Dual-energy X-ray absorptiometry bone densitometry and pitfalls in the assessment of osteoporosis: a primer for the prac
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ORIGINAL ARTICLE
Dual-energy X-ray absorptiometry bone densitometry and pitfalls in the assessment of osteoporosis: a primer for the practicing clinician Chen Pong Wong 1 & Linsey Utami Gani 2 & Le Roy Chong 1 Received: 20 February 2020 / Accepted: 17 August 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary A guide to the clinician on the use of dual-energy x-ray absorptiometry bone densitometry for the management of osteoporosis and the importance of recognizing its pitfalls. Purpose Osteoporosis is a major risk factor for severe fractures in the aging population worldwide, posing a serious public health issue. Dual-energy X-ray absorptiometry (DXA) is and remains the main tool for screening of osteoporosis and monitoring of osteoporosis treatment through quantitative measurement of bone mineral density (BMD). Employing DXA to measure BMD is not without pitfalls. We set out to analyze and classify the potential pitfalls of DXA acquisitions and BMD measurements encountered in clinical practice in our institution. Methods Technical inaccuracies and discrepancies in BMD interpretation in the history of our department were analyzed and classified into different categories of pitfalls. Results We found that major pitfalls of BMD acquisition and interpretation using DXA can be classified into technical, patient, and interpretive factors. These are illustrated with case examples. Conclusion Good technical understanding of BMD measurements using DXA and recognition of potential pitfalls allow for greater technical and interpretive accuracy, which together hopefully increases the precision of osteoporosis management when practiced in accordance with established clinical guidelines. Keywords Osteoporosis . Bone mineral density . Dual energy X-ray absorptiometry . Guidelines . Pitfalls
Introduction Osteoporosis is a systemic skeletal disease characterized by low bone mineral density and altered bone architecture, causing bone fragility with consequent increase in fracture risk [1, 2]. The public health impact of osteoporosis stems from its association with fractures, particularly hip fractures which have the greatest morbidity and mortality. In the latest report by the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11657-020-00808-2) contains supplementary material, which is available to authorized users. * Le Roy Chong [email protected] 1
Department of Radiology, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
2
Department of Endocrinology, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
National Osteoporosis Foundation (NOF), there were 2.5 million osteoporotic fractures in the USA in 2015, and nearly one in five patients die within 12 months of a new hip fracture. Furthermore, osteoporotic fractures are responsible for more hospital stays than myocardial infarction, strokes, and breast cancer combined (https://www.bonehealthpolicyinstitute.org/ full-milliman-report
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