T-score Range Research Articles

Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale.

Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 - 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 - 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 - 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78-0.6m/sec (AUC 0.65), while moderate-to-severe gait speed impairment was < 0.6m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.

Imaging of the Microstructural Failure Mechanism in the Human Hip.

Imaging the bone microstructure under progressively increasing loads allows for observing the microstructural failure behavior of bone. Here, we describe a protocol for obtaining a sequence of three-dimensional microstructural images of the entire proximal femur under progressively increasing deformation, causing clinically relevant fractures of the femoral neck. The protocol is demonstrated using four femora from female donors aged 66-80 years at the lower end of bone mineral density in the population (T-score range = -2.09 to -4.75). A radio-transparent compressive stage was designed for loading the specimens replicating a one-leg stance, while recording the applied load duringmicro-computed tomography (micro-CT) imaging. The field of view was 146 mm wide and 132 mm high, and the isotropic pixel size was 0.03 mm. The force increment was based on finite-element predictions of the fracture load. The compressive stage was used to apply the displacement to the specimen and enact the prescribed force increments. Sub-capital fractures due to opening and shear of the femoral neck occurred after four to five load increments. The micro-CTimages and the reaction force measurements were processed to study the bone strain and energy absorption capacity. Instability of the cortex appeared at the early loading steps. The subchondral bone in the femoral head displayed large deformations reaching 16% beforefracture, and a progressive increase in the support capacity up tofracture. The deformation energy linearly increased with the displacement up tofracture, while the stiffness decreased to near-zero values immediately beforefracture. Three-fourths of the fracture energy was taken by the specimen during the final 25% force increment. In conclusion, the protocol developed revealed a remarkable energy absorption capacity, or damage tolerance, and a synergic interaction between the cortical and trabecular bone at an advanced donor age.

Reducing Opioid Use for Chronic Pain With a Group-Based Intervention

Opioid use for chronic nonmalignant pain can be harmful. To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care. Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020. Participants were randomized 1:1 to either usual care or 3-day-long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months. The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (-4.1 in the intervention and -3.17 in the usual care groups; between-group difference: mean difference, -0.52 [95% CI, -1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt). In people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. isrctn.org Identifier: ISRCTN49470934.

Relationship between stair ascent gait speed, bone density and gait characteristics of postmenopausal women.

Stair ascent is a biomechanically challenging task for older women. Bone health may affect gait stability during stair walking. This study investigated the gait biomechanics associated with stair ascent in a group of postmenopausal women in relation to walking speed and bone health, quantified by T-score. Forty-five healthy women (mean (SD) age: 67 (14) years), with bone density ranging from healthy to osteoporotic (T-score range +1 to -3), ascended a custom-made five-step staircase with two embedded force plates, surrounded by 10 motion capture cameras, at their self-selected speed. Multivariate regression analyses investigated the explained variance in gait parameters in relation to stair ascent speed and T-score of each individual. Stair ascent speed was 0.65 (0.1) m·s-1 and explained the variance (R2 = 9 to 47%, P ≤ 0.05) in most gait parameters. T-score explained additional variance in stride width (R2 = 20%, P = 0.014), pelvic hike (R2 = 19%, P = 0.011), pelvic drop (R2 = 21%, P = 0.007) and hip adduction (R2 = 7%, P = 0.054). Increased stride width, and thereby a wider base of support, accompanied by increased frontal plane hip kinematics, could be important strategies to improve dynamic stability during stair ascent among this group of women. These findings suggest that targeted exercises of the hip abductors and adductors, including core trunk musculature, could improve dynamic stability during more challenging locomotor tasks. Balance exercises that challenge base of support could also benefit older women with low bone mineral density who may be at risk of falls.

Creating Clinical Meaning for the Promis Cognitive Function Abilities Instrument: Improving Remission Outcomes for Adults with Thrombotic Thrombocytopenic Purpura

