Vertebral ve vertebra dışı fraktürü olan yaşlı olgularda dual–enerji X-ışını absorbsiyometri ve kantitatif bilgisayarlı tomografi karşılaştırması: Preliminar sonuçlar

Abstract

Amaç: Günümüzde Dual-enerji X-ışını absorbsiyometrisi (DXA) ve kantitatif bilgisayarlı tomografi (KBT) kemik kütle ve yapısını değerlendirmek, kırık riskini belirlemek için kullanılan yöntemlerdir. Bu çalışmada vertebral ve vertebral bölge dışında kırığı olan yaşlı hastalarda, DXA ve KBT ile ölçülen spinal ve femoral bölge dansitometri sonuçlarını karşılaştırarak, osteoporoz ve kırık riskini belirlemede en etkin yöntemi araştırmayı amaçladık. Yöntemler: Bu retrospektif kohort çalışmasında 65- 84 yaş aralığında 45 yaşlı hasta analiz edildi. Grup 1’e atravmatik vertebral kırığı olan 11 hasta, Grup 2’ ye spinal bölgenin dışında kırığı olan 11 hasta, Grup 3’e ise kırığı olmayan 23 hasta dahil edildi. Spinal (lumbar 1-4) ve femoral (boyun) bölgelerden ölçülen, DXA ve KBT ile yapılan kemik mineral yoğunluğu (BMD) ölçümleri ve T skorları değerlendirildi. Bulgular: Gruplar arası değerlendirmede, DXA ve KBT ile ölçülen, lumbar ve femoral boyun BMD değerlerinde ve T skorlarında üç grup arasında istatistiksel olarak anlamlı bir farklılık bulunmadı (tümü P>0,05). Grup 1’de KBT ile ölçülen lumbar BMD değeri, lumbar ve femoral boyun T skor değerleri, DXA ölçümlerinden istatistiksel olarak anlamlı düşük bulundu (sırasıyla, P<0,001, P=0,004 ve P=0,037). Grup 2’de KBT ile ölçülen lumbar bölge BMD ve lumbar bölge T skor değerleri, DXA ölçümlerinden istatistiksel olarak anlamlı derecede düşük bulundu (P<0,001 ve P<0,001). Grup 3’de KBT lumbar bölge T skoru, lumbar ve femoral boyun BMD değerleri, DXA ölçümlerinden istatistiksel olarak anlamlı derecede düşük dulundu (sırasıyla, P<0,001, P<0,001 ve P=0,004). Sonuç: KBT, ileri yaş olgularda kırık ve artroz gibi DXA yönteminin yanlış pozitiflik verebileceği durumlarda kullanılabilecek etkin bir kemik mineral yoğunluğu ölçüm metodudur.

Keywords

• Yaşlı
• Osteoporoz
• Spinal kırık
• Kemik yoğunluğu
• DXA
• KBT

Comparison of quantitative computed tomography and dual-energy X-ray absorptiometry in elderly patients with vertebral and nonvertebral fractures: Preliminary results

Abstract

Aim: Dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) are methods used today to evaluate bone mass and structure and determine the risk of fractures. In this study, spinal and femoral bone density results measured by DXA and QCT in elderly patients with vertebral and non-vertebral fractures were compared to identify the most effective method in determining the risk of osteoporosis and fractures. Methods: In this retrospective cohort study, 45 elderly patients aged 65–84 years were analyzed. Group 1 included 11 patients with atraumatic vertebral fractures, Group 2 included 11 patients with non-vertebral fractures and Group 3 included 23 patients without fractures. T-scores and bone mineral density (BMD) values of spinal (lumbar 1-4) and femoral (neck) regions measured by both DXA and QCT were evaluated. Results: Spinal and femoral T-scores and BMD values measured by DXA and QCT were similar between the groups (P>0.05 for all). In Group 1, lumbar BMD value, lumbar and femoral neck T-scores measured by QCT were significantly lower than DXA (P<0.001, P=0.004 and P=0.037, respectively). In Group 2, lumbar BMD value and T-score measured by QCT were significantly lower than DXA (P<0.001 and P<0.001). In Group 3, lumbar T-score, lumbar and femoral neck BMD values measured by QCT were significantly lower than DXA (P<0.001, P<0.001 and P=0.004, respectively). Conclusion: QCT is an effective method that can be used in elderly patients with fractures and arthrosis where DXA may yield false-positive results.

