Distal Forearm Bone Mineral Density Research Articles

Preliminary study of distal forearm bone mineral density in residents of Doi Lo District: Observation and comparison with Mae Chaem, and Omkoi Districts, Chiang Mai Province, Thailand

Background: We previously reported distal forearm bone mineral density (BMD) information for individuals residing in Mae Chaem and Omkoi districts, Chiang Mai Province, Thailand. Objective: This study was aimed to observe distal forearm BMD in residents of Doi Lo District and compare this data with individuals residing in Mae Chaem District and Omkoi District in Chiang Mai Province, Thailand. Materials and methods: Two hundred fifty-one subjects (215 women, 36 men), aged 24 to 69 years, currently reside in Doi Lo District. BMD was measured on the non-dominant distal forearm using peripheral dual-energy X-ray absorptiometry (pDEXA). Subsequently, data from Doi Lo District were compared with data from Mae Chaem District and Omkoi District obtained from earlier studies. Results: Distal forearm BMD decreased, and the prevalence of osteoporosis increased in both females and males across age groups. This trend was consistent with data from Mae Chaem District and Omkoi District. Conclusion: This study demonstrated the prevalence of distal forearm BMD and osteoporosis among females and males in Doi Lo District. The findings from Doi Lo District were consistent with those from Mae Chaem District and Omkoi District in Chiang Mai Province, Thailand. These results provide valuable insights into bone health among residents of Chiang Mai Province, Thailand.

Cross-Sectional and Longitudinal Associations between Forearm Bone Mineral Density and Anthropometry in Adult Japanese Men and Women.

No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors. Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class. Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight. Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.

Impact of Adding Distal Forearm Bone Mineral Density Measurement to Axial Bone Mineral Density Measurement for the Diagnosis of Osteoporosis: Prevalence and Risk Factors for Diagnostic Discordance

Background: Studies have demonstrated the superiority of distal forearm bone mineral density (BMD) measurement over axial BMD measurement for prediction of osteoporotic fractures of distal radius. However, distal forearm BMD measurement is not routinely performed at most centers. Objective: To demonstrate the prevalence of discordance in diagnosis of osteoporosis using axial and distal forearm BMD measurement, and to assess whether age and other potential risk factors can predict major discordance. Materials and Methods: Postmenopausal women aged 45 years or older and men aged 50 years or older who underwent lumbar spine, hip, and distal forearm BMD measurement at Prompt Health Center, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand, between January 2021 and December 2021 were recruited. The T-scores of axial site and distal forearm were categorized based on World Health Organization classification to determine the prevalence of diagnostic discordance. Major discordance was defined as having one osteoporotic and one normal T-score. Factors potentially associated with major discordance were explored using univariate and multivariate logistic regression models. Results: Eight hundred eighty-one participants including 621 women and 260 men with a mean age of 59.2±6.7 years were analyzed. There were 13.2% participants diagnosed with osteoporosis of the axial site, and 16.0% of the one-third (1/3) radius. The rates of major discordance, minor discordance, and concordance between axial and 1/3 radius T-scores were 3.2%, 40.5%, and 56.3%, respectively. Age of 65 years or older was significantly associated with major axial and 1/3 radius T-score discordance, with an adjusted odds ratio of 2.7 and 95% confidence interval 1.24 to 5.87 (p=0.012). Conclusion: Diagnostic discordance is observed for at least one-third of the participants using axial and distal forearm BMD measurement. The age of 65 years or older is a risk factor for major discordance. Keywords: Bone mineral density; Osteoporosis; Spine; Hip; Distal forearm; Discordance

Bone Mineral Density at Distal Forearm in Women in Mae Chaem District, Chiang Mai Province, Thailand: A Cross-Sectional Study

