Prevalence and Predictors of Low Bone Mineral Density and Fragility Fractures Among HIV-Infected Patients at One Italian Center After Universal DXA Screening: Sensitivity and Specificity of Current Guidelines on Bone Mineral Density Management

A number of panoramic radiographic measurements have been associated with osteoporotic alterations. However, little is known about the differences in sensitivity and specificity among these measurements for screening low bone mineral density (BMD). Aim: To correlate and compare precision, sensitivity and specificity of panoramic radiomorphometric indices and fractal dimension (FD) for screening low BMD (i.e. osteopenia and osteoporosis). Methods: Sixty-eight female patients (42.78±15.59 years) were included in this study. Body mass index (BMI), mandibular cortical index (MCI), mandibular cortical width (MCW), FD and connectivity (C) were assessed. Low BMD was diagnosed by peripheral dual-energy X-ray absorptiometry (p-DXA). Non-parametric correlations were assessed among all variables. In addition, sensitivity and specificity of MCI, MCW and FD were estimated for screening low BMD. Results: Significant correlation was found between FD and BMI (p=0.013; r=0.269). In addition, FD was the most sensitive method for screening low BMD (70.8%, p=0.001). FD and MCI presented a significant and relatively high sensitivity, whereas MCW presented a high specificity for screening low systemic BMD Conclusions: Among the analyzed methods, FD and MCI offer a significant and relatively high sensitivity, whereas MCW offers a high specificity for screening low BMD.

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Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

Acta Endocrinologica ◽

10.1530/eje-13-0102 ◽

2013 ◽

Vol 169 (2) ◽

pp. 225-237 ◽

Cited By ~ 29

Author(s):

Cristina Eller-Vainicher ◽

Elisa Cairoli ◽

Volha V Zhukouskaya ◽

Valentina Morelli ◽

Serena Palmieri ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Fragility Fracture ◽

Fragility Fractures ◽

Hypovitaminosis D ◽

Urinary Calcium ◽

Idiopathic Hypercalciuria ◽

Primary Osteoporosis ◽

Mineral Density ◽

Low Bone Mineral Density

ObjectiveThe prevalence of subclinical contributors to low bone mineral density (BMD) and/or fragility fracture is debated. We evaluated the prevalence of subclinical contributors to low BMD and/or fragility fracture in the presence of normal 25-hydroxyvitamin D (25OHVitD) levels.DesignProspective observational study.MethodsAmong 1095 consecutive outpatients evaluated for low BMD and/or fragility fractures, 602 (563 females, age 65.4±10.0 years) with apparent primary osteoporosis were enrolled. A general chemistry profile, phosphate, 25OHVitD, cortisol after 1-mg overnight dexamethasone suppression test, antitissue transglutaminase and endomysial antibodies and testosterone (in males) were performed. Serum and urinary calcium and parathyroid hormone levels were also evaluated after 25OHVitD levels normalization. Vertebral deformities were assessed by radiograph.ResultsIn total, 70.8% of patients had low 25OHVitD levels. Additional subclinical contributors to low BMD and/or fragility fracture were diagnosed in 45% of patients, with idiopathic hypercalciuria (IH, 34.1%) and primary hyperparathyroidism (PHPT, 4.5%) being the most frequent contributors, apart from hypovitaminosis D. Furthermore, 33.2% of IH and 18.5% of PHPT patients were diagnosed only after 25OHVitD levels normalization. The subclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D were associated inversely with age (odds ratio (OR) 1.02, 95% CI 1–1.04, P=0.04) and BMI (OR 1.1, 95% CI 1.05–1.17, P=0.0001) and directly with fragility fractures (OR 1.89, 95% CI 1.31–2.73, P=0.001), regardless of BMD.ConclusionsSubclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D are present in more than 40% of the subjects with apparent primary osteoporosis. Hypovitaminosis D masks a substantial proportion of IH and PHPT patients.

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