Lateral Spine Densitometry in Obese Women

The lateral (LAT) spine scan has been suggested as a more sensitive measure than posterior-anterior (PA) scanning for assessing age-related bone loss in normal-weight postmenopausal women. The measurement error of PA and LAT bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) has also been shown to rise with incremental increases in fat and from large variance in fat thickness, respectively. The purpose of this cross-sectional study was to determine specific affects of obesity on paired PA and LAT lumbar (L₂–L₄) BMD and Z score (BMD of patient versus age-matched reference database) correlation in 30 obese postmenopausal women (mean BMI ± SD = 33.3 ± 4.06). The mean PA and LAT BMD ± SD were 0.946 ± 0.123 and 0.749 ± 0.134, respectively. The mean PA and LAT Z scores were −0.17 ± 1.15 and 0.80 ± 1.7. The correlation between PA and LAT BMD was significantly lower (r = 0.55; P < 0.05) than previously reported, and PA and LAT Z score correlation was (r = 0.57; P= 0.0016). After adjusting for body mass index (BMI), percent body fat, fat mass, and truncal fat by DXA, waist:hip ratio (WHR) and visceral and subcutaneous abdominal fat by computerized axial tomography (CT), PA and LAT Z score correlation increased to r = 0.62; P= 0.0065. In our subjects, the mean LAT Z score was 4.6 times higher than the mean AP Z, contrary to previous observations in normal-weight postmenopausal women. Our findings may be due to increased soft tissue composition and fat inhomogeneity in the LAT scanning field resulting in increased X-ray attenuation in obesity. Received: 22 July 1997 / Accepted: 26 January 1998     

Prediction of Body Composition From Spine and Hip Bone Densitometry

Body mass index (BMI) is used to assess overweight and obesity, but it does not account for the distribution or composition of excess weight. Dual-energy X-ray absorptiometry (DXA) is widely used for the assessment of osteoporosis. We hypothesized that measures of regional fat tissue composition from spine and hip DXA done for osteoporosis assessment could be used to estimate body composition more accurately than with BMI. We identified 427 adult patients who underwent DXA evaluation of the lumbar spine, hip, and whole body at the same visit. The population was randomly divided into 2 equal-sized subgroups: one used to derive prediction equations for whole-body fat tissue, whole-body lean tissue, and trunk fat tissue, and the other for independent validation. The estimates were compared with the actual measurements from the whole-body scans. In all analyses, prediction using the regional DXA scans outperformed prediction using BMI or its component variables, height and weight. When the predicted and actual measurements were compared in the validation cohort, regression slopes did not differ significantly from unity and the intercepts did not differ significantly from zero. We conclude that regional DXA scans of the spine and hip can be used to accurately measure body composition. Further research is needed to see whether these measures can in turn predict the metabolic complications associated with overweight and obesity.     

Ultrasound Bone Densitometry of the Os Calcis in Children and Adolescents

The aim of the present investigation was to evaluate reference data and to examine whether there were weight-, height-, age-, and sex-related differences of the quantitative ultrasound bone parameters for healthy children and adolescents. A total of 3299 healthy Caucasian children and teenagers (1623 girls and 1676 boys), age range from 6–18 years (mean age 11.4 ± 3.4 years for boys and mean age 11.5 ± 3.3 years for girls) were examined by quantitative ultrasound densitometry (QUS) using the bone sonometer SAHARA (Hologic Inc., Waltham, MA, USA), a waterless, dry system. The parameters broadband ultrasound attenuation (BUA) [dB/MHz] and speed of sound (SOS) [m/second] were evaluated on the right heel in relation to age, sex, weight, and height. There is no correlation between the ultrasound bone parameter SOS and age, height, and weight. BUA increases with age, height, and weight. Significant differences in SOS and BUA between girls and boys were found to probably be caused by the different onset of growth phases and the onset of puberty. SOS and BUA are influenced by changes of bone mineral density. But BUA is dependent on bone size, too. In conclusion, ultrasound bone densitometry is a useful measuring method showing the physiological bone development in childhood and adolescence. The presented results can be used as reference data. Further studies in children with disorders influencing bone metabolism will show in what way various patterns of osteopenia in childhood can be detected. Received: 20 August 1999 / Accepted: 20 April 2000 / Online publication: 22 September 2000     