Background: Osteoporosis is a common health problem worldwide and has a high impact on quality of life and economic losses. However, having an early risk assessment can resolve the problem. Objective: To investigate the prevalence of bone mineral density (BMD) and osteoporosis in the distal forearm among Thai women in Mae Chaem District, Chiang Mai Province, Thailand. Methods: The subjects were 456 women, aged between 24-88 years who inhabit Mae Chaem District, Chiang Mai Province, Thailand. The demographic characteristics data was obtained by using self-administered questionnaires that determine common risk factors for osteoporosis. The BMD of the non-dominant distal forearm of all subjects was determined according to standard protocol by use of peripheral dual energy X-ray absorptiometry (pDEXA) scanning. Results: The BMD decreased as a function of age (Pearson's r = -0.645) while the BMD increased as a function of weight (Pearson's r = 0.389), and height (Pearson's r = 0.267). The percentage of prevalence is increased as a function of age-group in osteoporosis group, while it is decreased in that of normal bone density. In addition, the BMD at distal forearm decreased when the duration of menopause increased (Pearson's r = -0.455) Conclusion: The prevalence of osteoporosis was found in the women who reside in Mae Chaem District, Chiang Mai Province, Thailand. The current study will provide the information to guide the strategies for preventing osteoporosis in the population.

Downturn in Childhood Bone Mass: A Cross-Sectional Study Over Four Decades.

ABSTRACTScreen time and physical inactivity have increased among children. As physical activity is a determinant of bone mass, there is a concern that children today have lower bone mass than earlier. If this is true, fractures may become more common in the future. In 2017–2018, we used single‐photon absorptiometry (SPA) to measure distal forearm bone mineral density (BMD; mg/cm2) in a normative cohort of 238 boys and 204 girls aged 7 to 15 years. We compared these results to BMD in a normative cohort collected in 1979–1981 (55 boys and 61 girls aged 7 to 15 years) measured by the same scanner. To investigate difference between the two cohorts, we used multiple linear regression with age, sex, and cohort as predictors. Predicted bone density at age 16 years was estimated through the slope values. The bone density‐age slope was flatter in the cohort measured in 2017–2018 than in the cohort measured 1979–1981 (−5.6 mg/cm2/yr [95% confidence interval −9.6 to −1.5]). Predicted bone density was at age 16 years in 2017–2018 in boys was 10% lower (−0.9 SD) and in girls 11% lower (−1.1 SD) than in their counterparts measured in 1979–1981. We found indications that children nowadays develop lower bone mass than four decades ago, giving concern that they may have a higher risk of osteoporosis and fragility fractures as they grow old. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

The skeletal phenotype of intermediate GM1 gangliosidosis: Clinical, radiographic and densitometric features, and implications for clinical monitoring and intervention.

GM1 gangliosidosis is a lysosomal storage disorder caused by mutations in GLB1 encoding a lysosomal β-galactosidase. This disease is a continuum from the severe infantile form with rapid neurological decline to the chronic adult form, which is not life-limiting. The intermediate or type 2 form can be further classified into late infantile and juvenile forms. The frequency and severity of skeletal outcomes in late infantile and juvenile patients have not been characterized. Our goals are to describe the radiological skeletal abnormalities, bone mineral density (BMD), and frequency of fractures in patients with intermediate GM1 gangliosidosis. We evaluated 13 late infantile and 21 juvenile patients as part of an ongoing natural history study. Average time from onset of symptoms to diagnosis was 1.9 and 6.3 years for late infantile and juvenile patients, respectively. All late infantile patients had odontoid hypoplasia and pear-shaped vertebral bodies, the frequency of which was significantly different than in patients with juvenile disease (none and 14%, respectively). Juvenile patients had irregular endplates of the vertebral bodies (15/21), central indentation of endplates (10/21), and squared and flat vertebral bodies (10/21); all allowed radiographic differentiation from late infantile patients. Lumbar spine, femoral neck, and total hip BMD were significantly decreased (-2.1, -2.2, and -1.8 Z-scores respectively). Lumbar spine BMD peaked at 19 years, while distal forearm BMD peaked at 30 years. Despite low BMD, no patients exhibited fractures. We have demonstrated that all late infantile patients have some degree of odontoid hypoplasia suggesting the need for cervical spine evaluation particularly prior to anesthesia, whereas juvenile patients had variable skeletal involvement often affecting activities of daily living. Type 2 GM1 gangliosidosis patients have skeletal abnormalities that are both an early indication of their diagnosis, and require monitoring and management to ensure the highest possible quality of life.

