corticosteroid-Induced.)

  • Nordin BE, Burnet RB, Fitzgerald S, et al: Bone densitometry in clinical practice: longitudinal measurements at three sites in postmenopausal women on five treatments. Climacteric 2001; 4:235-242

  • Xue Y, Jia W, Zhang H, et al: Urinary cross-linked N-telopeptides of type I collagen and bone metabolic diseases. Chin Med J (Engl) 1999; 112:149-152

  • Black DM, Steinbuch M, Palermo L, et al: An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 2001; 12:519-528

The FRACTURE Index is useful in the assessment of 5-year risk of hip and other osteoporotic fractures in older postmenopausal women, with or without bone mineral density (BMD) testing. It also helps clinicians identify and determine further evaluation/treatment needs for high-risk patients and is predictive of hip, vertebral, and nonvertebral fractures. The Study of Osteoporotic Fractures (SOF) in 7,782 women ≥65 years of age provided data for the development of the Fracture Index, which includes these variables: age, BMD T-score, fracture after 50 years of age, maternal hip fracture after age 50 years, weight ≤125 pounds (57 kg), smoking status, and use of arms to stand up from a chair. Ambulatory women ≥65 years of age were recruited from population-based listings in Oregon, Minnesota, Maryland, and Pennsylvania; the analysis excluded Caucasians who had a previous hip fracture or bilateral hip replacement. Mean age was 73.3 years, with a total hip BMD T-score of -1.5. A strong relationship exists between the FRACTURE Index and hip fracture risk, and it is shown even stronger when BMD measurement is included. Age is the most important component of the index, and higher values occur more often in older women.

Further clinical evaluation is recommended for postmenopausal women with a total score of ≥6 with BMD assessment or ≥4 without BMD assessment.

  • Dargent-Molina P, Poitiers F, Breart G: In elderly women, weight is the best predictor of a very low bone mineral density: evidence from the EPIDOS study. Ostoporos Int 2000; 11:881-888 (Please see annotation under Pathophysiology - Weight.)

  • Genant HK, Li J, Wu CY, et al: Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 2000; 3:281-290

  • Greenfield DM, Eastell R: Risk factors for ankle fracture. Osteoporos Int 2001; 12:97-103

  • Guthrie JR, Dennerstein L, Wark JD: Risk factors for osteoporosis: a review. Medscape Womens Health 2000; 5:E1

  • Huuskonen J, Vaisanen SB, Kroger H, et al: Determinants of bone mineral density in middle aged men: a population-based study. Osteoporos Int 2000; 11:702-708

  • Melton LJ III, Khosla S, Achenbach SJ, et al: Effects of body size and skeletal site on the estimated prevalence of osteoporosis in women and men. Osteoporos Int 2000; 11:977-983

  • NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285:785-795

  • Russell AS, Morrison RT: An assessment of the new "SCORE" index as a predictor of osteoporosis in women. Scand J Rheumatol 2001; 30:35-39

  • Smerdely P, Seller M, Smith A, et al: Predictors of bone mass in healthy older men in the community. Med J Aust 2000; 173:183-186

  • Trivitayaratana W, Trivitayaratana P, Kongkiatikus S: Arm span, height and forearm bone mineral density in normal young and postmenopausal women. J Med Assoc Thai 2001; 84(suppl 2):S510-S515

  • Trivitayaratana W, Trivitayaratana P: Limb measurements for height and bone mineral density estimation. J Med Assoc Thai 2001; 84(suppl 2):S505-S509

  • van der Voort DJ, Dinant GJ, Rinkens PE, et al: Construction of an algorithm for quick detection of patients with low bone mineral density and its applicability in daily general practice. J Clin Epidemiol 2000; 53:1095-1103

  • Vestergaard P, Hermann AP, Gram J, et al: Evaluation of methods for prediction of bone mineral density by clinical and biochemical variables in perimenopausal women. Maturitas 2001; 40:211-220

