Changing from male to female bone densitometer database for Tscore derivation in men: impact on bone loss diagnostic classification.

Imad Ghozlani, Mirieme Ghazi, Radouane Niamane, Abdellah El Maghraoui

Abstract


Objective: to evaluate the impact of changing from male to female database for T-score derivation on mean T-score, and bone mineral densitydiagnostic classification when applying the WHO criteria, in men.

Material and methods: 1200 men were enrolled. Lumbar spine and femur scans were obtained using a bone densitometer. Initially, the male normative database was used to calculate T-scores. Subsequently, all scans were reanalyzed using the female database for T-score derivation.

Results: when the scans were reanalyzed using the female databases, the female databases derived T-scores were lower (p<0.0001) and the proportion of men classified as having osteoporosis at any single site decreased from 14.8% to 11.2%. On reanalysis with female databases, T-scores increased (p<0.0001) with a positive bias of 0.45, 0.90, and 0.45 at L1-L4 spine, femur neck, and total hip respectively.

Conclusion: use of female databases to derive male T-scores reduces the number of men diagnosed with osteoporosis.


Keywords


database; T-score; osteoporosis

Full Text:

PDF

References


Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 1994;4(6):368-81.

El Maghraoui A, Mounach A, Rezqi A, Achemlal L, Bezza A, Ghozlani I. Vertebral fracture assessment in asymptomatic men and its impact on management. Bone. 2012;50(4):853-7.

El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I. Relationship between vertebral fracture prevalence and abdominal aortic calcification in men. Rheumatology (Oxford, England). 2012;51(9):1714-20.

Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2005;16 Suppl 2:S3-7.

Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. 2017.

Lloret A, Coiffier G, Couchouron T, Perdriger A, Guggenbuhl P. Risk factors of mortality during the first year after low energy osteoporosis fracture: a retrospective case-control study. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases. 2016;13(2):123-6.

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet (London, England). 1999;353(9156):878-82.

Ray R, Clement ND, Aitken SA, McQueen MM, Court-Brown CM, Ralston SH. High mortality in younger patients with major osteoporotic fractures. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2017;28(3):1047-52.

Lyons JG, Ensrud KE, Schousboe JT, McCulloch CE, Taylor BC, Heeren TC, et al. Slow Gait Speed and Risk of Long-Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures. Journal of the American Geriatrics Society. 2016;64(12):2522-7.

Giusti A, Bianchi G. Treatment of primary osteoporosis in men. Clinical interventions in aging. 2015;10:105-15.

Kaufman JM, Lapauw B, Goemaere S. Current and future treatments of osteoporosis in men. Best practice & research Clinical endocrinology & metabolism. 2014;28(6):871-84.

El Maghraoui A, Roux C. DXA scanning in clinical practice. QJM : monthly journal of the Association of Physicians. 2008;101(8):605-17.

El Maghraoui A, Mounach A, Gassim S, Ghazi M. Vertebral fracture assessment in healthy men: prevalence and risk factors. Bone. 2008;43(3):544-8.

de Laet CE, van der Klift M, Hofman A, Pols HA. Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2002;17(12):2231-6.

Selby PL, Davies M, Adams JE. Do men and women fracture bones at similar bone densities? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2000;11(2):153-7.

Melton LJ, 3rd, Orwoll ES, Wasnich RD. Does bone density predict fractures comparably in men and women? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2001;12(9):707-9.

Wiemann LM, Vallarta-Ast N, Krueger D, Binkley N. Effect of female database use for T-score derivation in men. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2007;10(3):244-8.

Leslie WD, Adler RA, El-Hajj Fuleihan G, Hodsman AB, Kendler DL, McClung M, et al. Application of the 1994 WHO classification to populations other than postmenopausal Caucasian women: the 2005 ISCD Official Positions. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2006;9(1):22-30.

Binkley NC, Schmeer P, Wasnich RD, Lenchik L. What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2002;5 Suppl:S19-27.

The Writing Group for the ISCD Position Development Conference . Diagnosis of osteoporosis in men, premenopausal women, and children. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2004;7(1):17-26.

El Maghraoui A, Koumba BA, Jroundi I, Achemlal L, Bezza A, Tazi MA. Epidemiology of hip fractures in 2002 in Rabat, Morocco. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2005;16(6):597-602.

El Maghraoui A, Do Santos Zounon AA, Jroundi I, Nouijai A, Ghazi M, Achemlal L, et al. Reproducibility of bone mineral density measurements using dual X-ray absorptiometry in daily clinical practice. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2005;16(12):1742-8.

El Maghraoui A, Achemlal L, Bezza A. Monitoring of dual-energy X-ray absorptiometry measurement in clinical practice. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2006;9(3):281-6.

El Maghraoui A, Ghazi M, Gassim S, Mounach A, Ghozlani I, Nouijai A, et al. Bone mineral density of the spine and femur in a group of healthy Moroccan men. Bone. 2009;44(5):965-9.

El Maghraoui A, Guerboub AA, Achemlal L, Mounach A, Nouijai A, Ghazi M, et al. Bone mineral density of the spine and femur in healthy Moroccan women. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2006;9(4):454-60.

Melton LJ, 3rd, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1998;13(12):1915-23.

Stegman MR, Heaney RP, Recker RR. Comparison of speed of sound ultrasound with single photon absorptiometry for determining fracture odds ratios. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1995;10(3):346-52.

El Maghraoui A, Morjane F, Mounach A, Ghazi M, Nouijai A, Achemlal L, et al. Performance of calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry in the discrimination of prevalent asymptomatic osteoporotic fractures in postmenopausal women. Rheumatology international. 2009;29(5):551-6.

Leidig-Bruckner G, Limberg B, Felsenberg D, Bruckner T, Holder S, Kather A, et al. Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2000;11(2):102-19.

Kruse C, Eiken P, Vestergaard P. Machine Learning Principles Can Improve Hip Fracture Prediction. Calcified tissue international. 2017.

Marques EA, Gudnason V, Lang T, Sigurdsson G, Sigurdsson S, Aspelund T, et al. Association of bone turnover markers with volumetric bone loss, periosteal apposition, and fracture risk in older men and women: the AGES-Reykjavik longitudinal study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(12):3485-94.

Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000;27(5):585-90.

Riggs BL, Melton Iii LJ, 3rd, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, et al. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2004;19(12):1945-54.

Nissen N, Hauge EM, Abrahamsen B, Jensen JE, Mosekilde L, Brixen K. Geometry of the proximal femur in relation to age and sex: a cross-sectional study in healthy adult Danes. Acta radiologica (Stockholm, Sweden : 1987). 2005;46(5):514-8.

Faulkner KG, Cummings SR, Black D, Palermo L, Gluer CC, Genant HK. Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1993;8(10):1211-7.

O'Neill TW, Varlow J, Silman AJ, Reeve J, Reid DM, Todd C, et al. Age and sex influences on fall characteristics. Annals of the rheumatic diseases. 1994;53(11):773-5.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2008;19(4):385-97.

Patel A, Coates PS, Nelson JB, Trump DL, Resnick NM, Greenspan SL. Does bone mineral density and knowledge influence health-related behaviors of elderly men at risk for osteoporosis? Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2003;6(4):323-30.

Kim SR, Park YG, Kang SY, Nam KW, Park YG, Ha YC. Undertreatment of osteoporosis following hip fractures in jeju cohort study. Journal of bone metabolism. 2014;21(4):263-8.


Refbacks

  • There are currently no refbacks.