Introduction: Patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP) describe cognitive concerns years after acute episodes. However, these concerns are not routinely addressed during hematology visits. The Patient-Reported Outcomes Measurement Information System (PROMIS) cognitive function abilities survey is an easy to administer, valid, reliable, generic instrument that has not been evaluated in iTTP patients from the United States (US). Therefore, the first aim of this study was to compare PROMIS scores of iTTP patients in remission to the normative US population. Also, research in other disorders reported that a barrier to integrating PROMIS into routine care was physician uncertainty related to interpreting results. PROMIS instruments utilize normative scoring, which lacks clinical meaning. Therefore, creation of clinical severity cut-points (‘mild’, ‘moderate’, 'severe') is critical to facilitate clinical interpretation. The second aim was to create clinical severity thresholds for the PROMIS instrument.Methods: iTTP patients were recruited from 9 US centers (8/2019 to present). Eligibility included: 1) age >18 years, 2) documented ADAMTS13 deficiency (< 10% activity) at diagnosis or during a relapse and 3) > 1-year clinical remission. Following informed consent, patients were administered the PROMIScognitive survey via their preferred mode (online, telephone, or self-administered). The instrument focused on cognitive function over the last 7 days. Responses were a 5-point Likert scale ranging from 'not at all' (indicating poor function) to ‘very much’ (no current problem). Demographics and the PROMIS global health question ('In general, would you say your health is') were also obtained.Descriptive statistics summarized patient scores relative to the US population (mean 50, SD 10) with lower scores indicating worse function. Additionally, we determined the T-score ranges for patients who reported 'not at all/a little bit' on all cognitive items and for those who reported ‘quite a bit/very much’ on all cognitive items. The upper end of the T-score range for patients reporting ‘not at all/a little bit’ determined the threshold for ‘Severe’ impairment and the lower end of the T-score range for those reporting ‘quite a bit/very much’ determined the threshold for ‘No/Mild’ impairment. Scores greater than the threshold for ‘Severe’ but lower than the threshold for ‘No/Mild’ were considered ‘Moderate’ cognitive impairment. Patients were then classified into a severity category based on their T-scores. As a descriptive validity check, we compared the proportion of patients reporting ‘excellent/very good’ on the global health question between the ‘Severe’ and ‘No/Mild’ impairment classifications.Results: To date, 94 patients have completed the study (83% female; 54% White; 34% Black; median age 49 years [range 26-85 years]). Overall the mean cognitive score was 45 (SD 9) compared to the US mean 50 (SD 10). Patients who preferred online administration had a mean score of 47 (SD 9) vs patients who preferred telephone or self-administered (mean score of 43 [SD 9]).T-scores for patients reporting ‘not at all/a little bit’ on all items ranged from 23.4-35.1. Based on T-scores, 14 patients (15%) were then classified as having ‘Severe’ cognitive impairment with T-scores < 35.1 (Figure 1). Only 14% of patients classified as having ‘Severe’ cognitive impairment reported their general health as ‘excellent/very good’. T-scores for patients reporting ‘quite a bit/very much’ on all items ranged from 49.2-68.9. Thirty-one (33%) patients were classified as ‘No/Mild’ impairment with T-scores >49.2 (Figure 1) and 52% of these patients classified their health as ‘excellent/very good’.Conclusion: iTTP patients in remission have descriptively lower cognitive scores versus the US population. Our results are similar to those reported from a cohort of iTTP patients from the United Kingdom (PROMIS cognitive mean 40, SD 8). Further, results showed that patients with cognitive T- scores <35 have severe cognitive impairment vs those with scores >49, who have no/mild cognitive impairment. This is the first study to create clinical severity thresholds for the PROMIS cognitive function abilities instrument. Our data provide clinical meaning for PROMIS which should facilitate clinical use in iTTP by identifying patients with severe impairment who need referral to specialists. [Display omitted] DisclosuresTerrell: Sanofi: Consultancy; Takeda: Consultancy. Journeycake: LFB: Honoraria; HEMA Biologics: Honoraria. Mazepa: Sanofi Aventis: Other; Answering TTP Foundation: Research Funding. Cuker: Novartis: Research Funding; Bayer: Research Funding; Alexion: Research Funding; UpToDate: Patents & Royalties; Synergy: Consultancy; Spark Therapeutics: Research Funding; Pfizer: Research Funding; Novo Nordisk: Research Funding; Sanofi: Research Funding; Takeda: Research Funding. Chaturvedi: Sanofi Genzyme: Other: Advisory board member; Alexion: Other: Advisory board member; Dova: Other: Advisory board member; Argenx: Other: Advisory board member; UCB: Other: Advisory board participation. Lim: Hema Biologics: Honoraria; Dova Pharmaceuticals: Honoraria; Sanofi Genzyme: Honoraria. Gangaraju: Sanofi Genzyme: Consultancy; Alexion: Consultancy. Cataland: Ablynx/Sanofi: Consultancy, Research Funding; Sanofi Genzyme: Consultancy; Takeda: Consultancy; Alexion: Consultancy, Research Funding.