Comparison of Three Bone Densitometry Methods in Osteoporotic Women

Three techniques of bone mass measurement were evaluated in the diagnosis of postmenopausal osteoporosis; the overlap in the measurements and the capacity for discriminating was determined among 51 postmenopausal normal (mean age 66.6 ± 8.4 years) and 42 postmenopausal osteoporotic women (mean age 68.5 ± 7.5 years). All bone mass was evaluated by total body bone mineral content (BMC_TB), density (BMD_TB), ultrasound bone velocity (UBV) in proximal phalanxes 2–5 of the nondominant hand (UBV = mean value of all ultrasound measurements), and peripheral quantitative computed tomography of the nondominant forearm (pQCT). BMC_TB was found to be significantly better (P < 0.0001) for diagnosing postmenopausal osteoporosis than the other methods; both cortical and trabecular pQCT measurements were more discriminating than the corresponding UBV measurements (P < 0.001). T-score values in normals, subjects versus osteoporotic ones were BMC_TB−1.15 ± 0.79 versus −3.17 ± 0.74; BMD_TB−1.01 ± 0.97 versus −3.28 ± 0.81; UBV −1.51 ± 1.02 versus −2.34 ± 1.21; trabecular-pQCT −0.40 ± 0.72 versus −1.57 ± 0.37; cortical-pQCT −1.00 ± 0.87 versus −2.67 ± 0.53; and total-pQCT −0.65 ± 1.01 versus −2.34 ± 0.27, respectively. The overlap in values between the postmenopausal normal and postmenopausal osteoporotic groups was 50% with UBV, 6% with BMC_TB, 9% with BMD_TB, 25% with cortical pQCT, and 42% with trabecular pQCT. BMC_TB, BMD_TB, UBV, and pQCT correlated well with each other as measurements of bone mass, but BMC_TB was more discriminating than the other measurements in the diagnosis of osteoporosis. Received: 7 June 1995 / Accepted: 21 May 1997     

The Tromsø Study: Artifacts in Forearm Bone Densitometry – Prevalence and Effects

Suboptimal performance of bone densitometer, operator and/or subject may cause artifacts of consequence both for individual patient management and research. The prevalence and effects of such artifacts are largely unknown in densitometry. A cross-sectional population-based study was carried out of artifacts in forearm bone densitometry with single X-ray Absorptiometry (SXA) of the nondominant hand (distal and ultradistal site). After the screening, all scans were reviewed for artifact detection and reanalysis. The effect on the bone mineral density (BMD) result was found by comparing artifactual scans with a reanalyzed version or with normal repeat scans. All women aged 50–74 years, all men aged 55–74 years and 5–10% samples of other age groups aged ≥25 years attending the fourth Troms? health study were invited to have bone densitometry. The response rate from the background population was 80% (n= 7948). Fourteen percent of subjects had a movement artifact at either the distal or ultradistal site. The individual BMD variation was twice as large in scans with a movement artifact (0.94%) compared with normal scans (0.58%) (p= 0.0027). The radial endplate was inaccurately detected in 74% of the scans. Reanalysis of these scans led to a mean 3.8% decrease in the BMD value and an increase in the prevalence of osteoporosis of 10%. Artifacts were thus common, and their effects were clinically relevant in forearm bone densitometry. Artifacts and their effects need to be characterized in other bone densitometry settings also. Received: 25 February 1999 / Accepted: 3 May 1999     

Bone Mineral Densitometry Substantially Influences Health-Related Behaviors of Postmenopausal Women

