Disparities in osteoporosis screening between caucasian and african american women in us

Abstract

Introduction: Osteoporosis is considered as one of the most prevalent diseases in bone. As a late complication vertebral fractures occur frequently. Vertebral morphometry combined with measurement of the bone mineral density (BMD), e.g. by quantitative computed tomography (QCT), are established methods for fracture assessment and diagnosis of osteoporosis. Low BMD is believed to be associated with vertebral height reductions and vertebral fractures. We compare a new innovative method for morphometry (MorphoXpress®) with QCT to evaluate suspected links between both methods in patients with osteoporosis. Patients and method: 303 patients with osteoporosis (♂=51, ♀=252, mean age: 69 J.) were evaluated retrospectivly. All patients present with a standardized spine x-ray and a BMDmeasurement by QCT. Quantitative morphometric assessment was performed using a computer-assisted method for vertebral shape analysis (MorphoXpress®). Statistical calculations included calculations of correlation between BMD and percentage of heigth reduction in vertebral bodies as well as group comparisons according to semiquantitative assessment scores (after Genant and Wu et al.). Results: QCT measurements showed a BMD below 80 mg/cm3HA (hydroxylapatite) in 219/303 patients (mean: 65.2 mg/cm3HA; SD: 29.4 mg/cm3HA). Quantitative morphometry resulted in a total of 567 vertebral bodies with height reductions over 20% in 202/303 patients. These were primarily located around Th7 and Th12. Mean height reduction was 28%. Group comparison showed significantly lower BMD-Scores in patients with stronger reductions of the vertebral height compared to those with higher BMD scores. The sensitivity of morphometry detecting patients with low BMD was 84.7%, specificity was 52.5%. Discussion: In patients with low BMD (b 80 mg/cm3), quantitative morphometry detects height reductions with good accuracy. Therefore MorphoXpress® seems to be a feasable tool to detect vertebral fractures in patients with reduced BMD. As both methods aim at two different parameters in diagnosis, quantification, and follow-up of osteoporosis, one cannot replace the other, but will rather be of support. The enhanced quantitative morphometry using MorphoXpress® offers in addition to the measurement of BMD a reproducable and objective method for assessing vertebral deformaties. We believe it can be of good value especially in the follow-up of osteoporotic patients.