Distal Forearm Bone Mineral Density Among Hill Tribes in the Omkoi District, Chiang Mai Province, Thailand

Background:Osteoporosis is a major public health issue in several countries worldwide because it increases healthcare costs, and is a risk for mortality. There have been several studies that have examined BMD among the various Thai people and the regions that they inhabit.Objective:This study examined the distal forearm Bone Mineral Density (BMD) in men and women over 40 years of age among members of various Karen hill-tribes located in the Omkoi District, Chiang Mai Province, Thailand.Methods:Two hundred and sixty-two subjects (180 women, 82 men), ranging from 40 to 83 years old were recruited in this study. The non-dominant distal forearm bone mineral density was assessed by using peripheral dual-energy X-ray absorptiometry (pDEXA).Results:The results showed that the BMD were 0.530 ± 0.065, 0.508 ± 0.087, 0.461 ± 0.098, and 0.438 ± 0.124 g/cm2for men age 40-49 years, age 50-59 years, age 60-69 years, and ages 70-83 years, respectively. For women, the BMD were 0.392 ± 0.051, 0.337 ± 0.063, 0.232 ± 0.065, and 0.212 ± 0.069 g/cm2among women age 40-49 years, age 50-59 years, age 60-69 years, and ages 70-83 years, respectively. BMD had decreased in post-menopause as a function of duration time after menopause.Conclusion:We determined the prevalence of osteoporosis of men and women of Karen hill-tribes in the Chiang Mai Province, Thailand. These findings provided important information regarding bone health in Karen hill-tribes for any healthcare planning done in the immediate future.

Risk factors for osteoporosis in men aged 40 years or older: the results of the program «Osteoscreening-Russia»

Objective:to estimate the prevalence of individual risk factors (RFs) for osteoporosis (OP) and fractures, the frequency of high-risk osteoporotic fractures by the Fracture Risk Assessment Tool (FRAXR) and OP according to distal forearm X-ray densitometric findings in men aged 50 years or older in different regions of Russia.Patients and methods.Random cluster proportionally stratified samples of men aged 40 years or older were formed in the district polyclinics of 23 towns of the country with over 100,000 people in the framework of the social program «Osteoscreening-Russia» (OSR). The survey was conducted using a unified questionnaire. Screening also involved a densitometric study of distal forearm bone mineral density using a peripheral X-ray osteodensitometer (Osteometer Meditech DTX-200). The final analysis included 5057 men from 14 towns of 5 federal districts (FDs) of Russia.Results.Estimation of the prevalence of individual RFs for osteoporotic fractures in men aged 40 years or older showed that the most common RFs were insufficient dietary calcium intake (91%), smoking (30%), low-energy fractures in the history (20%), low physical activity (16%), and secondary causes of OP (11%). The men in the Ural FD (UFD), Siberian FD, and Central FD were more frequently found to have ≥3 RFs. 5% of men aged 50 years or older were at high risk for osteoporotic fractures by FRAXR, whereas the frequency of OP according to peripheral densitometric findings was 19%. The inhabitants of the North-Western FD and UFD had the greatest need for medical and preventive measures, which was identified by the FRAXR algorithm.Conclusion.The OSR survey could reveal the most common clinical RFs for OP and osteoporotic fractures in men in 5 regions of the Russian Federation, insufficient dietary calcium intake and assess the risk of osteoporotic fractures and the rate of OP according to peripheral densitometric findings.

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. The study population constituted 6565 participants aged 50-79years at baseline in the Tromsø Study wave 4 conducted in 1994-1995. Forearm BMD measured by SXA was categorized as "normal," "osteopenia," or "osteoporosis" following WHO's definition. Cox regression with all-cause mortality as the outcome over 22years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.

Does vitamin D supplementation improve bone density in vitamin D-deficient children? Protocol for an individual patient data meta-analysis

IntroductionOur previous study-level (aggregate data) meta-analysis suggested that vitamin D supplements may be beneficial for bone density specifically in children with vitamin D deficiency. However, the misclassification of vitamin D...