Although bone mineral density measurements are helpful in predicting future risk for osteoporotic fractures, there is limited information available on how the results of bone densitometry influence a woman's use of therapeutic alternatives. To assess the role of bone mineral densitometry in influencing postmenopausal women to change health behaviors associated with osteoporosis, we prospectively followed, for an average of 2.9 years, 701 postmenopausal women over 50 years of age referred to an osteoporosis prevention program in a large metropolitan area. Assessments included bone mineral densitometry by dual-energy X-ray absorptiometry (with classification of skeletal health), medical history, use of hormone replacement therapy, calcium intake, caffeine intake, exercise, smoking habits, and fall precaution measures. Women classified at baseline with moderate low bone mass were twice as likely (33%), and women with severe low bone mass more than three times as likely (47%) to start hormone replacement therapy compared with women with a normal result (13%, P < 0.001). This was true regardless of whether they had taken hormone replacement therapy in the past. Below-normal BMD was a strong predictor of a woman's initiation of hormone replacement therapy (OR 4.2; 95% CI 2.7–6.4; P < 0.05) even after adjustment for age, education, history of osteoporosis or fracture, and medical condition related to osteoporosis. Women with moderate or severe low bone mass were also much more likely to start calcium supplements (81–90% versus 67%), increase dietary calcium (71–82% versus 60%), decrease use of caffeine (44–60% versus 34%), start exercising (61–76% versus 52%), and quit smoking (22–24% versus 11%) relative to their behaviors prior to testing (P < 0.01). In conclusion, postmenopausal women report that the results of bone densitometry substantially influence the decision to begin hormone replacement therapy and calcium supplements, increase dietary calcium, decrease caffeine, increase exercise, decrease smoking, and take precautions to prevent falls. More studies are needed to measure the long-term effects of this influence. Received: 19 March 1999 / Accepted: 13 August 1999     

The Effect of Common Artifacts Lateral to the Spine on Bone Mineral Density in the Lumbar Spine

Artifacts such as surgical clips, gallstones, and kidney stones are often present in the soft tissue stripe lateral to vertebral bodies. Using cadaveric specimens, we placed bra wires, gallbladder clips, a large gallstone, a calcium carbonate or a calcium citrate pill lateral to L1, or a large or small calcium-containing kidney stone lateral to L3 and compared the mean bone mineral density (BMD) of individual vertebral bodies and L1–L4 with and without the soft tissue artifact. The specimens used had high BMD (L1–L4 BMD = 1.049 g/cm²) and low BMD (L1–L4 BMD = 0.669 g/cm²) and were scanned with a Hologic Discovery W scanner with 12.7 software in the array mode. None of the artifacts affected L1 or L3 BMD or L1–L4 BMD significantly in the high BMD spine. However, bra wires, a large calcium citrate pill lateral to L1, 3 calcium citrate pills lateral to L1, a calcium carbonate pill over L1, and 3 calcium carbonate pills lateral to L1 did affect L1–L4 BMD in low BMD torso. Gallbladder clips or gallstone did not affect L1–L4 BMD in either specimen. We conclude that artifacts lateral to the spine, particularly in a low BMD spine, can affect the interpretation of L1–L4 BMD using a Hologic Discovery W scanner with 12.7 software in array mode.     

Bone Densitometry in Infants and Young Children: The 2013 ISCD Pediatric Official Positions

Infants and children <5 yr were not included in the 2007 International Society for Clinical Densitometry Official Positions regarding Skeletal Health Assessment of Children and Adolescents. To advance clinical care of very young children, the International Society for Clinical Densitometry 2013 Position Development Conference reviewed the literature addressing appropriate methods and skeletal sites for clinical dual-energy X-ray absorptiometry (DXA) measurements in infants and young children and how results should be reported. DXA whole-body bone mineral content and bone mineral density for children ≥3 yr and DXA lumbar spine measurements for infants and young children 0–5 yr were identified as feasible and reproducible. There was insufficient information regarding methodology, reproducibility, and reference data to recommended forearm and femur measurements at this time. Appropriate methods to account for growth delay when interpreting DXA results for children <5 yr are currently unknown. Reference data for children 0–5 yr at multiple skeletal sites are insufficient and are needed to enable interpretation of DXA measurements. Given the current scarcity of evidence in many areas, it is likely that these positions will change over time as new data become available.     

