Dual-Energy X-ray Absorptiometry Diagnostic Discordance Between Z-Scores and T-Scores in Young Adults |
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| Authors: | John J. Carey Miriam F. Delaney Thomas E. Love Barbara A. Cromer Paul D. Miller Bradford J. Richmond Martha Manilla-McIntosh Steven A. Lewis Charles L. Thomas Angelo A. Licata |
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| Affiliation: | 1. Department of Rheumatology, Merlin Park University Hospital, Galway, Ireland;2. Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, USA;3. Department of Pediatrics, Division of Adolescent Medicine, MetroHealth Medical Center, Cleveland, OH, USA;4. Colorado Center for Bone Research, South Wadsworth, Lakewood, CO, USA;5. Department of Musculoskeletal Radiology, Cleveland, OH, USA;6. Department of Endocrinology, Cleveland Clinic, Cleveland, OH, USA;7. The Center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic, Cleveland, OH, USA;1. Thyroid Cancer Research Laboratory, Endocrine Surgery Unit, The Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Wang ACC 460, Boston, MA 02115, USA;2. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA;1. The University of North Carolina at Charlotte, Charlotte, NC, USA;2. Center for Precision Metrology, USA;1. Department of Surgery, University of Chicago, 5812 South Ellis Avenue, Chicago, IL 60637, USA;2. Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA;3. Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA;1. Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62781, USA;2. Department of Orthopaedic and Sports Medicine, Detroit Medical Center, 311 Mack Avenue, 5th Floor, Detroit, MI 48201, USA;1. Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick 274, Providence, RI 02903, USA;2. Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, LA 166, Worcester, MA 01655, USA |
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| Abstract: | Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20–49 yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20–49 yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen's kappa: 0.53–0.75). The use of Z-scores resulted in significantly fewer (McNemar's p < 0.001) subjects diagnosed with “osteopenia,” “low bone mass for age,” or “osteoporosis.” Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with “osteoporosis” by T-score were reclassified as either “normal” or “osteopenia” when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density. |
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