Comparison of the effects of denosumab with either active vitamin D or native vitamin D on bone mineral density and bone turnover markers in postmenopausal osteoporosis

Osteoporosis is a worldwide health concern. Although treatment with denosumab plus the active vitamin D alfacalcidol has been found to improve femoral neck (FN) and distal forearm bone mineral density (BMD), there have been no reports on the efficacy or adverse effects of denosumab plus eldecalcitol (ELD) in primary osteoporosis patients. Fifty-six treatment-naïve post-menopausal women with primary osteoporosis were recruited and divided into denosumab plus native vitamin D or denosumab plus ELD. Ultimately, 26 subjects in the native vitamin D group and 24 in the ELD group were analyzed. Lumbar and total hip BMD significantly increased in both groups. However, there was no significant difference in the percent increase of lumbar and total hip BMD between two groups. FN-BMD was significantly increased from 6 to 12 months in the ELD group compared with baseline. This study revealed that combination therapy with denosumab and ELD could improve FN-BMD more effectively than denosumab plus native vitamin D. Thus, the addition of ELD may enhance the effects of denosumab treatment for primary osteoporosis.

Plasma n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Renal Transplant Recipients

Renal transplant recipients (RTR) suffer high rates of bone loss and increased risk of fracture. Marine n-3 polyunsaturated fatty acids (n-3 PUFA), found mainly in fish and seafood, may have beneficial effects on bone and are positively associated with bone mineral density (BMD) in healthy elderly. The aim of this study was to investigate if this association prevails despite the more complex causes of bone loss in RTR. A total of 701 RTR were included in a cross-sectional analysis. BMD of lumbar spine, proximal femur, and distal forearm were measured by dual energy x-ray absorptiometry scan, and blood samples were drawn in the fasting state for measurement of plasma fatty acid composition 10weeks posttransplant. Multiple linear regression analysis was used to assess the association between plasma marine n-3 PUFA levels and BMD. Mean age was 52.2years, and two-thirds were men. Based on femoral neck T-scores, 26% of patients were osteoporotic and 52% osteopenic. Z-scores increased significantly across quartiles of marine n-3 PUFA levels, and marine n-3 PUFA was a positive predictor of BMD at total hip and lumbar spine after multivariate adjustment. No association was found between n-6 PUFA content and BMD. Plasma marine n-3 PUFA levels were positively associated with BMD at the hip and lumbar spine 10weeks posttransplant.

Preterm Children Born Small for Gestational Age are at Risk for Low Adult Bone Mass.

Cross-sectional studies suggest that premature birth and low birth weight may both be associated with low peak bone mass. We followed bone traits in preterm individuals and controls for 27 years and examined the effects of birth weight relative to gestational age [stratified as small for gestational age (SGA) or appropriate for gestational (AGA)] on adult bone mineral density (BMD). We measured distal forearm BMC (g/cm) and BMD (g/cm(2)) with single-photon absorptiometry (SPA) in 46 preterm children (31 AGA and 15 SGA) at mean age 10.1 years (range 4-16) and in 84 healthy age-matched children. The measurements were repeated 27 years later with the same SPA apparatus but then also with dual energy absorptiometry and peripheral computed tomography (pQCT). Preterm individuals were shorter (p = 0.03) in adulthood than controls. Preterm AGA individuals had similar BMC and BMD height-adjusted Z-scores in adulthood compared to controls. Preterm SGA individuals had lower distal forearm BMC and BMD height-adjusted Z-scores in adulthood than both controls and preterm AGA individuals. Preterm SGA individuals had lower gain from childhood to adulthood in distal forearm BMC height-adjusted Z-scores than controls (p = 0.03). The deficits in preterm SGA individuals in adulthood were also captured by DEXA in height-adjusted femoral neck (FN) BMC Z-score and height-adjusted FN BMD Z-score and by pQCT in tibial cross-sectional area (CSA) Z-score and stress strain index (SSI) Z-score, where all measurements were lower than controls (all p values <0.05). Preterm SGA individuals are at increased risk of reaching low adult bone mass, at least partly due to a deficit in the accrual of bone mineral during growth. In our cohort, we were unable to find a similar risk in preterm AGA individuals.