Keywords

• Geriatrics
• Ostoeporosis
• Vertebral Fractures
• Bone Density
• DXA
• QCT

Supporting Institution

yok

References

1. 1. Rosen CJ. Clinical practice. Postmenopausal osteoporosis. N Engl J Med. 2005;353(3):595-603.
2. 2. Gerdhem P. Osteoporosis and fragility fractures: Vertebral fractures. Best Pract Res Clin Rheumatol. 2013;27(6):743-55.
3. 3. Del Pino Montes J. Epidemiology of osteoporotic fractures: vertebral and nonvertebral fractures. Rev Osteoporos Metab Miner. 2010;2 (Supl 5):8-12.
4. 4. Gauthier A, Kanis J, Jiang Y, Martin M, Compston JE, Borgström F, et al. Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos. 2011;6(1-2):179-88.
5. 5. Kimi L. Kondo, D.O. Osteoporotic Vertebral Compression Fractures and Vertebral Augmentation. Semin Intervent Radiol. 2008;25(4):413–24.
6. 6. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465-75.
7. 7. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999;14(5):821-28.
8. 8. Piscitelli P, Iolascon G, Argentiero A, Chitano G, Neglia C, Marcucci G, et al. Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging. 2012;7:575-83.

9. 9. Cosman F, de Beur SJ, Le Boff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-81.
10. 10. Kaptoge S, Armbrecht G, Felsenberg D, Lunt M, O’Neill TW, Silman AJ, et al. When should the doctor order a spine X-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2004;19(12):1982-93.
11. 11. Engelke K. Quantitative computed tomography-current status and new developments. J Clin Densitom. 2017;20(3):309-21.
12. 12. Ko JH, Lim S, Lee YH, Yang IH, Kam JH, Park KK. Does simultaneous computed tomography and quantitative computed tomography show better prescription rate than dual-energy X-ray absorptiometry for osteoporotic hip fracture? Hip Pelvis. 2018;30(4):233-40.
13. 13. Lang TF, Guglielmi G, vanKuijk C, De Serio A, Cammisa M, Genant HK. Measurement of bone mineral density at the spine and proximal femur by volumetric quantitative computed tomography and dual-energy X-ray absorptiometry in elderly women with and without vertebral fractures. Bone. 2002;30(1):247-50.
14. 14. Chalhoub D, Orwoll ES, Cawthon PM, Ensrud KE, Boudreau R, Greenspan S, et al. Osteoporotic Fractures in Men (MrOS) Study Research Group. Areal and volumetric bone mineral density and risk of multiple types of fracture in older men. Bone. 2016(11);92:100-6.
15. 15. Lafferty FW, Rowland DY. Correlations of Dual-Energy X-ray Absorptiometry, Quantitative Computed Tomography, and Single Photon Absorptiometry with Spinal and Non-Spinal Fractures. Osteoporos Int. 1996; 6(5):407-15.
16. 16. Wu SY, Qi J, Lu Y, Lan J, Yu JC, Wen LQ, et al. Densitometric and geometric measurement of the proximal femur in elderly women with and without osteoporotic vertebral fractures by volumetric quantitative multi-slice CT. J Bone Miner Metab. 2010;28(6):682-9.
17. 17. Riggs BL, Khosla S, Melton III LJ. Type 1/Type 2 Model for involutional osteoporosis. In: Marcus R. Feldman DD. Kelsey J (Eds). Osteoporosis, Academic Press. San Diego 2001. pp 49-58.
18. 18. Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury. 2016;47 (Suppl 2):11-20.
19. 19. Legrand E, Chappard D, Pascaretti C, Duquenne M, Rondeau C, Simon Y, et al. Bone mineral density and vertebral fractures in men. Osteoporos Int. 1999;10(4):265-70.
20. 20. Wu SY, Jia HH, Hans D, Lan J, Wang LY, Li JX, et al. Assessment of volumetric bone mineral density of the femoral neck in postmenopausal women with and without vertebral fractures using quantitative multi-slice CT. J Zhejiang Univ Sci B. 2009;10(7):499-504.
21. 21. Bergot C, Laval-Jeantet AM, Hutchinson K, Dautraix I, Caulin F, Genant HK. A comparison of spinal quantitative computed tomography with dual-energy X-ray absorptiometry in European women with vertebral and nonvertebral fractures. Calcif Tissue Int. 2001;68(2):74-82.
22. 22. Mao YF, Zhang Y, Li K, Wang L , Ma YM, Xiao WL et al. Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat. 2019;16:33–9.
23. 23. Cohen A, Lang TF, McMahon DJ, Liu XS, Guo XE, Zhang C, et al. Central QCT Reveals Lower Volumetric BMD and Stiffness in Premenopausal Women With Idiopathic Osteoporosis, Regardless of Fracture History. J Clin Endocrinol Metab. 2012;97(11):4244-52.
24. 24. Liu XS, Cohen A, Shane E, Yin PT, Stein EM, Rogers H, et al. Bone density.geometry. Microstructure, and stiffness: Relationships between peripheral and central skeletal sites assessed by DXA, HR-pQCT, and cQCT in premenopausal women. J Bone Miner Res. 2010;25(10):2229-38.
25. 25. Amstrup AK, Jakobsen NF, Moser E, Sikjaer T, Mosekilde L, Rejnmark L. Association Between Bone Indices Assessed by DXA, HR-pQCT and QCT Scans in Post-Menopausal Women. J Bone Miner Metab. 2016;34(6):638-45.