Technical and patient-related sources of error and artifacts in bone mineral densitometry using dual-energy X-ray absorptiometry: A pictorial review

Dual-energy X-ray absorptiometry (DXA) is the method of choice for assessing bone mineral density (BMD). Unfortunately, the performance and interpretation of DXA can be challenging and errors are common. In fact, it has been reported that up to 90% of BMD reports contain at least 1 error. Errors can be the result of technique or interpretative in nature or both and can result in inappropriate diagnosis and management. In this article, we review the various types of pitfalls frequently encountered by physicians interpreting DXA studies. Being aware of these pitfalls will help readers recognize and avoid them when encountered in clinical practice.

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Comparison of Bone Mineral Densitometry at 2 Sites Versus 3 Sites in Patients Suspicious for Osteoporosis

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119849017 ◽

2019 ◽

Vol 12 ◽

pp. 117954411984901 ◽

Cited By ~ 2

Author(s):

Ahad Azami ◽

Hasan Anari ◽

Manouchehr Iranparvar ◽

Amin Azizi ◽

Afshin Habibzadeh

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Bone Mineral ◽

Dual Energy ◽

Mineral Density ◽

X Ray ◽

T Score ◽

Femur Neck ◽

Bone Mineral Densitometry

Objectives: In this study, we aim to evaluate the bone mineral density (BMD) results of 2 standard sites with 3 sites including wrist in diagnosing osteoporosis. Methods: We evaluated the BMD results of 1272 individuals referred for suspected osteoporosis between 2012 and 2015. Those individuals were included with BMD at lumbar spine, femur neck, and wrist. Bone mineral density was measured using a dual-energy X-ray absorptiometry (DXA) device. Bone mineral density and T score were measured for all 3 sites. Results: There was significant correlation between wrist T score with hip T score ( r = 0.606, P < .001) and lumbar T score ( r = 0.527, P < .001). With BMD of 2 sites, patients had osteopenia in 46.3% and osteoporosis in 23.7%, while by adding wrist T-BMD, subjects had osteopenia in 46.6% and osteoporosis in 33%. Between BMD at 2 sites and 3 sites, there was concordance in 81.9%, minor discordance in 17.6%, and major discordance in 0.5%. Conclusions: We observed discordance between BMD measurements of 2 sites and 3 sites, with latter detecting more cases with osteoporosis. In fact, measurement of T scores of wrist along with lumbar and femur neck improves the diagnosis.

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Bone Mineral Densitometry (BMD) Precision and Scattered Radiation Level of Dual Energy X-ray Absorptiometry (DXA) Installed in Mymensingh Nuclear Medicine Unit, Bangladesh

Universal Journal of Medical Science ◽

10.13189/ujmsj.2016.040202 ◽

2016 ◽

Vol 4 (2) ◽

pp. 65-68

Author(s):

M. F. Uddin ◽

S. M. M. Islam ◽

M. N. Khan ◽

R. Khatun ◽

T. A. Biman ◽

...

Keyword(s):

Nuclear Medicine ◽

Bone Mineral ◽

Scattered Radiation ◽

Dual Energy ◽

Radiation Level ◽

X Ray ◽

Bone Mineral Densitometry

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Bone health index by hand X-ray compared with bone mineral density by dual-energy X-ray absorptiometry in children with Duchenne muscular dystrophy

Bone Abstracts ◽

10.1530/boneabs.7.p91 ◽

2019 ◽

Author(s):

Jonathan J Bowden ◽

Ramkumar Krishnamurthy ◽

Houchun Hu ◽

Brent Adler ◽

Rajesh Krishnamurthy ◽

...

Keyword(s):

Bone Mineral Density ◽

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Bone Mineral ◽

Bone Health ◽

Dual Energy ◽

Health Index ◽

Mineral Density ◽

X Ray ◽

Bone Health Index

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POS0045 LEAST SIGNIFICANT CHANGE IN BONE DENSITOMETRY IN PATIENTS WITH OBESITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3819 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 227.2-228

Author(s):

D. Claire ◽

M. Geoffroy ◽

L. Kanagaratnam ◽

C. Isabelle ◽

A. Hittinger ◽

...

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

General Population ◽

Bone Mineral ◽

Bone Densitometry ◽

Dual Energy ◽

Mineral Density ◽

Least Significant Change ◽

X Ray ◽

Significant Change

Background:Dual energy X-ray absoprtiometry is the reference method to mesure bone mineral density (1). Loss of bone mineral density is significant if it exceeds the least significant change. The threshold value used in general population is 0,03 g/cm2 (2). Patients with obesity are known for having a higher bone mineral density due to metabolism and physiopathology characteristics (3,4).Objectives:The aim of our study was to determine the least significant change in bone densitometry in patients with obesity.Methods:We conducted an interventionnal study in 120 patients with obesity who performed a bone densitometry. We measured twice the bone mineral density at the lumbar spine, the femoral neck and the total hip in the same time (5,6). We determined the least significant change in bone densitometry from each pair of measurements, using the Bland and Altman method. We also determined the least significant change in bone densitometry according to each stage of obesity.Results:The least significant change in bone densitometry in patients with obesity is 0,046g/cm2 at the lumbar spine, 0.069 g/cm2 at the femoral neck and 0.06 g/cm2 at the total hip.Conclusion:The least significant change in bone densitometry in patients with obesity is higher than in general population. These results may improve DXA interpretation in this specific population, and may personnalize their medical care.References:[1]Lees B, Stevenson JC. An evaluation of dual-energy X-ray absorptiometry and comparison with dual-photon absorptiometry. Osteoporos Int. mai 1992;2(3):146-52.[2]Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R, et al. Actualisation 2018 des recommandations françaises du traitement de l’ostéoporose post-ménopausique. Rev Rhum. oct 2018;85(5):428-40.[3]Shapses SA, Pop LC, Wang Y. Obesity is a concern for bone health with aging. Nutr Res N Y N. mars 2017;39:1-13.[4]Savvidis C, Tournis S, Dede AD. Obesity and bone metabolism. Hormones. juin 2018;17(2):205-17.[5]Roux C, Garnero P, Thomas T, Sabatier J-P, Orcel P, Audran M, et al. Recommendations for monitoring antiresorptive therapies in postmenopausal osteoporosis. Jt Bone Spine Rev Rhum. janv 2005;72(1):26-31.[6]Ravaud P, Reny JL, Giraudeau B, Porcher R, Dougados M, Roux C. Individual smallest detectable difference in bone mineral density measurements. J Bone Miner Res. août 1999;14(8):1449-56.Disclosure of Interests:None declared.

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