Abstract
Introduction: Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is the primary screening tool for diagnosis of osteopenia and osteoporosis. BMD alone does not provide information regarding the structural characteristics of bone and this limitation has been a driver for the development of techniques, including trabecular bone score (TBS) software, to assess bone microarchitecture. Precision error in DXA is important for accurately monitoring changes in BMD and it has been demonstrated that BMD precision error increases with increasing body mass index (BMI). Information on in vivo precision error for TBS is very limited. This study evaluated short-term precision error (STPE) of lumbar spine BMD & TBS measurement, and investigated the effect of obesity on DXA precision error. Method: DXA lumbar spine scans (L1-L4) were performed using GE Lunar Prodigy. STPE was measured in ninety-one women at a single visit by duplicating scans with repositioning in-between. Precision error was calculated as the percentage coefficient of variation. Participants were sub-divided into four groups based on BMI to assess the effect of obesity on STPE. Results: STPE is poorer for TBS than for BMD. STPE is adversely affected for both BMD and TBS measurements by increasing BMI but this effect is mitigated for TBS in the highest BMI category where use of the thick scanning mode improves signal to noise ratio. Conclusion: Results from serial BMD and TBS measurements should take account of differences in precision error in the two techniques and in different BMI categories.
Highlights
Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is the primary screening tool for diagnosis of osteopenia and osteoporosis
short-term precision error (STPE) is adversely affected for both BMD and trabecular bone score (TBS) measurements by increasing body mass index (BMI) but this effect is mitigated for TBS in the highest BMI category where use of the thick scanning mode improves signal to noise ratio
The BMI sub-groups were well matched, with no significant differences for mean age, height, lumbar spine BMD and TBS except for group A.3 who were significantly older with lower mean TBS scores compared to the normal BMI group
Summary
Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is the primary screening tool for diagnosis of osteopenia and osteoporosis. This study evaluated short-term precision error (STPE) of lumbar spine BMD & TBS measurement, and investigated the effect of obesity on DXA precision error. Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is currently the primary screening tool for clinical diagnosis of osteopenia and osteoporosis on the basis of its relatively low cost, convenience for patients, ISSN 1925-4008 E-ISSN 1925-4016 www.sciedu.ca/jbgc short scan times and minimal radiation dose [1]. A combination of structural and densotomic indices potentially provide a more accurate assessment of bone quality and fragility that may improve sensitivity and/or specificity to identify individuals at heightened fracture risk [7]
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