The Precision of Lumbar Spine BMD and TBS on Different Vertebral Combinations
Keywords:
Precision, Least significant change, Bone mineral density, Trabecular bone score, Dual Energy X-ray AbsorptiometryAbstract
OBJECTIVE The objective of this study is to compute the precision and LSC of BMD and TBS at the lumbar spine using dual-energy X-ray absorptiometry in different vertebral combinations.
METHODS Thirty female participants (age 58.8 ± 4.0 years, height: 155.0 ± 5.2 cm, weight: 57.4 ± 8.6 kg and BMI: 23.9 ± 3.6) were scanned at the lumbar spine twice in the same day using DXA. The precision and LSC of BMD and TBS were computed in terms of the RMS-SD and %CV using the ISCD Advanced Precision Calculation Tool.
RESULTS The precision and LSC of BMD of the 4 vertebrae combinations showed the best precision and also showed a similar trend (0.005 g/cm2 and 0.62%, 0.013 g/cm2 and 1.71%), respectively. For TBS, the precision and LSC followed a similar pattern as BMD but was inferior to those of BMD. The %CV LSC of BMD for all vertebrae combinations did not exceed 5.3% as recommended by ISCD (15). The %CV LSC of TBS for 2-4 vertebrae combinations were within 5.8% with the exception of the individual vertebra which was unacceptable (%CV range 6.17-8.98).
CONCLUSIONS All vertebrae combinations had an acceptable level of precision and LSC for BMD monitoring. However, the precision and LSC of TBS were inferior to those of BMD, and individual vertebra were not appropriate for TBS monitoring.
References
Krueger D, Vallarta-Ast N, Checovich M, Gemar D, Binkley N. BMD measurement and precision: a comparison
of GE Lunar Prodigy and iDXA densitometers. J Clin Densitom. 2012;15:21-5.
Lewiecki EM, Binkley N, Morgan SL, Shuhart CR, Camargos BM, Carey JJ, et al. Best Practices for Dual Energy X-ray Absorptiometry Measurement and Reporting: International Society for Clinical Densitometry Guidance. J Clin Densitom. 2016;19:127-40.
Kendler DL, Compston J, Carey JJ, Wu CH, Ibrahim A, Lewiecki EM. Repeating measurement of bone mineral density when monitoring with dual-energy x-ray absorptiometry: 2019 ISCD Official Position. J Clin Densitom. 2019;22:489-500.
Nogueira ML, Ramos I. The role of central DXA measurements in the evaluation of bone mineral density. Eur J Radiol. 2009;1:103-7.
Kong SH, Hong N, Kim JW, Kim DY, Kim JH. Application of the Trabecular Bone Score in Clinical Practice. J Bone Metab. 2021;28:101-13.
Palomo T, Muszkat P, Weiler FG, Dreyer P, Brandão CMA, Silva BC. Update on trabecular bone score. Arch Endocrinol Metab. 2022;66:694-706.
Shepherd JA, Wang L, Fan B, Gilsanz V, Kalkwarf HJ, Lappe J, et al. Optimal monitoring time interval between DXA measures in children. J Bone Miner Res. 2011;26:2745-52.
Nelson L, Gulenchyn KY, Atthey M, Webber CE. Is a fixed value for the least significant change appropriate? J Clin Densitom. 2010;13:18-23.
Siglinsky E, Binkley N, Krueger D. Do textiles impact DXA bone density or body composition results? J Clin Densitom. 2018;21:303-7.
Hind K, Oldroyd B. Bone mineral density precision for individual and combined vertebrae configurations from lumbar spine dual-energy X-ray absorptiometry scans. J Clin Densitom. 2020;23:673-7.
Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury,
Peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics. J Clin Densitom. 2019;22:453-71.
Wilson KE, Kelly TL. Horizon™ DXA System: Technical and Clinical Advantages. Hologic Inc. [Internet]. 2013 [cited 2023 Aug 10]. Available from: https://hologiced.com/library/horizon-dxa-system-technical-and-clinical-advantages/
Bonnick SL, Lewis LA. Bone densitometry for technologists. 3rd ed. Totowa, NJ: Humana Press; 2013.
International Society for Clinical Densitometry (ISCD). ISCD DXA machine cross calibration tool. ISCD [Internet]. 2023 [cited 2023 Aug 15]. Available from: https://iscd.org/learn/ resources/calculators/
Krohn K, Schwartz EN, Chung YS, Lewiecki EM. Dual-energy X-ray Absorptiometry Monitoring with Trabecular Bone Score: 2019 ISCD Official Position. J Clin Densitom. 2019;22:501-5.
Shevroja E, Mo Costabella F, Gonzalez Rodriguez E, Lamy O, Hans D. The fracture predictive ability of lumbar spine BMD and TBS as calculated based on different combinations of the lumbar spine vertebrae. Arch Osteoporos. 2022;17:83. PubMed PMID: 35678937
International Society for Clinical Densitometry (ISCD). 2019 ISCD Official Positions Adults. ISCD [Internet]. 2019 [cited 2023 Jul 15]. Available from: https://iscd.org/learn/official-positions/adult-positions/
El Maghraoui A, Roux C. DXA scanning in clinical practice. Qjm. 2008;101:605-17.
Whittaker LG, McNamara EA, Vath S, Shaw E, Malabanan AO, Parker RA, et al. Direct Comparison of the Precision of the New Hologic Horizon Model With the Old Discovery Model. J Clin Densitom. 2018;21:524-8
McNamara EA, Kilim HP, Malabanan AO, Whittaker LG, Rosen HN. Enhanced Precision of the New Hologic Horizon Model Compared with the Old Discovery Model Is Less Evident When Fewer Vertebrae Are Included in the Analysis. J Clin Densitom. 2018;21:125-9.
Krueger D, Vallarta-Ast N, Libber J, Gangnon R, Binkley N. Does the precision of dual-energy X-ray absorptiometry for bone mineral density differ by sex? J Clin Densitom. 2014;17:505-9.