  • Yarbrough DE, Barrett-Connor E, Morton DJ: Birth weight as a predictor of adult bone mass in postmenopausal women: the Rancho Bernardo Study. Osteoporos Int 2000; 11:626-630

  • Westfall G, Littlefield R, Heaton A, et al: Methodology for identifying patients at high risk for osteoporotic fracture. Clin Ther 2001; 23:1570-1588

  • Knapp KM, Blake GM, Spector TD, et al: Multisite quantitative ultrasound: precision, age- and menopause-related changes, fracture discrimination, and T-score equivalence with dual-energy x-ray absorptiometry. Osteoporos Int 2001; 12:456-464

Multisite ultrasound is an innovative and promising technique for analyzing skeletal status in the clinical setting. Researchers tested the in vitro and in vivo short- and long-term precision of a new multisite ultrasound device to determine accuracy and effectiveness in evaluating bone status. The device is capable of measuring speed of sound at the radius, tibia, phalanx and metatarsal. The ultrasound proved to be capable of differentiating between pre- and postmenopausal women and has a T-score equivalence similar to that of dual-energy x-ray absorptiometry .

  • Adler RA, Funkhouser HL, Holt CM: Utility of heel ultrasound bone density in men. J Clin Densitom 2001; 4:225-230 (Please see annotation under Special Groups - Men.)

  • Cetin A, Erturk H, Celiker R, et al: The role of quantitative ultrasound in predicting osteoporosis defined by dual x-ray absorptiometry. Rheumatol Int 2001; 20:55-59

  • Damilakis J, Perisinakis K, Gourtsoyiannis N: Imaging ultrasonometry of the calcaneus: opotimum T-score thresholds for the identification of osteoporotic subjects. Calcif Tissue Int 2001; 68:219-224

  • Drozdzowska B, Pluskiewicz W: Quantitative ultrasound at the calcaneus in premenopausal women and their postmenopausal mothers. Bone 2001; 29:79-83 (Please see annotation under Pathophysiology - Genetics.)

  • Frost ML, Blake GM, Fogelman I: Quantitative ultrasound and bone mineral density are equally strongly associated with risk factors for osteoporosis. J Bone Miner Res 2001; 16:406-416

  • Ingle BM, Sherwood KE, Eastell R: Comparison of two methods for measuring ultrasound properties of the heel in postmenopausal women. Osteoporos Int 2001; 12:500-505

  • Jorgensen HL, Warming L, Bjarnason NH, et al: How does quantitative ultrasound compare to dual x-ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories? Clin Physiol 2001; 21:51-59

  • Lin JD, Chen JF, Chang HY, et al: Evaluation of bone mineral density by quantitative ultrasound of bone in 16,862 subjects during routine health examination. Br J Radiol 2001; 74:602-606

  • Montagnani A, Gonnelli S, Cepollaro C, et al: Usefulness of bone quantitative ultrasound in management of osteoporosis in men. J Clin Densitom 2001; 4:231-237

  • Njeh CF, Hans D, Li J, et al: Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimination. Osteoporos Int 2000; 11:1051-1062

  • Ohishi T, Kushida K, Yamazaki K, et al: Ultrasound measurement using CUBA clinical system can discriminate between women with and without vertebral fractures. J Clin Densitom 2000; 3:227-231

  • Vanderjagt DJ, Bond B, Dulai R, et al: Assessment of the bone status of Nigerian women by ultrasound and biochemical markers. Calcif Tissue Int 2001; 68:277-284 (Please see annotation under Special Groups - Ethnic.)

  • Wear KA, Armstrong DW III: Relationships among calcaneal backscatter, attenuation, sound speed, hip bone mineral density, and age in normal adult women. J Acoust Soc Am 2001; 110:573-578

  • Weiss M, Ben-Shlomo AB, Hagag P, et al: Reference database for bone speed of sound measurement by a novel quantitative multi-site ultrasound device. Osteoporos Int 2000; 11:688-696