The HOPE Project (Helping Older People Engage): Relevance to Upstream Suicide Prevention

The HOPE Project is an ongoing RCT testing whether Senior Corps volunteering for lonely older adults (age 60+) leads to reduced loneliness and improved quality of life—outcomes associated with suicide in later life. We have randomly assigned 130 participants to 12-months of volunteering or active control. We will describe the trial as well as baseline characteristics of participants that may predict non-compliance with volunteering/control. We found no difference between conditions nor demographic characteristics (age, gender) on non-compliance. Participants demonstrated wide variability in depression at baseline (PROMIS t-score range 38.9 to 71.4) and 18% reported suicide ideation; neither were associated with compliance (p>.20). These preliminary findings indicate that those with more severe mental health symptoms were equally willing/able to engage in volunteering as those without depression and suicide ideation. Volunteering is a highly scalable intervention (given nationwide Senior Corps infrastructure) that may function as upstream suicide prevention.

Early-Onset Osteopenia and Osteoporosis in Patients with Pyruvate Kinase Deficiency

Early-Onset Osteopenia and Osteoporosis in Patients with Pyruvate Kinase Deficiency

Paediatric supraventricular tachycardia patients potentially more at risk of developing psychological difficulties compared to healthy peers.

Assess executive and socio-emotional/behavioural functioning in paediatric supraventricular tachycardia (SVT) patients. SVT patients aged 7-17 who had not undergone catheter ablation were included. Parents completed the Child Behaviour Checklist (CBCL/6-18) and the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants age 11-17years completed the Youth Self-Report (YSR/11-18) and the BRIEF Self-Report (BRIEF-SR). One-sample z test was used to compare questionnaire results to the average t-score range (M=50, SD=10). Thirty (18 female) children/adolescents participated (M=12.6years old, SD=3.2years) with a mean SVT onset age of 7years (SD=4.3years). BRIEF and BRIEF-SR results suggested no difference in executive functioning from average. Mean t-scores of CBCL/6-18 and YSR/11-18 subscales Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems, Diagnostic and Statistical Manual of Mental Disorders (DSM) Affective Problems, DSM Anxiety Problems and DSM Somatic Problems were significantly elevated compared to average. YSR/11-18 subscales Social Problems, Attention Problems, Internalizing Problems, DSM ADHD Problems and DSM Oppositional Defiant Problems had elevated mean t-scores compared to average. Effect sizes were small to medium (0.2≤d≤0.8). Paediatric patients with SVT potentially have a greater risk of developing behaviour, especially internalizing, problems compared to similarly aged children/adolescents without SVT.

Reliability, convergent validity and applicability of the Assistive Technology Outcome Profile for Mobility for middle-aged and older power wheelchair users.

The Assistive Technology Outcome Profile for Mobility (ATOP/M) was designed to isolate the impact of mobility assistive technology on perceived difficulty with activity and participation. The study objectives were to examine its measurement properties (test-retest reliability and convergent validity) and applicability for middle-aged and older power wheelchair (PWC) users. Four ATOP/M subscales were administered using computer adaptive testing (activity with mobility device, activity without mobility device, participation with mobility device, participation without mobility device). Test-retest reliability (4-wk interval), convergent validity (a priori hypothesis testing of correlations with participation (Late-life Disability Instrument) and mobility (Life-space Assessment)) and applicability (respondent burden, distributions) were examined with 116 PWC users between 50 and 85years of age presenting with a variety of diagnoses. When using powered mobility, perceived difficulty with activity and participation scores were similar to the general population of mobility devices users (T-score range 46.3-53.7), while activity and participation were significantly lower without mobility devices (T-score range 35.3-39.4). Test-retest reliability intra-class coefficients of the four subscales ranged between 0.82 and 0.91, and convergent validity was supported by moderate correlations (r=0.35-0.47). Respondent burden was higher for the without devices subscales and none of the subscales had significant floor/ceiling effects. Our results provide support for reliability and convergent validity of the ATOP/M for PWC users. Specific strategies were recommended to optimise applicability with this population such as administration guidelines for reframing the without device scale and timing of data collection.

