Phalangeal Bone Mineral Density Research Articles

Relation between phalangeal bone mineral density and radiographic knee osteoarthritis: a cross-sectional study.

BackgroundMajor reports have suggested that bone mineral density (BMD) is higher in patients with osteoarthritis (OA), while other studies do not agree. Our aim was to examine the cross-sectional association between phalangeal BMD and radiographic knee OA.MethodsA total of 2855 participants were included in this study. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) Grade ≥ 2 in at least one leg. BMD scans of the middle phalanges of the second, third and fourth digits of the nondominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). A multivariable logistic analysis model was applied to test the relation between phalangeal BMD with radiographic knee OA, the presence of knee osteophytes (OSTs), and knee joint space narrowing (JSN) after adjusting for a number of potential confounding factors.ResultsThe multivariable-adjusted odds ratios with 95 % confidence intervals [ORs (95 % CI)] of radiographic knee OA across phalangeal BMDs were 1.08 (95 % CI 0.89–1.32) and 0.62 (95 % CI 0.45–0.86), respectively. The P for trend was 0.09. For the female population, the multivariable-adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 1.01 (95 % CI 0.73–1.37) and 0.58 (95 % CI 0.38 − 0.87), respectively. The P for trend was 0.02. This positive finding, however, did not exist in the male subgroup. There was a significantly lower prevalence of OST in the osteoporosis (OP) group than in the normal group (OR = 0.59, 95 % CI 0.40–0.88; P for trend was 0.01). In contrast, the prevalence of JSN was significantly higher in the osteopenia group (OR = 1.22, 95 % CI 1.00–1.48) and the OP group (OR = 1.35, 95 % CI 1.00–1.84) than in the normal group. The P for trend was 0.02.ConclusionsThis study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal subjects. The prevalence of JSN was higher in the osteopenia and OP groups than in normal subjects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0918-x) contains supplementary material, which is available to authorized users.

Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture.

Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61-81years). Correlation between the two methods was estimated using correlation coefficient (r) and Bland-Altman plots. A moderate correlation between phalangeal BMD versus total hip (r=0.47) and lumbar spine (r=0.51), and an AUC on 0.80 was found. The mean difference between phalangeal T score and total hip T score/lumbar spine T score was low, and ranged from -0.26 SD to -0.31 SD depending on site and reference database used for calculation of T scores, but, large variation was seen at an individual level. When applying a triage approach approx. one-third of all DXA scan could be avoided and only 6% of women in the low-risk group would be false negatives.

The controversial relationship between osteoarthritis and osteoporosis: an update on hand subtypes

To compare hand osteoarthritis (HOA) subtypes and to examine possible links with local bone mineral density (BMD). Fifty-five patients with erosive hand osteoarthritis (EHOA) and 21 patients with nodal hand osteoarthritis (NOA) fulfilling American College of Rheumatology criteria for HOA were evaluated. Subjects showing at least two erosions of the interphalangeal joints were assigned to the EHOA group; the others were considered NOA. Disease duration, number of active joints and radiological scores were assessed. All patients and 174 controls underwent phalangeal radiographic absorptiometry (pRA) of the middle phalanges of the non-dominant hand to assess BMD, T- and Z-scores. BMD was higher in EHOA with respect to NOA and controls (P=0.05); T- and Z-scores were significantly higher in EHOA (P=0.01 and P<0.01). Values suggestive of osteopenia were found in 32% of EHOA and 22% of NOA patients, and in 44% of controls (P=0.05 EHOA vs. NOA); a T-score <-2.5 standard deviations was present in 15% of EHOA and 28% of NOA patients, and in 21% of controls (P=0.05 EHOA vs. NOA). Phalangeal BMD was higher in EHOA compared to NOA and controls. This characteristic could potentially be exploited to differentiate the two hand OA subtypes.

Quantitative ultrasound measurements of the calcaneus and hand phalanges in elderly Spanish men: relationship with peripheral bone mineral density of the hand phalanges.