Cancellous Bone of the Spine is Greater in Black Women

The bone mineral density (BMD) of the spine was measured in the posteroanterior (PA) and lateral projections as well as the total body BMD in 447 black and white women. The lateral projection is comprised predominantly of cancellous bone whereas the total body BMD is predominantly cortical bone, and the PA spine is intermediate in composition. Black women had a higher BMD than white women for each measurement, but the difference was greatest in the lateral spine. Similarly, black women showed less decline in cancellous bone density with aging. The development of a high peak cancellous bone mass with reduced involutional loss may provide a major contribution towards protection against osteoporotic fractures in black women. Metabolic and pharmacologic studies in black and white women should consider the possibility of the influence of a larger cancellous bone mass. Received: 14 November 1997 / Accepted: 11 December 1998     

Major Depressive Disorder and Bone Mass in Adolescents and Young Adults

Depression has been associated with reduced bone mass in adults, but the mechanisms remain unclear. In addition, little is known about the association between depression and bone health during growth and development. To address this knowledge gap, we examined bone density and structure in 222 adolescents and young adults (69% females, mean ± SD age: 19.0 ± 1.5 years), enrolled within 1 month of starting a selective serotonin reuptake inhibitor (SSRI) or unmedicated. Psychiatric functioning was assessed with self‐report and researcher‐administered instruments, including the Longitudinal Interval Follow‐up Evaluation for Adolescents (A‐LIFE). Anthropometric and laboratory measures included dual‐energy x‐ray absorptiometry and peripheral quantitative computed tomography scans. Linear multivariable regression analysis tested the association between depression and bone mass, after accounting for relevant confounders. The presence of current depression was associated with a significant reduction in age‐sex‐height‐race‐specific bone mineral density (BMD) and content (BMC) of total body less head and lumbar spine. The findings varied by assessment method with self‐report scales, capturing symptom severity over the prior week or two, yielding the weakest associations. Depression was also associated with reduced cortical thickness and a trend for increased endosteal circumference. In contrast, generalized anxiety disorder was not associated with bone deficits. In sum, depressive illness is associated with significantly lower bone mass in youths. Future investigations must examine whether bone recovery is possible following depression remission or whether remedial interventions are warranted to optimize bone mass in order to minimize the long‐term risk of osteoporosis. © 2014 American Society for Bone and Mineral Research.     

Determinants of Bone Mass and Bone Geometry in Adolescent and Young Adult Women

Bone mass and bone geometry are considered to have independent effects on bone strength. The purpose of this study was to obtain data on bone mass and geometry in young female populations and how they are influenced by body size and lifestyle factors. In a cross-sectional, observational study in six European countries, 1116 healthy Caucasian girls aged 11–15 and 526 women aged 20–23 participated. Their radius was scanned at the ultradistal site and at a site approximately 30% of the radius length from the distal end with dual energy X-ray absorptiometry (DXA). The following parameters were assessed from the scans: bone mineral content (BMC), bone mineral density (BMD), cortical wall thickness (CWT), middistal diameter (D), cortical index (CI = 2CWT/D), and the Breaking Bending Resistance Index (BBRI = (D⁴− [D-CWT]⁴)/D). Calcium intake was assessed by 3-day food records and physical activity by questionnaire. Body size parameters were measured by anthropometry. All parameters showed an increasing trend with pubertal stage and age, except for physical activity and calcium intake. BMC and BMD were relatively more dependent on body weight and age at menarche, whereas variation in D and the mechanical index BBRI was better explained by differences in height and grip strength. CI and CWT were relatively independent of variation in body size, whereas BMC and BBRI especially were explained for a substantial proportion (25–33% in the young adults) by body size parameters. Dietary intake of calcium and level of physical activity seem to contribute little to variation in bone parameters. Received: 1 October 1998 / Accepted: 26 July 1999     

Spine Trabecular Bone Score Subsequent to Bone Mineral Density Improves Fracture Discrimination in Women

Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis and assess fracture risk. However, DXA cannot evaluate trabecular microarchitecture. This study used a novel software program (TBS iNsight; Med-Imaps, Geneva, Switzerland) to estimate bone texture (trabecular bone score [TBS]) from standard spine DXA images. We hypothesized that TBS assessment would differentiate women with low trauma fracture from those without. In this study, TBS was performed blinded to fracture status on existing research DXA lumbar spine (LS) images from 429 women. Mean participant age was 71.3 yr, and 158 had prior fractures. The correlation between LS BMD and TBS was low (r = 0.28), suggesting these parameters reflect different bone properties. Age- and body mass index–adjusted odds ratios (ORs) ranged from 1.36 to 1.63 for LS or hip BMD in discriminating women with low trauma nonvertebral and vertebral fractures. TBS demonstrated ORs from 2.46 to 2.49 for these respective fractures; these remained significant after lowest BMD T-score adjustment (OR = 2.38 and 2.44). Seventy-three percent of all fractures occurred in women without osteoporosis (BMD T-score > −2.5); 72% of these women had a TBS score below the median, thereby appropriately classified them as being at increased risk. In conclusion, TBS assessment enhances DXA by evaluating trabecular pattern and identifying individuals with vertebral or low trauma fracture. TBS identifies 66–70% of women with fracture who were not classified with osteoporosis by BMD alone.     

Bone Mineral Density of the Spine and Femur in Healthy Moroccan Women

Bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DXA) are widely used to diagnose osteoporosis and assess its severity. Previous studies show the necessity to establish reference data for bone mass measurements for each particular population. Such data are lacking for the Moroccan population. The aim of this study was to determine spine and femur BMD reference values for the Moroccan female population and to compare them with values from western and other Arab countries. A cross-sectional study of 569 Moroccan women, (randomly selected in the area of Rabat, the capital of Morocco, aged between 20 and 79 yr) was carried out to establish reference values of BMD. Measurements were taken at the lumbar spine and proximal femurs using DXA (Lunar Prodigy Vision, GE). The data were compared with published normative data taken by United States (U.S.), European, Kuwaiti, Lebanese, and Saudi women over 6 decades of age. The percentage of osteoporosis in postmenopausal women using our reference curve was compared to that observed when the other curves (US, European and Arab) implemented in the Lunar machine was used. Our results showed that the Moroccan women showed the expected decline in BMD at both sites with age after peaking at 20–29 years of age. Moroccan females have lower BMD at the spine than U.S., Europeans, and Kuwaitis (approximately 10–12% for patients older than 50 yr). The BMD values of the total femur in Moroccan females were close to western (European and American), and Kuwaitis, but higher than Lebanese and Saudis. Using our reference database, 37.9% of postmenopausal women had spine osteoporosis vs. 39.6% and 23.4% using US/European and Arabic Lunar reference values respectively. At the femurs, 6.7% had osteoporosis vs. 2.5% using the Arabic Lunar reference values. In conclusion, our study emphasizes the importance of using population-specific reference values for BMD measurements to avoid over or underdiagnosis of osteoporosis.     

Estimation of Total-Body and Regional Soft Tissue Composition From DXA Bone Densitometry of the Lumbar Spine and Hip

The percent fat in soft tissues adjacent to the lumbar spine and proximal femur, which are required parameters in the calculation of bone mineral by conventional dual-energy X-ray absorptiometry (DXA) of the spine and hip, were analyzed for their relationship with the total-body soft tissue–scanning derivatives. The cohort (N = 149), consisting of stable actively treated male human immunodeficiency virus HIV-positive patients, was split in half to obtain prediction equations with one half to be validated by the other half. Prediction equations for the dependent variables total-body fat, total-body lean mass, trunk fat, total arm + leg fat, and leg fat were derived by step-down multiple regression. A Bland-Altman comparison of the predicted and observed values showed that the limits of agreement were too large to be clinically helpful. The correlations of the ratio of adjacent spine/hip fat with ratios of trunk/arm + leg fat and trunk/leg fat, markers of peripheral lipoatrophy in HIV, were 0.725 and 0.780, respectively. The 3 ratios were compared with the clinical diagnosis of the presence or absence of peripheral lipoatrophy by receiver operating characteristic analysis. The area under the curve was 0.720 for adjacent spine/hip fat ratio and 0.655 and 0.699 for trunk/arm + leg fat and trunk/leg fat, respectively; they were not significantly different. In conclusion, for male HIV-positive patients, the difference between predicted values and actual values rendered limits of agreement that were too wide to be clinically acceptable. The ratio of percent fat in the lumbar spine region to percent fat in the proximal femur region reflected the presence of peripheral lipoatrophy as effectively as the trunk/peripheral fat ratio that was derived from the total-body scan.     