Relationships between walking speed, T-score and age with gait parameters in older post-menopausal women with low bone mineral density

BackgroundThe gait patterns of women with low bone mineral density (BMD) or osteoporosis have not been thoroughly explored, and when examined, often studied in relation to falls and kyphosis.Research question: The aim of this study was to investigate the relationships between gait parameters and comfortable, self-selected walking speed and BMD in older post-menopausal women with a broad range of T-scores (healthy to osteoporotic). Methods3D kinematic and kinetic data were collected from forty-five women mean (SD) age 67.3 (1.4) years during level walking at their preferred speed. Multiple regression analyses explored the explained variance attributable to speed, femoral neck T-score, and age. ResultsThe mean (SD) walking speed 1.40 (0.19) m·s−1 explained the variance in most temporal-spatial, kinematic and joint powers (R2 = 12–68%, P ≤ 0.01). T-score accounted for (R2 = 23%, P ≤ 0.001) of the shared explained variance in stride width. It also increased the explanatory power for knee flexion (R2 = 7%, P ≤ 0.05) and knee range of motion (R2 = 12%, P ≤ 0.01). Power absorption by the knee flexors in terminal swing (K4) was the only power burst resulting in significant slope coefficients for all predictor variables (R2 = 52 and 54%) (P ≤ 0.001) and (R2 = 68%, P ≤ 0.05). SignificanceSpeed alone explained most of the variance in the gait parameters, while speed and T-score combined increased the explanatory power of the regression models for some of the knee joint variables. Our findings demonstrated that older post-menopausal women, with a broad range of T-scores, are able to walk at comfortably fast speeds, generating gait patterns similar to those of younger women. The results also suggest that strengthening the hip abductor, knee extensor and flexor muscle groups may benefit the gait patterns of older postmenopausal women with low BMD.

Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis.

Although BMD testing is routinely performed in RA patients, the interval between BMD tests has not been determined. We retrospectively recruited 360 consecutive female patients with RA, who underwent repeated BMD testing, with a mean age of 53.7 ± 10.2years and a mean follow-up duration of 7.4 ± 5.0years. We stratified the study participants into five groups based on their baseline T-score range. The testing interval was defined as the estimated time for 10% of patients in each subgroup to transition to osteoporosis. Competing-risk analyses were performed with sensitivity analysis by menopausal status and risk factors for transition to osteoporosis. At baseline, 15% of screened patients had osteoporosis, and during follow-up, that proportion increased to 24.8%. The estimated BMD testing interval for 10% of patients to develop osteoporosis was 9.6years for those with normal BMD, 7.6years for those with mild osteopenia, 4.7years for those with moderate osteopenia, and 2.1years for those with severe osteopenia. No significant risk factor for transition to osteoporosis was identified in this cohort. Our data indicate that osteoporosis will develop in less than 10% of female RA patients during rescreening intervals of approximately 9years for those with normal bone density at baseline, 7years for those with mild osteopenia, 4years for those with moderate osteopenia, and 2years for those with severe osteopenia at baseline. BMD interval in RA patients could be adjusted according to their baseline BMD T-scores.

Development of a PROMIS item bank to measure pain interference

This paper describes the psychometric properties of the PROMIS-pain interference (PROMIS-PI) bank. An initial candidate item pool ( n = 644) was developed and evaluated based on the review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue = 35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50–80, the reliability was equivalent to 0.96–0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity ( p < 0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.

Enhanced prediction of fracture risk combining vertebral fracture status and BMD

Prevalent vertebral fractures are associated with increased fracture risk, but the magnitude of this effect across a range of BMD T-scores has not been quantified. In this analysis, for any given BMD T-score, incident fracture risk varied up to twelve fold when information regarding prevalent radiographic vertebral fracture status was considered. Clinical fracture risk evaluation of older women usually includes assessment of bone mineral density (BMD) but often not vertebral fracture status. In this analysis, we quantified the impact of vertebral fracture burden on two year fracture risk across a range of BMD T-scores. Data were from 2,651 postmenopausal women who were assigned to the placebo groups of the Fracture Prevention Trial (median observation 21 months) and the Multiple Outcomes of Raloxifene Evaluation Trial (MORE; observation 2 years). Using the Genant visual semiquantitative criteria, we defined prevalent vertebral fracture status as: a) presence or absence of fracture; b) fracture number; c) maximum semi-quantitative (SQ) score (normal=0, mild fracture=1, moderate fracture=2, severe fracture=3); and d) spinal deformity index (SDI) score (sum of SQ scores of T4 to L4 vertebrae). Incident fractures over two years were identified via lateral spine radiographs and outside the spine by questioning of patients and review of radiographs or radiographic reports. Femoral neck BMD T-score provided significant information regarding fracture risk. Across the range of T-scores, vertebral fracture status provided additional prognostic information. The risk increased with increasing number and severity of prevalent vertebral fractures and SDI, a summary measure of spine fracture burden. Across a range of BMD values, prevalent spine fracture burden as assessed by SDI increased the risk of incident vertebral fractures by up to 12-fold, nonvertebral fractures by about twofold, and any fractures by up to sevenfold. These findings indicate that at any given BMD T-score, the risk of incident vertebral, non-vertebral, and any fracture depended heavily on prevalent radiographic vertebral fracture status. Assessment of vertebral fracture status, in addition to BMD, provides practical and relevant clinical information to aid in predicting fracture risk in postmenopausal women.