The aims of this pilot study were to describe quantitative ultrasound (US) measurements and peripheral bone mineral density (BMD) of the hand phalanges on dual-energy x-ray absorptiometry and to examine the correlations between them in elderly Spanish men. We studied 199 healthy men (mean age ± SD, 73.31 ± 5.10 years). The participants were not taking any medications, and they reported no diseases, including diseases that are associated with abnormalities in mineral metabolism. Phalangeal and calcaneal quantitative US measurements and phalangeal BMD measurements were performed in all participants. A bivariate correlation analysis showed no association between quantitative US assessments at the phalanges or the calcaneus (P = .409). After adjustment for potential confounders, the correlation between phalangeal BMD and phalangeal quantitative US measurements was r = 0.417 (P < .0001), and the correlation for calcaneal quantitative US was r = 0.26 (P = .001). Further adjustment by percentage of body fat increased quantitative US correlations with phalangeal BMD: r = 0.450 (P < .0001) at the phalanges; r = 0.291 (P = .001) at the calcaneus. There is a small correlation between quantitative US measurements at the calcaneus and phalangeal BMD that increases to a moderate level with quantitative US measurements at the phalanges in elderly Spanish men.

Fracture Risk Prediction Using Phalangeal Bone Mineral Density or FRAX®?—A Danish Cohort Study on Men and Women

In this prospective study, we investigated the ability of Fracture Risk Assessment Tool (FRAX), phalangeal bone mineral density (BMD), and age alone to predict fractures using data from a Danish cohort study, Danish Health Examination Survey 2007–2008, including men (n = 5206) and women (n = 7552) aged 40–90 yr. Data were collected using a self-administered questionnaire and by phalangeal BMD measurement. Information on incident and prevalent fractures, rheumatoid arthritis, and secondary osteoporosis was retrieved from the Danish National Patient Registry. Survival analyses were used to examine the association between low, intermediate, and high risk by phalangeal T-score or FRAX and incident fractures, and receiver operating characteristic curves were obtained. Mean follow-up time was 4.3 yr, and a total of 395 persons (3.1%) experienced a fracture during follow-up. The highest rate of major osteoporotic fractures was observed in persons with a high combined risk (FRAX ≥20% and T-score ≤−2.5; women: 32.7 and men: 27.6 per 1000 person-yr). This group also had the highest risk of hip fractures (women: 8.1 and men: 7.2 per 1000 person-yr). FRAX and T-score in combination analyzed as continuous variables performed overall best in the prediction of major osteoporotic fractures. In predicting hip fractures, there was a tendency of T-score performing worse than the other methods.

Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women—results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008)

This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures. The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures. This prospective study included a cohort of 15,542 men and women aged 18–95 years, who underwent a BMD scan in Danish Health Examination Survey 2007–2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International Classification of Diseases (ICD-10). Follow-up was 27–45 months. Major osteoporotic fractures (vertebral fractures, humerus fractures, forearm fractures and hip fractures) were used in the analyses. Fracture events were calculated as "persons with fracture" and evaluated using survival analysis. A total of 307 (1.98 %) of the participants had experienced a new fracture during follow-up. BMD was significantly lower in subjects with fracture (0.32 vs. 0.34 g/cm(2); p < 0.001 adjusted for age, gender, prevalent fractures, height, weight and smoking). In both women and men, a 1 SD decrease in BMD (T score units) was associated with an increased risk of fracture when adjusted for age and prevalent fractures (women: HR = 1.39, CI 1.24–1.54, p < 0.001; men: HR = 1.47, CI 1.20–1.79, p < 0.001). Phalangeal BMD as measured using RA predicts the incidence of major osteoporotic fractures.

Phalangeal Densitometry Compared With Dual Energy X-ray Absorptiometry for Assessment of Bone Mineral Density in Elderly Women

Reduced bone mineral density (BMD) is identified as a major risk factor for fracture. The World Health Organization criterion for diagnosis of osteoporosis (T-score ≤-2.5 SD) is based on dual energy X-ray absorptiometry (DXA) measurements. However DXA availability may be limited in some regions. In this study the ability of the phalangeal radiographic absorptiometry (RA) device, MetriScan, to identify women with reduced BMD at the femoral neck assessed by DXA was evaluated. The study population contained women with recent low-energy distal radius fracture and women recruited from the general population, all aged ≥50 years. A triage approach was applied in which two cut-offs for RA T-score were defined at which individuals with 90% sensitivity and 90% specificity could be identified to have or not have reduced BMD at the femoral neck defined as T-score ≤-2.5 SD. The correlation between phalangeal RA BMD and femoral neck DXA BMD was r=0.65 (p<0.001). The upper and lower RA T-score cut-off was -1.5 SD and -2.9 SD. With the triage approach being used for the whole cohort, 34% would require a central DXA assessment to determine if the femoral neck T-score is below or above -2.5 SD. The application of the RA MetriScan device can reduce the number of DXA assessments needed to detect reduced BMD. The device may thus be of clinical value if access to DXA is limited, as well as for screening purposes.

Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study—the Danish Health Examination Survey 2007–2008

The study investigates an association between phalangeal bone mineral density (BMD) and self-reported passive smoking using data on 15,038 persons (aged 18-95 years), who underwent a BMD scan in the Danish KRAM study. BMD was significantly lower in persons exposed to long-term passive smoking in their home during adulthood. Smoking is associated with decreased bone mineral density (BMD) and increased risk of osteoporotic fractures. This study aimed to investigate a possible association between BMD at the phalangeal bones and self-reported passive smoking. The study included a cohort of 15,544 men and women aged 18-95 years, who underwent a BMD scan in the Danish KRAM study. BMD scans of the middle phalanges of the second, third and fourth digits of the non-dominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). Also, height, weight and body fat percentage were measured and 96.7% (n = 15,038) of the participants answered a self-reported questionnaire with information on passive smoking, other lifestyle factors, education, etc. The association between passive smoking and BMD was examined using multiple linear regression analysis. A total of 39.1% (n = 5,829) of the participants had been exposed to passive smoking in adulthood at home. BMD was significantly lower in subjects exposed to passive smoking, 0.343 vs. 0.331 g/cm(2); p < 0.01 (unadjusted) and 0.339 vs. 0.337 g/cm(2); p < 0.05 (adjusted for age, gender, height and weight, and smoking). Multiple linear regression analysis showed that exposure to passive smoking for more than 20 years in adulthood at home was significantly related to BMD when adjusted for potential confounders (men, β = -4.4 × 10(-3); r = -0.05; p < 0.01 and women, β = -2.3 × 10 (-3); r = -0.03; p < 0.05). This relationship was also seen in the group of never smokers (β = -3.3 × 10(-3); r = -0.03; p = 0.01). Our study supports a potential negative effect of long-term passive smoking in adulthood at home on phalangeal BMD.

Clinical Evaluation of a Phalangeal Bone Mineral Density Assessment System

Because osteoporosis is common and usually managed in primary care, there is a requirement for cheap and convenient methods of measuring bone mineral density (BMD). AccuDEXA (Lone Oak Medical Technologies, Doylestown, PA) is a tabletop dual-energy X-ray absorptiometry (DXA) device that performs BMD measurements of the hand in the middle phalanges of the third finger. The aims of this study were to (1) evaluate the use of AccuDEXA in UK women; (2) investigate the concordance between AccuDEXA T-scores and DXA T-scores for central (spine and hip) sites; (3) investigate the comparative response of AccuDEXA measurements to clinical risk factors for osteoporosis. Measurements of phalangeal and central BMD were performed in 620 women referred by their family doctors for bone densitometry (group 1) and 159 healthy female volunteers (group 2). For 65 women in group 2, aged 39 yr or younger, the mean Z-scores for AccuDEXA and the central sites calculated from US reference ranges were consistent with the expected value of 0, whereas for the 62 group 2 women, aged 50 yr or older, the mean Z-scores for AccuDEXA and the central sites were in the range 0.4–0.7 and were statistically significantly different from 0. In both group 1 and group 2, the AccuDEXA T-scores in older and younger women were systematically higher than those in the central sites by up to 1 unit. Of the 157 women aged 50 yr or older, with osteoporosis, based on their central DXA results, only 34 (22%) had an AccuDEXA T-score less than or equal to −2.5, whereas 76 (48%) had osteopenia and 47 (30%) were normal based on their AccuDEXA T-scores. When assessed by the effect of clinical risk factors on Z-scores, both AccuDEXA and central BMD were affected to a similar extent. We conclude that the conventional World Health Organisation T-score criteria for the diagnosis of osteoporosis should not be applied to AccuDEXA measurements in UK women. Clinical risk factors for low BMD were found to affect AccuDEXA measurements to a similar extent as central BMD measurements. AccuDEXA measurements could, therefore, provide an alternative method for identifying individuals with low bone mass, provided care is taken in interpreting T-scores, perhaps, through the use of device-specific thresholds.