Pressing and vibrating bone acupoints for female primary osteoporosis

Objective To observe the clinical efficacy of pressing and vibrating bone acupoints for female primary osteoporosis.Methods In May,2009,80 patients with osteopotosis were chosen from the female retirees in the medical examination center of our institute as research objects and then were randomly divided into a treatment group and a control group,40 cases for each group.The control group administered 1.5 g calcium carbonate,125 IU vitamin D3,and 240 IU (twice) salmon calcitonin nasal spray daily and maintained normal life; in addition,the treatment group were pressed and vibrated the bone acupoints with acupoint pressing and vibrating device with a vibration frequency of 30-50 Hz and a pressure of 3 ～ 5 kg 5times a week,45 minutes each time for 6 months.The changes of distal forearm bone mineral density and lumbar and back pain situation were observed after the treatment.Results After the treatment,the efficacy rate was 92.30％ in the treatment group and was 21.10％ in the control group,with a statistical difference (P ＜ 0,01).The distal forearm bone mineral density of the treatment group was (0.274 ± 0.073) g/cm2 before the treatment and was (0.386 ± 0.057) g/cm2 after the treatment,with a statistical difference (P ＜ 0.01).Conclusions Pressing and vibrating bone acupoints for female primary osteoporosis is markedly effective and can increase bone mineral density. Key words: Female primary osteoporosis; Pressing and vibrating bone acupoint; Bone mineral density; Treatment

Impact of adding distal forearm DXA to hip and spine measurements on DXA report

Dual energy X-ray absorptiometry (DXA) is the gold standard modality for non-invasive diagnosis of osteoporosis but controversy exists about the optimal site (s) for bone mineral density (BMD) measurement. The objective was to find out impact of adding distal forearm BMD to hip and spine measurements on final diagnosis of a DXA study. This prospective study recruited 279 consecutive patients [female 256 (92%); male 23 (8%)] with a mean age of 63.25 ± 10.62 years from April 2011 to April 2012. The BMD was measured over hip (total hip and femoral neck), spine and distal forearm in all patients. Based on T-Score values of hip and spine (2 sites), diagnosis was normal in 34%, low bone mass in 40% and osteoporosis in 26% patients. However, adding distal forearm BMD and T-score (3 sites), diagnosis was normal in 28%, low bone mass in 37% and osteoporosis in 35%. Therefore, distal forearm BMD has upstaged the diagnosis from normal to low bone mass in 14%, from normal to osteoporosis in 2% and from low bone mass to osteoporosis in 18% patients. We conclude that combining distal forearm BMD with spine and hip can identify more patients with low bone mass or osteoporosis.

Bone mineral density in Nigerian children after discontinuation of calcium supplementation

BackgroundNigerian toddlers with low dietary calcium intakes increased forearm bone mineral density (BMD) after 18months of calcium supplementation compared with placebo. However, it is not known if this bone mineral accretion is sustained after calcium supplement withdrawal. We therefore investigated the influence of prior calcium supplementation on forearm BMD 12months after withdrawal of the supplement. MethodsNigerian toddlers aged 12–18months from three urban communities were enrolled in a controlled trial of calcium supplementation. Two communities received daily calcium supplements, one as calcium carbonate (400mg), and the other as ground fish (529±109mg), for a duration of 18months, and all three communities received vitamin A (2500IU daily) as placebo. Forearm BMD was measured 5 times during 18months of calcium supplementation and at 12months after supplement withdrawal. ResultsOf 647 children enrolled, 390 completed the trial of calcium supplementation and 261 of these returned for the final follow-up 12months after discontinuation of supplementation. During the 18months of supplementation, an adjusted model demonstrated that the increase in both distal and proximal forearm BMD over time was significantly greater in the calcium supplemented groups than in the placebo group (P<0.04). However, after supplement withdrawal, the increase in BMD over time was largely attenuated and only remained significant at the proximal forearm in the ground fish group (P=0.03). ConclusionThe benefit of calcium supplementation on forearm BMD in young Nigerian children is not sustained after supplement withdrawal.

