Yaşlı Türk Erkeklerinde Dejeneratif Artefaktlara Bağlı DXA Yanlış Sınıflaması

Öz

Amaç: Dejeneratif lomber artefaktlar (osteofit, abdominal aort kalsifikasyonu [AAK], skolyoz) çift enerjili X-ışını absorbsiyometrisinde (DXA) kemik mineral yoğunluğunu (KMY) yanlış yüksek gösterebilir. Yaşlı Türk erkeklerinde bu duruma bağlı osteoporoz yanlış sınıflandırılma oranını belirlemeyi amaçladık. Gereç ve Yöntem: Retrospektif kesitsel tasarımlı bu çalışmaya 65–75 yaş arası 220 erkek dahil edildi. DXA sonuçlarına kör değerlendirilen lomber radyografilerde osteofit, AAK ve skolyoz varlığı 0–3 arasında skorlandı. Dünya Sağlık Örgütü kriterlerine göre lomber ve femur boynu T-skorları bireyler içinde karşılaştırıldı. Birincil sonlanım, femur boynunda lomber omurgaya kıyasla daha düşük kemik yoğunluğu kategorisine yeniden sınıflandırılma oranıydı. Yeniden sınıflandırma ile ilişkiler, 14 karıştırıcıya göre düzeltilmiş çok değişkenli lojistik regresyon ile değerlendirildi. Bulgular: Artefakt sıklığı %82,3 olarak saptandı (181/220; osteofit %72,3, AAK %38,6, skolyoz %19,1). Lomber ve femur boynu T-skorları arasındaki ortalama fark 1,27 birim (%95 güven aralığı [GA] 1,09–1,46) olup uyum zayıftı (ağırlıklı κ = 0,37). 220 olgunun 74'ü (%33,6) femur boynunda daha düşük kemik yoğunluğu kategorisine yeniden sınıflandı. Yeniden sınıflandırma oranı artefakt skoru grupları arasında farklılık gösterdi (eğilim p=0,03). T-skoru uyumsuzluğu için de aynı eğilim izlendi (eğilim p=0,001). Osteofit varlığında L4 KMY %13,0 daha yüksekti (%95 GA 7,1–20,0). Yeniden sınıflandırma ile bağımsız olarak ilişkili tek artefakt AAK idi (düzeltilmiş rölatif risk 1,75, %95 GA 1,23–2,51). Elastik-net ve LASSO ile korunan tek değişken de AAK oldu. Sonuç: Yaşlı Türk erkeklerinin üçte birinde femur boynu kemik yoğunluğu kategorisi lomber omurgaya kıyasla daha düşük bulundu ve bu durumla en güçlü ilişkili artefakt AAK oldu. Spinal dejenerasyonu olan, özellikle de AAK bulunan yaşlı erkeklerde femur boynu ölçümleri ayrı bir dikkat gerektirmektedir.

Anahtar Kelimeler

• Absorbsiyometri
• Kemik Yoğunluğu
• Osteofit
• Osteoporoz
• Skolyoz
• Tanı Hataları

Destekleyen Kurum

Yazarlar; bu çalışmanın yürütülmesi, yazımı veya yayımlanması için herhangi bir dış finansman, hibe ya da maddi destek almadıklarını beyan eder. Çalışma, Hacettepe Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Geriatri Bilim Dalı'nda (Ankara, Türkiye) yürütülmüştür.

Etik Beyan

Bu çalışma, Helsinki Bildirgesi'ne ve Araştırma ve Yayın Etiği ilkelerine uygun olarak yürütülmüştür. Verilerin ikincil analizi için Hacettepe Üniversitesi Sağlık Bilimleri Araştırmaları Etik Kurulu'ndan onay alınmıştır (Karar No: 2024/15-47, Tarih: 03.09.2024, Araştırma No: SBA 24/876). Çalışmanın retrospektif tasarımı nedeniyle bilgilendirilmiş onam alınması koşulu aranmamıştır.

Teşekkür

Yok.

DXA Misclassification from Degenerative Artifacts in Older Turkish Men

Öz

Objective: Degenerative lumbar artifacts (osteophytes, abdominal aortic calcification [AAC], scoliosis) can falsely elevate bone mineral density on dual-energy X-ray absorptiometry (DXA). We assessed the resulting discordance in bone density classification in older Turkish men. Material and Methods: In this retrospective cross-sectional study of 220 men aged 65–75 years, osteophytes, AAC, and scoliosis were assessed on DXA-blinded lumbar radiographs and scored 0–3. Lumbar and femoral neck T-scores were compared within subjects using World Health Organization categories. The primary outcome was reclassification to a lower bone density category at the femoral neck. Associations with reclassification were estimated by logistic regression adjusted for 14 confounders. Results: Artifacts were present in 181 of 220 men (82.3%; osteophytes 72.3%, AAC 38.6%, scoliosis 19.1%). The mean lumbar–femoral T-score difference was 1.27 units (95% confidence interval [CI] 1.09–1.46), with poor agreement (weighted κ=0.37). Overall, 74 of 220 men (33.6%) were reclassified to a lower bone density category at the femoral neck. Reclassification varied across artifact score groups (p for trend=0.03), as did T-score discordance (p for trend=0.001). Osteophytes were associated with 13.0% higher L4 bone mineral density (95% CI 7.1–20.0). AAC was the only artifact independently associated with reclassification (adjusted relative risk 1.75, 95% CI 1.23–2.51), and the only variable retained by elastic-net and LASSO. Conclusion: One-third of older Turkish men had a lower bone density category at the femoral neck than at the lumbar spine, with AAC being the artifact most strongly associated with this reclassification. The femoral neck warrants particular attention in older men with spinal degeneration, especially when AAC is present.

Anahtar Kelimeler

• Absorptiometry
• Bone Density
• Diagnostic Errors
• Osteophyte
• Osteoporosis
• Scoliosis

Destekleyen Kurum

The authors declare that no external funding, grant, or financial support was received for the research, authorship, or publication of this article. The study was conducted at the Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye.

Etik Beyan

This study was conducted in accordance with the Declaration of Helsinki and complies with Research and Publication Ethics principles. Secondary analysis of the data was approved by the Hacettepe University Health Sciences Research Ethics Committee (Decision No: 2024/15-47, Date: 03.09.2024, Research No: SBA 24/876). Informed consent was waived due to the retrospective nature of the study.

Teşekkür

None.

Kaynakça

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