Comparison of phalangeal bone mineral content and density between the dominant and non-dominant sides

Compared to the non-dominant side, higher bone mineral content (BMC) and density (BMD) have been demonstrated in the forearm bones in the dominant side. Clinicians are compelled to scan the dominant side when deformities or artifacts are found in the non-dominant side. This study was done to evaluate the differences in phalangeal BMC and BMD, measured using accuDXA, between the dominant and non-dominant hands. Design and participants A group of 333 subjects, comprising 267 healthy volunteers (185 women and 82 men) and 66 women with rheumatoid arthritis. Phalangeal BMD and BMC, were measured using accuDEXA, both in the non-dominant and dominant hands. Main results BMC and BMD showed strong correlations between the two sides (r = 0.95, p < 0.001 for both). Compared to the non-dominant side, dominant side BMC was 5% higher (mean values =1.54 and 1.47, mean difference = 0.064, 95% CI for the mean difference = 0.048-0.081 g, p < 0.001) and BMD was 4% higher (mean values = 0.480 and 0.463, mean difference = 0.018, 95% CI for the mean difference = 0.014-0.021 g/cm2, p < 0.001). In the subgroup analysis, percentage differences of BMD between the two sides were found to be similar among men (n=82), women (n=251), people below 50 years (n=24), people above 50 years (n=122) and also among patients with rheumatoid arthritis (n=66). Conclusions When the non-dominant hand is not suitable for scanning, the clinician should consider scanning the dominant hand instead. However, the differences in BMD between the two hands should be taken into consideration when interpreting results.

Prevalence and determinants of osteoporosis among men aged 50 years or more in Sri Lanka: a community-based cross-sectional study

SummaryThis study, based on phalangeal bone mineral density (BMD) of 1,174 community dwelling male volunteers aged 50 years or more from seven provinces in Sri Lanka, shows 5.8% prevalence of osteoporosis among them. Advancing age, less physical activity, and low body weight were associated with low BMD. Men with larger families were more likely to have a lower bone mineral density.PurposeThe prevalence of osteoporosis among Sri Lankans is not well-known. We wished to estimate the prevalence and determinants of osteoporosis among older men in Sri Lanka.MethodsOne thousand one hundred seventy-four healthy, community dwelling male volunteers, aged 50 years or more from seven out of nine provinces in Sri Lanka underwent phalangeal bone mineral density estimation using an AccuDXA® scanner. We calculated T scores using the local reference data, and subjects with T score equal or less than −2.5 was considered to have osteoporosis.ResultsSixty-six men (5.8%) were detected to have osteoporosis. In contrast to men in the highest tertile of bone mineral density, men in the lowest tertile were older (60.0 versus 55.8 years, p < 0.001), lighter (56.3 versus 65.6 kg, p < 0.001), less physically active (16.1% versus 5.5%, p < 0.001) and had larger families consisting of four or more children (36% versus 20.9%, p < 0.001). Smoking, alcohol, or milk consumption showed no association with bone mineral density.ConclusionsWe report 5.8% prevalence of osteoporosis among men older than 50 years in Sri Lanka, and advancing age, less physical activity, and low body weight were associated with low bone mineral density. Men with larger families were more likely to have a lower bone mineral density.

Phalangeal Quantitative Ultrasound and Bone Mineral Density in Evaluating Cortical Bone Loss: A Study in Postmenopausal Women With Primary Hyperparathyroidism and Subclinical Iatrogenic Hyperthyroidism

Twenty-five postmenopausal women with primary hyperparathyroidism (PHPT) and 30 age-matched women with subclinical hyperthyroidism (sHTH) were studied to assess cortical bone loss. One hundred two healthy women were also recruited. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at lumbar spine (LS), femoral neck (FN) and femoral total (FT), and at one-third of the radius (R). Amplitude-dependent speed of sound (ADSoS) and Ultrasound Bone Profile Index (UBPI) were also evaluated using phalangeal quantitative ultrasound (QUS). A significant correlation was found between QUS and BMD at LS (ADSoS, p < 0.05) and R (ADSoS and UBPI, p < 0.001) in controls. QUS significantly correlated with BMD at LS, FN ( p < 0.01), and FT ( p < 0.001) in sHTH. No correlations were found in the PHPT group. Mean T-score values of all parameters were significantly lower in patients compared with controls ( p < 0.001); however, they did not differ between PHPT and sHTH patients. T-score of R, ADSoS, and UBPI was reduced compared with other sites ( p < 0.001) in both diseases. In postmenopausal women with PHPT and sHTH, bone loss is mainly detectable at cortical level. However, qualitative and/or structural changes of bone could account for the lack of correlations between these 2 techniques at cortical sites.

