Abstract
BackgroundAreal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. However, as aBMD is calculated as bone mineral content (BMC) divided by the scanned area, aBMD displays an inverse relationship with bone size. In a skeleton that is increasing in size, this is a problem, as bone size is an independent factor that determines bone strength. It could therefore be questioned whether peak aBMD is the period with greatest bone strength, a period that in the hip then would occur in ages 16–19. The aim of this study was to evaluate whether there are changes in bone size in men after age 18 that may influence peak bone strength. Another aim was to provide updated normative DXA data.MethodsWe scanned left femoral neck by DXA in a cross-sectional study with a population-based selection of 1052 men aged 18–28, and then registered bone mineral content (BMC, gram), aBMD (gram/cm2) and bone area (cm2) in each one-year age group. We performed analyses of variance (ANOVA) to evaluate whether there were differences in these traits between the age groups. We then used Pearson’s correlation analyses to test for trends with ageing after peak bone mass was reached.ResultsWe found the highest absolute femoral neck aBMD at age 19, with statistically significant differences between the one-year age groups in BMC, aBMD, and bone area (all p < 0.05). From peak bone mass onwards (n = 962), there are negative correlations between age and BMC (r = − 0.07; p < 0.05) and age and aBMD (r = − 0.12; p < 0.001), and positive correlation between age and bone area (r = 0.06; p < 0.05).ConclusionAs femoral neck bone size in young adult men becomes larger after peak bone mass, it could be questioned whether DXA estimated peak aBMD correlates with peak bone strength. We infer that aBMD must be interpreted with care in individuals with a growing skeleton, since skeletal strength may then increase, in spite of decreasing aBMD. This should be taken into account when performing DXA measurements in these ages.
Highlights
Areal bone mineral density estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture
Observational studies have further shown that one standard deviation (SD) higher Areal bone mineral density (aBMD) is associated with halved fracture risk [3]. aBMD is used in the clinical situation to identify patients with high fracture risk [4] and, applying the World Health Organization (WHO) definition, to define osteoporosis [5, 6]
As DXA is based on a two-dimensional imaging technique [1, 2], with aBMD derived by dividing the amount of bone mineral (bone mineral content (BMC in grams) by the scanned bone area, there will rise problems when estimating bone strength in growing skeletons
Summary
Areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. As DXA is based on a two-dimensional imaging technique [1, 2], with aBMD derived by dividing the amount of bone mineral (bone mineral content (BMC in grams) by the scanned bone area (cm2), there will rise problems when estimating bone strength in growing skeletons. This is because decreased aBMD could be due to (i) decreased amount of bone minerals within an anatomic region with unchanged size, (ii) increased bone size in a region with unchanged amount of bone minerals or (iii) a combination. A decreased aBMD, based selectively on an increased bone size, may erroneously lead to the conclusion that the individual is developing weaker bone
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