Heterogeneity and Spatial Distribution of Intravertebral Trabecular Bone Mineral Density in the Lumbar Spine Is Associated With Prevalent Vertebral Fracture

The spatial heterogeneity in trabecular bone density within the vertebral centrum is associated with vertebral strength and could explain why volumetric bone mineral density (vBMD) exhibits low sensitivity in identifying fracture risk. This study evaluated whether the heterogeneity and spatial distribution of trabecular vBMD are associated with prevalent vertebral fracture. We examined the volumetric quantitative computed tomography (QCT) scans of the L₃ vertebra in 148 participants in the Framingham Heart Study Multidetector CT study. Of these individuals, 37 were identified as cases of prevalent fracture, and 111 were controls, matched on sex and age with three controls per case. vBMD was calculated within 5-mm contiguous cubic regions of the centrum. Two measures of heterogeneity were calculated: (i) interquartile range (IQR); and (ii) quartile coefficient of variation (QCV). Ratios in the spatial distributions of the trabecular vBMD were also calculated: anterior/posterior, central/outer, superior/mid-transverse, and inferior/mid-transverse. Heterogeneity and spatial distributions were compared between cases and controls using Wilcoxon rank sum tests and t tests and tested for association with prevalent fractures with conditional logistic regressions independent of integral vBMD. Prevalent fracture cases had lower mean ± SD integral vBMD (134 ± 38 versus165 ± 42 mg/cm³, p < .001), higher QCV (0.22 ± 0.13 versus 0.17 ± 0.09, p = .003), and lower anterior/posterior rBMD (0.65 ± 0.13 versus 0.78 ± 0.16, p < .001) than controls. QCV was positively associated with increased odds of prevalent fracture (OR 1.61; 95% CI, 1.04 to 2.49; p = .034), but this association was not independent of integral vBMD (p = .598). Increased anterior/posterior trabecular vBMD ratio was associated with decreased odds of prevalent fracture independent of integral vBMD (OR 0.38; 95% CI, 0.20 to 0.71; p = .003). In conclusion, increased trabecular vBMD in the anterior versus posterior centrum, but not trabecular vBMD heterogeneity, was associated with decreased risk of prevalent fracture independent of integral vBMD. Regional measurements of trabecular vBMD could aid in determining the risk and underlying mechanisms of vertebral fracture. © 2019 American Society for Bone and Mineral Research.     

Bone Densitometry and Vertebral Fracture Assessment

Measurement of bone mineral density (BMD) is used to diagnose osteoporosis, assess fracture risk, and monitor response to therapy. Of the different methods for measuring BMD, dual-energy X-ray absorptiometry (DXA) is the only technology for classifying BMD according to criteria established by the World Health Organization (WHO) and the only technology that is validated for BMD input with the WHO fracture risk assessment algorithm, FRAX. Vertebral fracture assessment (VFA) by DXA provides an image of the thoracic and lumbar spine for the purpose of detecting vertebral fracture deformities. Identification of a previously unrecognized vertebral fracture may change diagnostic classification, assessment of fracture risk, and treatment decisions. In comparison with standard radiographs of the spine, the correlation for detecting moderate and severe vertebral fractures is good, with a smaller dose of ionizing irradiation, greater patient convenience, and lower cost. Optimal performance of DXA and VFA requires training and adherence to quality standards.     