A Cross-Sectional Association of Phalangeal Bone Mineral Density Versus Hip Bone Mineral Density with Osteoporosis and Non-Vertebral Fracture

To examine the predictive validity of prior cultures at predicting the microorganism isolated at the time of suspicion of ventilator-associated pneumonia (VAP).We performed a retrospective analysis of a randomized controlled trial of different diagnostic and antibiotic strategies. In a subset of patients with pre-enrollment cultures, we examined agreement between cultures 1 to 3 days before suspicion of VAP and enrollment cultures performed on the day of suspicion of VAP and potential antibiotic error rates (estimated using the equation 1 − crude agreement).Two hundred eighty-one (39%) of 739 patients had pre-enrollment culture. One hundred thirty (46%) of 281 yielded a pathogenic microorganism. In patients with positive pre-enrollment cultures, crude agreement was 0.63 (95% confidence interval, 0.55-0.71) for organism, 0.84 (0.77-0.89) for Gram class, and 0.61 (0.52-0.69) for species with sensitivity. Potential antibiotic error rates ranged from 16% (11%-33%) to 39% (31%-48%). Better agreement (P = .033) occurred in isolates from patients receiving new antibiotics during the surveillance period (0.78 [0.64-0.87]) compared to those not on antibiotics (0.58 [0.45-0.69]), or on no new antibiotics (0.50 [0.32-0.68]).There is poor agreement between prior cultures and cultures performed at time of suspicion of VAP. Prior cultures should not be used to narrow the spectrum of empiric antibiotics.

Phalangeal quantitative ultrasound and bone mineral density in evaluating cortical bone loss: A study in postmenopausal women with hyperparathyroidism and subclinical iatrogenic hyperthyroidism

Phalangeal quantitative ultrasound and bone mineral density in evaluating cortical bone loss: A study in postmenopausal women with hyperparathyroidism and subclinical iatrogenic hyperthyroidism

Effect of parity on phalangeal bone mineral density in post‐menopausal Sri Lankan women: a community based cross‐sectional study

There is paucity of studies related to parity and bone mineral density in South Asian countries. We recruited 713 healthy, community dwelling post-menopausal women from seven provinces in Sri Lanka for this survey. The number of pregnancies, including miscarriages beyond 20 weeks of gestation, was recorded. Women with diseases and those who have taken drugs that can affect bone mineral density (BMD) were excluded (n = 15). Phalangeal BMD and bone mineral content (BMC) were measured using AccuDEXA in 713 women. Mean (SE) BMD of nulliparous women (n = 32), women with one to two pregnancies (n = 284), three to four pregnancies (n = 290) and more than four pregnancies (n = 107) were 0.437(0.014), 0.454(0.005), 0.455(0.005) and 0.417(0.006) g/cm(2), respectively (P < 0.001). Corresponding mean (SE) BMCs were 1.30(0.063), 1.41(0.021), 1.43(0.022) and 1.32(0.033) g, respectively (P < 0.001). Women with more than four pregnancies were older and lighter when compared with other groups. When results were adjusted for current age and current weight, differences in mean BMD and BMC between groups became non-significant. BMD of nulliparous women remained low in all analyses. We report a significant difference in unadjusted phalangeal BMD in women categorized according to their parity. Women with one to four pregnancies had the highest phalangeal BMD and BMC, while multi-parous (more than four pregnancies) and nulliparous women had lower values. However, in an adjusted analysis, the differences in BMD and BMC were partially explained by the differences of age and body weight between the groups and the unique effect of parity was difficult to determine. Women with lower BMD may have a higher risk of future fractures.

