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Related Experiment Videos

Discordance in patient classification using T-scores.

K G Faulkner1, E von Stetten, P Miller

  • 1Synarc Portland, Portland, OR 97220, USA. ken.faulkner@synarc.com

Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry
|November 5, 1999
PubMed
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A universal T-score criterion for osteoporosis is not suitable for all bone mineral density (BMD) measurements. Different skeletal sites and measurement techniques yield varying osteoporosis prevalence rates, necessitating site-specific criteria.

Area of Science:

  • Osteoporosis research
  • Bone mineral density (BMD) assessment
  • Geriatric medicine

Background:

  • The World Health Organization (WHO) T-score criterion of -2.5 for osteoporosis diagnosis is widely applied across various bone mineral density (BMD) measurement techniques.
  • This criterion was primarily derived from forearm measurements and their correlation with hip fracture in postmenopausal Caucasian women.
  • The sensitivity of T-scores to measurement site, technique, and reference populations suggests potential limitations of a universal threshold.

Purpose of the Study:

  • To compare the prevalence of osteoporosis using the T = -2.5 criterion across different skeletal sites and BMD measurement techniques.
  • To evaluate the appropriateness of a single T-score threshold for diverse densitometric evaluations.
  • To investigate the influence of skeletal site, measurement technique, and reference populations on osteoporosis prevalence estimates.

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Main Methods:

  • Comparison of osteoporosis prevalence (T = -2.5) at heel (ultrasound), hip (DXA), spine (PA DXA, lateral DXA, QCT), and forearm (DXA) using manufacturer normative data.
  • Determination of expected mean T-scores for a 60-year-old Caucasian female at each skeletal site.
  • Calculation of the expected percentage of 60-year-old Caucasian women classified as osteoporotic based on a -2.5 standard deviation criterion for each technique, assuming normal T-score distribution.

Main Results:

  • Expected mean T-scores for 60-year-old Caucasian females varied from -2.5 (spine QCT) to -0.7 (heel).
  • Osteoporosis prevalence estimates ranged significantly, from 3% at the heel to 50% for spine QCT.
  • Skeletal sites most strongly related to hip fracture risk (hip and heel) exhibited the least age-related T-score decline and lowest prevalence.

Conclusions:

  • A single T-score criterion is inadequate for all BMD measurements due to variations in age-related bone loss, reference populations, and technology.
  • Significant discrepancies in osteoporosis prevalence are observed across different measurement sites and techniques.
  • Site-specific T-score criteria may be necessary for accurate osteoporosis diagnosis, particularly considering the low prevalence with heel ultrasound versus high prevalence with spine QCT or lateral DXA.