Bone Mineral Density in Young Women on Methadone Substitution

Little is known about bone mineral density (BMD) in patients with heroin addiction and subsequent methadone substitution. The goal of this study was to compare bone mass density of young HIV-negative women on long-term methadone treatment to a local group of young healthy women. Eleven women (aged 20–29) with previous heroin dependence and current methadone substitution (20–140 mg, median 60, daily) for 1.5–9 (median 3) years were compared to 30 healthy women (aged 20–28). Participants were examined with dual-energy X-ray absorptiometry of the lumbar spine (L2–L4), of the total proximal hip area, and of the femoral neck. Patients and controls had neither current nor lifetime underweight condition, had comparable ages at menarche, and did not differ significantly in current body mass index (21.9 ± 4.0, respectively, 20.5 ± 1.5 kg/m²) in spite of a largely unhealthy lifestyle (cigarette, alcohol, and cocaine consumption in patients). Patients’ total-hip parameters were marginally lower than those of controls (BMD P = 0.054, T score P = 0.049), whereas the femoral neck and lumbar spine parameters did not differ significantly between the two groups. Long-term methadone substitution in HIV-negative women seems to slightly affect bone mass density.     

Prevalence of Postmenopausal Osteoporosis in Italy and Validation of Decision Rules for Referring Women for Bone Densitometry

We report the prevalence of osteoporosis, osteopenia, and fractures in a cohort of Italian women randomly recruited among the general population and validate the use of clinical guidelines in referring women for bone density testing. We enrolled in the study 995 healthy women (age range 45–92 years). A bone density test at the lumbar spine and femur was performed and a questionnaire on osteoporosis risk factors completed for all patients. The prevalence of osteoporosis was 33.67 %, that of osteopenia was 46.63, and 19.7 % were normal at bone density testing. Osteoporotic women were generally older and thinner, with a shorter period of estrogen exposure. The prevalence of fractures was 21.9 %, and fractured women had a lower bone density, were older, and had a longer postmenopausal period. Clinical guidelines for referring women for bone density testing performed poorly (the best performance was 68 %). This is the first study providing data on the prevalence of osteoporosis/osteopenia and of fractures in a cohort of healthy postmenopausal women. Known risk factors influence bone density and risk of fractures. The role of screening in detecting women with postmenopausal osteoporosis is far from optimal.     

Forearm Bone Mineral Densitometry Cannot be Used to Monitor Response to Alendronate Therapy in Postmenopausal Women

Alendronate significantly increases bone mass and reduces hip and spine fractures in postmenopausal women. To determine whether forearm densitometry could be used to monitor the efficacy of alendronate, we examined changes in bone mineral density (BMD) at the forearm (one-third distal, mid-distal, ultradistal radius) versus changes at the hip (femoral neck, total hip) and spine (posteroanterior and lateral) in a double-masked, randomized, placebo-controlled clinical trial of 120 elderly women (mean age 70 ± 4 years) treated with alendronate for 2.5 years. We found that among women in the treatment group, BMD increased by 4.0–12.2% at the hip and spine sites (all p<0.001), whereas BMD increased only nominally at the one-third distal radius (1.3%, p<0.001) and mid-radius (0.8%, p<0.05), and remained stable at the ultradistal radius. At baseline, forearm BMD correlated with that of the hip (r= 0.55–0.64, p<0.001), femoral neck (r= 0.54–0.61, p<0.001) and posteroanterior spine (r= 0.56–0.63, p<0.001). Changes in radial BMD after 1 year of therapy were not correlated with changes in hip and spine BMD after 2.5 years of therapy. In contrast, short-term changes in total hip and spine BMD were generally positively associated with long-term changes in total hip, femoral neck and spine BMD (r= 0.30–0.71, p<0.05). Furthermore, long-term BMD changes at the forearm did not correlate with long-term hip and spine BMD changes, in contrast to the moderate correlations seen between spine and hip BMD at 2.5 years (r= 0.38–0.45, p<0.01). We conclude that neither short- nor long-term changes in forearm BMD predict long-term changes in overall BMD for elderly women on alendronate therapy, suggesting that measurements of clinically relevant central sites (hip and spine) are necessary to assess therapeutic efficacy. Received: 18 February 1999 / Accepted: 20 May 1999