Assessment of quantitative ultrasound densitometry in 100 persons with fractures due to osteoporosis

To assess the role of quantitative ultrasound densitometry on person with osteoporosis fracture. We measure BUA T-score of Os-calis in a sample of 100 persons (Male 54, Female46), aged 45-99 years at Rajindra Hospital, Patiala. We observed that none of the patient in our study had normal BUA T Score measured by quantitative ultrasound densitometry. All patient had BUA T-Score range -5.5 to -1.2, mean with SD -2.60 1.07. Thus quantitative ultrasound densitometry seems to be a good predictor of fracture risks due to osteoporosis. We also observed that in osteoporotic patient with age 45 years or over there was age related decline BUA T. Score. This was higher in women compared with men. We conclude that all patients with fractures due to osteoporosis had poor bone quality. Thus quantitative ultrasound densitometry may be mandatory for a person with osteoporosis facture.

Osteoporosis assessment strategies for male nursing home residents

Objectives: Twenty-five to thirty percent of hip fractures occur in men, and nursing home residents have a 5–10-fold greater fracture risk than community-dwellers. Osteoporosis prevalence in men in long-term care, however, is poorly defined. Our objectives were to determine the prevalence of osteoporosis, as assessed by peripheral bone mineral density (BMD), in a group of institutionalized veterans, and to determine how many men with low BMD had received a prior diagnosis of osteoporosis. Methods: Subjects were residents in a 740-bed skilled nursing facility (78% men). Male residents ( n=103) competent to give informed consent underwent bilateral calcaneal and forearm BMD by dual-energy X-ray absorptiometry (DXA). Prior osteoporosis documentation was sought in medical records. Results: Twenty percent of veterans (95% confidence interval (CI) 12–28%) exhibited calcaneal osteoporosis ( T-score < −2.5), and 62% (CI 52–72%) were osteoporotic at the forearm. Forearm and calcaneal BMD were correlated ( r=0.678, P<0.001). BMD of the left and right forearm, and of left and right calcaneus, were highly correlated ( r=0.880, P<0.001 and r=0.931, P<0.001, respectively). Documentation of osteoporosis existed for one of 20 men with calcaneal osteoporosis and four of 59 men with forearm osteoporosis. Conclusions: Osteoporosis was prevalent but poorly documented in institutionalized veterans. Discordance in T-scores between forearm and heel was similar to that reported in other studies. The broad range of T-scores among subjects suggests that peripheral BMD measurement may be useful for clinical fracture risk stratification. Correlation among skeletal sites indicates that measuring a single site may be practical.

Discordant normal ranges for proximal femur bone density in Australia.

The aim of the study was to investigate the reference ranges currently in use for femoral neck bone mineral density (BMD) in Australia. Representative scans were obtained of the proximal femur from 78 dual-energy X-ray absorptiometry centers across Australia. Femoral neck BMD was standardized using published conversion equations and corresponding T-scores calculated using an Australian reference range (ARR) and using the NHANES-III reference range (NH3RR). Reported T-scores (TR) from the DXA centers were compared with T-scores derived from the NH3RR (TNH) and from the ARR (TA). Examination of the regression lines comparing TR with TNH, and TR with TA, demonstrated that the reference ranges used by centers with Lunar, and some of the Norland and Hologic instruments, differed only slightly from both the NH3RR and the ARR. A number of centers, however, with Norland or Hologic scanners, were using reference ranges which differed from both the NH3RR and ARR. The reference ranges used with these latter Hologic or Norland scanners could result in T-score differences of up to I standard deviation in the clinically relevant T-score range. The NH3RR was compared with the ARR using a set of BMD values covering the clinical range. There was close agreement between TNH and corresponding TA, confirming close agreement between the NH3RR and ARR. There are thus clinically important differences in the reference ranges currently used within Australia for interpretation of femoral neck BMD. For consistency, and in view of its validation, the NH3RR is recommended as the most appropriate Caucasian normal range in Australia. The ARR for femoral neck BMD does not differ significantly from the NH3RR and is also acceptable. Problems relating to the use of discordant BMD reference ranges potentially may exist in other countries.