Does a childhood fracture predict low bone mass in young adulthood?—A 27-year prospective controlled study

A fracture in childhood is associated with low bone mineral density (BMD), but it is debated whether a fracture at growth also predicts low BMD in young adulthood. The purpose of this work was to gender-specifically evaluate whether children with a fracture are at increased risk of low BMD in young adulthood. Distal forearm BMD (g/cm2) was measured with single-photon absorptiometry (SPA) in 47 boys and 26 girls (mean age 10 years, range 3-16 years) with an index fracture and in 41 boys and 43 girls (mean age 10 years, range 4-16 years) with no fracture. BMD was re-measured mean 27 years later with the same SPA apparatus and with dual-energy absorptiometry (DXA), quantitative ultrasound (QUS), and peripheral computed tomography (pQCT). Individual Z-scores were calculated using the control cohort as reference population. Data are presented as means with 95% confidence intervals (95% CI) within brackets and correlation with Pearson's correlation coefficient. Boys with an index fracture had at fracture event a distal forearm BMD Z-score of -0.4 (95% CI, -0.7 to -0.1) and at follow-up -0.4 (95% CI, -0.7 to -0.1). Corresponding values in girls were -0.2 (95% CI, -0.5 to 0.1) and -0.3 (95% CI, -0.7 to 0.1). The deficit in absolute bone mass was driven by men with index fractures in childhood due to low energy rather than moderate or high energy. There were no changes in BMD Z-score during the follow-up period. The BMD deficit at follow-up was in boys with an index fracture verified with all advocated techniques. A childhood fracture in men was associated with low BMD and smaller bone size in young adulthood whereas the deficit in women did not reach statistical significance.

Bone Mineral Density Measured by a Portable X-ray Device Agrees With Dual-Energy X-ray Absorptiometry at Forearm in Preschool Aged Children

Dual-energy X-ray absorptiometry (DXA) measures of bone mineral density (BMD) are generally not feasible in fieldwork. The present study determined the agreement between BMD measured by DXA and portable peripheral DXA in preschool aged children. Fifty-seven children (4.2±1.0yr) had their nondominant distal forearm scanned using a peripheral DXA scanner (PIXI; GE Medical Systems Lunar, Madison, WI) at their daycare and a DXA (4500A Discovery Series; Hologic Inc., Bedford, MA) at our research clinic. Correlation analysis, one-way analysis of variance, and Bland-Altman plots were performed to examine the agreement between measurements. Data were also divided into tertiles for cross-classification analysis and calculation of kappa coefficients. Distal forearm BMD measured by PIXI was significantly correlated with DXA measures of total forearm BMD (r>0.51; p<0.001), proximal 1/3 BMD (r>0.41; p<0.001), mid-BMD (r>0.37; p<0.001), and ultradistal (UD) BMD (r>0.57; p<0.001). Cross-classification in the same or adjacent tertile between measures (UD forearm: 96.5%; UD radius: 94.4%; total forearm: 87.7%; total radius: 84.2%) resulted in weighted kappa coefficients of 0.46, 0.58, 0.42, and 0.43, respectively. Bland-Altman plots further clarified these agreements as all had low bias (UD forearm: bias=0.003±0.002; UD radius: −0.015±0.021; total forearm: −0.062±0.027; total radius: −0.077±0.026). These results demonstrate that portable DXA measures of forearm BMD agree moderately with DXA.

What is the utility of distal forearm DXA in primary hyperparathyroidism?

Primary hyperparathyroidism (PHPT) leads to increased bone turnover, low bone mineral density, and increased fracture risk. These effects are, however, preferentially seen in the distal forearm, which is rich in cortical bone. This study aimed to determine how frequently the distal forearm T score was the worst T score and if this T score alone led to higher rate of diagnosis of osteopenia or osteoporosis. We retrospectively reviewed a prospective database of 300 patients undergoing parathyroidectomy at our institution between November 2000 and January 2009. The bone mineral density of the lumbar spine, total proximal femurs, and distal third of the nondominant radius was measured by dual x-ray absorptiometry. Data on bone density are reported as T scores. The mean T scores were -1.30 ± 0.2 in the distal forearm, -1.0 ± 0.1 in the total proximal femurs, and -0.9 ± 0.1 in the spine. The distal forearm T score was the worst bone mineral density T score in 39% of patients. This T score alone led to an upstaging in diagnosis to osteopenia or osteoporosis in 9.4% of patients. In patients with PHPT, the worst T score is commonly found in the distal forearm. This T score can identify additional patients with a diagnosis of osteopenia or osteoporosis. Distal forearm bone mineral density should, therefore, be assessed in all patients who have a diagnosis of PHPT.

The association between caffeine intake and forearm bone mineral density in postmenopausal women: The Oslo Health Study

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