Age-Related Trends in Phalangeal Bone Mineral Density in Sri Lankan Men and Women Aged 20 Years or More

To establish normative reference values and to study the age-related trends in phalangeal bone mineral density (BMD), 4504 male and 5215 female volunteers aged 20 yr or more were recruited from 7 provinces from October 2004 to October 2005. Subjects suffering from diseases and those who were taking medications, which could affect BMD were excluded from the analysis (n = 530). Phalangeal BMD was measured in the nondominant hand using an AccuDXA. Men and women were categorized to age groups of 20–29 (1087 men and 1079 women), 30–39 (1122 men and 1146 women), 40–49 (1148 men and 1455 women), 50–59 (810 men and 1111 women), 60–69 (250 men and 335 women), and 70 yr or more (87 men and 94 women). Mean BMDs (SD) of men in above categories were 0.595 (0.057), 0.603 (0.061), 0.591 (0.066), 0.576 (0.069), 0.558 (0.077), and 0.522 (0.079) g/cm 2, respectively. The corresponding BMDs (SD) in women were 0.495 (0.057), 0.506 (0.062), 0.502 (0.064), 0.462 (0.072), 0.406 (0.072), and 0.340 (0.055) g/cm 2, respectively. Peak BMD was seen in 30–39-age category in both sexes. Women after 50 yr lost BMD at a rate of 0.006 (standard error 0.0003) g/cm 2/yr, whereas the corresponding value in men was 0.002 (standard error 0.0001) g/cm 2/yr. These data provide normative reference data for the calculation of T-score and Z-score for phalangeal BMD in Sri Lankan men and women aged more than 20 yr.

The Alara Metriscan phalangeal densitometer: evaluation and triage thresholds

The Metriscan (Alara Inc, CA) is a compact digital radiographic absorptiometry device capable of determining phalangeal bone mineral density in arbitrary units (BMD(au)) from the second phalanges of the middle three digits. We have examined the utility and the in vitro and in vivo performances of the Metriscan, and established triage thresholds based on the UK's National Osteoporosis Society guidelines on peripheral densitometry. 170 white female participants (70 osteoporotic and 100 non-osteoporotic at the hip or spine) aged between 55 years and 70 years were recruited from patients attending for routine dual X-ray absorptiometry (DXA) examination. All participants underwent two scans of the non-dominant hand (with repositioning) and one of the dominant hand. An additional 10 participants were excluded owing to finger or hand deformities. Radiation exposure to the patient per scan was <0.1 microSv, and a controlled area of 1 m was established around the device. Phantom-based in vitro short-term precision (%CV) was 0.17% without, and 0.22% with, repositioning. Long-term in vitro precision was 0.31% over a 6-month period. In vivo short-term precision was 1.42% for the group as a whole, and 1.30% and 2.23% for the non-osteoporotic and osteoporotic groups, respectively. Triage thresholds for reassurance/referral or referral/treatment were 54.30 BMD(au) and 46.89 BMD(au), respectively, for the non-dominant hand, and 55.02 BMD(au) and 48.73 BMD(au) for the dominant hand. The dominant side proved superior for triage purposes, with a triage referral rate of 44%, compared with 48% for the non-dominant hand. The Metriscan is suitable for use on post-menopausal women in a community-based setting preferably in a triage role as an adjunct to axial BMD.

Hand osteoarthritis and bone mineral density in postmenopausal women; clinical relevance to hand function, pain and disability

The aim of the present study was to assess phalangeal bone mineral density (BMD) in postmenopausal females with hand osteoarthritis (OA) and to correlate the measured levels with the radiographic OA grade, pain, function and disability of the hand. The study group constituted 40 postmenopausal women with hand OA (range; 45-83 years). Socio-demographic data were collected. They underwent a comprehensive clinical examination of joint status and health outcome measure including Australian Canadian (AUSCAN) OA hand index. Hand radiographs were quantified and graded according to Kellgren and Lawrence (K-L) scoring system. Bone mineral content (BMC) and BMD of the third finger were measured using the accuDEXA (Schick, New York, NY). Twenty females matched for age and years of menopause were studied as a control group. Phalangeal BMC and BMD were significantly reduced in women with hand OA compared to controls and related to radiological erosive OA. The AUSCAN pain and function subscales were worse in proportion to the severity of hand OA. OA X-ray score was significantly associated with reduced right grip strength, pain, and function scales while, decreased BMD was related to Ritchie index and pain scale. Postmenopausal women with clinical and radiological hand erosive OA are at risk of development of hand osteoporosis (OP). Phalangeal bone densitometry is an objective reproducible investigation. Poor physical function due to increased pain associated with increasing severity of radiographic hand OA leads to worse BMD results.

