Articles

T-Score Discordance Between Hip and Spine in Diagnosis of Osteoporosis in Patients From Iranian Population

Abstract

Today, osteoporosis is a major healthcare system problem globally. Each year, osteoporosis leads to more than 8.9 million fractures. In practice, osteoporosis can be diagnosed following a low-energy trauma fragility fracture of a bone or by a bone mineral density measurement using dual X-ray absorptiometry showing a T-score of ≤-2.5. This is a retrospective study that reviewed all subjects with osteoporosis or osteopenia indication, which were referred by practitioners for diagnostic densitometric evaluation to Alzahra hospital in Isfahan, Iran. from January 1, 2017, to December 31, 2019. Bone mineral density (BMD) reports were reviewed to identify all cases of osteoporosis or osteopenia. Our data analysis according to the World Health Organization (WHO) diagnostic classification showed that simultaneously measured T-scores at the spine and hip are concordant in 49.60% of patients and discordant by at least one diagnostic class in 49.95%. There was no significant discordance prevalence when one site was osteoporotic, and another site was normal (The prevalence was only 4.74%). Major T-score discordance was directly correlated to age (r=0.908, P=0.005), but there was no statistical relationship between minor T-score discordance and age (P=0.07). Clinicians should expect that at least half of patients tested by DXA will demonstrate T-score discordance between spine and total hip measurement sites. However, discordance is a real finding, and clinicians should be familiar with this issue and adopt specific strategies for these patients to investigate the cause or causes of the discordance.

1. Clynes MA, Harvey NC, Curtis EM, Fuggle NR, Elaine M, Cooper C. Europe PMC Funders Group The Epidemiology of Osteoporosis. 44(0).
2. Cawston H, Maravic M, Fardellone P, Gauthier A. Epidemiological burden of postmenopausal osteoporosis in France from 2010 to 2020 : estimations from a disease model. 2020;(2012):237–46.
3. K.H. Sunil Kumar PB. Osteoporosis - An Emerging Disease of the 21st Century, Part 1: An Overview. J Fam Med Prim Care. 2012;1(1):66–8.
4. MA EMAGAALMANAGMBAT. Bone Mineral Density of the Spine and Femur in Healthy Moroccan WomenNo Title. J Clin Densitom. 2006;9(4):454–60.
5. Cooley H JG. A population-based study of fracture incidence in southern Tasmania: lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int. 2001;12(2):124–30.
6. Hasserius R, Karlsson MK, Nilsson BE et al. Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int. 2003;14(1):61–8.
7. Kanis JA, Oden A, Johnell O et al. The components of excess mortality after hip fracture. Bon. 2003;32(5):464–73.
8. Women A, Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, et al. International Original Article Survival and Potential Years of Life Lost After Hip Fracture in Men and. 2002;731–7.
9. Trombetti A, Herrmann F, Hoffmeyer P et al. Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int. 2002;13:731.
10. Haentjens P, Johnell O, Kanis JA, Bouillon R, Cooper C, Lamraski G, et al. Evidence From Data Searches and Life‐Table Analyses for Gender‐Related Differences in Absolute Risk of Hip Fracture After Colles’ or Spine Fracture: Colles’ Fracture as an Early and Sensitive Marker of Skeletal Fragility in White Men. J bone Miner Res. 2009;19(12):1933–44.
11. THE MIDDLE EAST &. 2011;
12. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. . Am J Med. 1993;94:646–50.
13. WHO. Assessment of Fracture Risk, its Application to Screening for Postmenopausal Osteoporosis. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. 1994.
14. B. MASAKTNSMHAL. Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocr Disord. 2005;5(3).
15. DT G. The nonskeletal consequences of osteoporotic fractures. Psychologic and social outcomes. Rheum Dis Clin North Am. 2001;27:255–62.
16. Woodson G. Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites. J Clin Densitom. 2000;3:319–24.
17. B. MASAKTNSMHAL. Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocr Disord. 2005;5(3).
18. A EMAMADGIMANAGMAAB. Prevalence and risk factors of discordance in diagnosis of osteoporosis using spine and hip bone densitometry. Ann Rheum Dis. 2007;66(2):271–2.
19. Derakhshan S, Shahsavari S. Discordance in diagnosis of osteoporosis using spine and femur bone densitometry : prevalence and related factors Discordance in diagnosis of osteoporosis. 2012;20(2):14–9.
20. P FK von SEM. Discordance in patient classification using T-scores. J Clin Densitom. 1999;2:343–50.
21. Aziziyeh R, Perlaza JG, Saleem N, Sadat-ali M, Mctavish RK, Duperrouzel C, et al. scorecard and economic model Ac ce pt e d us cr. J Med Econ [Internet]. 2020;0(0):000. Available from: http://dx.doi.org/10.1080/13696998.2020.1737536
22. K.H. Sunil Kumar B p. Osteoporosis - An Emerging Disease of the 21st Century, Part 1: An Overview. J Fam Med Prim Care. 2012;1(1):66–8.
23. Thambiah SC, Yeap SS, Chretien G, Martin F. Osteoporosis in South-East Asian Countries. 2020;41(1):29–40.
24. Derakhshan S SS. Discordance in diagnosis of osteoporosis using spine and femur bone. Iran J Nucl Med. 2012;(20):14–9.
25. Yeap SS, Hew FL, Damodaran P, Chee W, Lee JK, Goh EML et al. A summary of the Malaysian Clinical Guidance on the management of postmenopausal and male osteoporosis. Osteoporos Sarcopenia. 2016;2:1–12.
26. Li-Yu J, Perez EC, Cañete A, Bonifacio L, Llamado LQ, Martinez R et al. Osteoporosis Society of Philippines Foundation, Inc. (OSPFI); Philippine Orthopedic Association (POA) Clinical Practice Guidelines Task Force Committee on Osteoporosis. Consensus statements on osteoporosis diagnosis, prevention, and management in the Phil. Int J Rheum Dis. 2011;14:223–38.
Files
IssueVol 60 No 12 (2022) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v60i12.11827
Keywords
Osteoporosis Discordance Densitometry T-score.
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Beigy H, Mousavi M, Karimi J, Karimzadeh H, Arezomandi N, Pakzad B. T-Score Discordance Between Hip and Spine in Diagnosis of Osteoporosis in Patients From Iranian Population. Acta Med Iran. 2023;60(12):749-755.