Prevalence of osteoporosis among postmenopausal women in Sri Lanka: a cross‐sectional community study

AbstractObjective: This study was designed to estimate the prevalence of osteoporosis among postmenopausal women selected from seven provinces in Sri Lanka.Method: The study was a community‐based cross‐sectional survey of a group of 1642 community‐dwelling postmenopausal women in seven provinces, except the North and East, in Sri Lanka. Phalangeal bone mineral density (BMD) was measured in all subjects using an AccuDEXA. In a subgroup of 150 women BMDs in the spine from L2–L4 and proximal femur were measured using a Norland Eclipse central DXA machine. In this subgroup, the diagnosis of osteoporosis was made according to the WHO criteria based on T‐scores of the spine or femoral neck. The sensitivity, specificity, positive predictive value and negative predictive value of different phalangeal BMD levels were examined and the prevalence of osteoporosis was calculated using the most acceptable cut‐off value.Results: A sharp decline in phalangeal BMD (0.006 g/cm2/year) was seen during the postmenopausal period. Phalangeal T‐score of −2.00, which had sensitivity, specificity, positive predictive value and negative predictive value of 78%, 85%, 91% and 68% respectively, was selected as the most suitable value to predict osteoporosis: 357 women had phalangeal T‐scores either equal to or lower than −2.00. When the positive predictive value and negative predictive value of this cut‐off value were applied, 736 women (44.9%) in our sample were likely to have osteoporosis.Conclusions: Osteoporosis is a prevalent disease among postmenopausal women in Sri Lanka. Similar prevalence figures have been reported from other Asian countries.

Genetic effects of estrogen receptor α and collagen IA1 genes on the relationships of parathyroid hormone and 25 hydroxyvitamin D with bone mineral density in Caucasian women

There is a growing body of evidence that estrogen receptor α (ERα) and collagen IA1 (COLIA1) genes may affect bone mineral density (BMD) levels in postmenopausal women. In a recent study we found that the Px haplotype of the ERα gene (resulting from combined PvuII and XbaI restriction fragment-length polymorphisms [RFLPs] in intron 1) was associated with low radiographic phalangeal hand BMD in elderly women (62.7 ± 6.5 years of age), of European origin. The combination of the Px haplotype and “s” allele of the COLIA1 gene (MscI RFLP in Sp1 locus) decreased BMD in these women. The major aim of the present study was to investigate whether the genetic effects of these genotypes on cancellous and cortical hand BMD, in the same elderly women (N = 122), are possibly mediated through circulating levels of parathyroid hormone (PTH) and/or 25 hydroxyvitamin D [25(OH)D], and may be related to biochemical markers of bone turnover (propeptide of type I procollagen [PICP] and osteocalcin). Multiple regression analyses of age-adjusted cancellous BMD revealed that ERα polymorphism and circulating levels of PTH were independent predictors of about 12.9% of its variation. Some 17.9% of cortical BMD variations were attributable to the combined effects of ERα polymorphism and plasma concentrations of 25(OH)D, estradiol, and PTH. The significant inverse association between PTH and BMD of both types was further confirmed by association analysis according to categorical subgroups of BMD values, as well by haplotype status. The mean difference in PTH concentrations between subjects carrying the Px haplotype (higher mean) and those lacking it (lower mean) reached 0.59 SD (P = .01). The difference in PTH levels further increased when explored in the 4 subgroups formed by combinations of polymorphic ERα and COLIA1 genotypes. Mean PTH of subjects carrying both the Px haplotype and “s” allele was higher by 1.52 SD (P = .001) than in subjects lacking both the Px haplotype and “s” allele. Those carrying both Px haplotype and “s” allele were also characterized by highest mean value of PICP and lowest means of 25(OH)D and BMD (both tissue types). We conclude that in the studied elderly women, the Px haplotype may be involved in causing the phenotypic expression of higher circulating levels of PTH and higher bone turnover, which, in turn, may lead to bone loss.