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PubMed1996

[Computerized presentation of densitometry values of the size of bone defects].

On the basis of experimental knowledge, this investigation intended to give its contribution to knowledge of the process of bone reparation and regeneration of alveolar extension cyst's. The results have shown that the denzinometrics, as a possible way of reparational and regenerational processes verification, has its full X-ray and clinical justification as it enables not only the observation of the reparational process but also mutual comparison.

Absorptiometry, Photon↗
PubMed1998

[Use of densitometry examinations for evaluation of proximal femur fracture risk in people over 50 years of age].

The paper presents the use of dual energy X-ray absorptiometry for selecting patients with high risk of proximal femur fracture. A group of 63 patients with fracture has been compared with a group of 306 patients who fell down but did not sustain a fracture, all individuals aged over 60. Most significant bone density decrease (p < 0.001) presented as Z indices related to young population was found in all three examined areas of the proximal femur. The difference between the groups ranged between 1.62 to 2.19 SD depending on the area and the sex. Threshold values for ZYA have been established. For the femoral neck it was -1.3 SD, for Ward's triangle -1.5 SD and for trochanteric area -0.4 SD.

Absorptiometry, Photon↗
PubMed1998

[Quality control of bone densitometry: precision, reproducibility, and clinical application].

Dual energy x-ray absorptiometry (DEXA) is one of the most widely used methods for bone mineral density (BMD), total body mass (TBM), total body fat (TBF), percentage of total body fat (%TBF) and total body fat-free mass (TBFFM) measurements. We investigated the in vitro and in vivo accuracy and precision of DEXA in repeated measurements of a lumbar spine phantom and in 30 healthy volunteers. Based on precision, the minimal significant variability (MSV) at 95% confidence level between 2 measurements of the same object or subject was calculated. In vitro accuracy and MSV were 99.8 and 0.9% respectively. In vivo indexes were 99.4 and 0.9% for whole-body BMD, 98.6 and 2% for lumbar spine BMD, 96.6 and 4.8% for femoral neck BMD, 98 and 2.8% for major trochanter BMD, 96 and 5.7% for Ward's triangle BMD, 99.5 and 0.7% for TBM, 98 and 2.9% for TBF, 97.9 and 3% for %TBF and 99 and 1.4% for TBFFM. Our findings indicate that DEXA is a very reliable instrument and in order to be 95% confident of a real change between 2 scans a difference of at least the calculated MSV must be measured.

Absorptiometry, Photon↗
PubMed1998

Osteoporosis in clinical practice--bone densitometry and fracture risk.

Osteoporosis is a condition of decreased bone mass and bone density associated with an increase in fracture risk. Bone mineral density (BMD) of the lumbar spine and femur can be reliably measured by double-beam X-ray absorptiometry (DEXA), which provides a measure of bone strength. Reduction in BMD is a continuum and is associated with a progressive increase in fracture risk. The diagnosis of osteoporosis is based on BMD relative to that of healthy young adults and criteria for diagnosis are arbitrary. The original 'normal' BMD data published by some manufacturers were relatively high, leading to a relative over-diagnosis of osteoporosis. Revised normative BMD values of the spine and femur and revised criteria using degrees of severity are proposed and may provide a better basis for diagnosis and for the management of patients with osteoporosis. The indications for BMD measurement, the age at which BMD is measured, and number of measurements, depends upon the purpose of the measurement and how the result will affect the management of each patient in clinical practice.

Absorptiometry, Photon↗
PubMed1998

Osteointegration of a replanted tooth followed by RVG densitometry.

The frequency of dental traumas in children has been increasing. This work reviews a patient aged 9 who had the 2-day old fracture of the root of first permanent central incisor skewed palatinally 3 mm under the bone. The tooth was extracted, its canal filled with calcium hydroxide, and within less than 10 minutes the tooth was replanted and fixed by a metal splint. Daily follow-up did not show either pathological perioodontal changes or subjective pain symptoms. After 3 months the tissue density of both incisors was the same, i.e. the fractured tooth showed entire osteointegration.

Absorptiometry, Photon↗
PubMed1992

Changes in fat-free mass in obese subjects after weight loss: a comparison of body composition measures.

Estimates of body composition by densitometry were made in 84 apparently healthy subjects (42 men, 42 women) with a mean age of 40 +/- 6 years (mean +/- s.d.), before and after weight loss. The initial body mass index (BMI) was 30.7 +/- 2.3 kg/m2 and the achieved weight loss on a 4.2 MJ/day energy deficit diet for 13 weeks was 12.2 +/- 3.7 kg. The results by densitometry were compared with estimates obtained by four other techniques: deuterium oxide dilution, skinfold thickness, bioelectrical impedance (three equations) and BMI (two equations). The fat-free mass (FFM) loss estimated by densitometry in men and women was 2.8 +/- 1.8 kg and 1.3 +/- 1.3 kg respectively. The dilution technique gave comparable results with densitometry. The losses of FFM assessed by skinfold thicknesses, BMI and impedance equations were almost similar, but significantly larger than the reduction in FFM measured by densitometry. These deviations were mainly the result of significantly larger differences from densitometry before compared to after weight loss. No correlation was found between change in FFM by densitometry and change in resistance measured by the bioelectrical impedance method in both sexes. It is concluded that application of published prediction formulae in weight loss studies are less appropriate and will lead to changes in FFM that are significantly different from the changes estimated by densitometry or deuterium oxide dilution.

Adult↗
PubMed2004

[Management of osteoporosis at a primary care center].

OBJECTIVES: To find how suitable a semFYC guide is for the indication of bone densitometry in menopausal women; and how appropriate their Osteoporosis treatment is. DESIGN: Cross-sectional study.Setting. Girona-3 Health District. PARTICIPANTS: Women between 50 and 80 allocated to the Girona-3 Health District. Suffering a grave psychiatric disorder or a terminal illness were considered criteria for exclusion. 409 out of the 420 women envisaged were included, to achieve a 5% accuracy and a 0.05% alpha error. MAIN MEASUREMENTS: Whether bone densitometry took place or otherwise, other diagnostic tests, risk factors for osteoporosis recorded and drug treatment prescribed. RESULTS: Of the 125 women with risk factors for osteoporosis, 12 (9.6%) had had a bone densitometry. 20% of all bone densitometries done showed pathology. Only in 3 cases (0.7%) of the pathological cases was any recommendation on life-style recorded. 19.8% of the women took drug treatment. In 8% this was justified. The most common treatment prescribed was calcium, on its own or linked to vitamin D. 20% of cases had a bone densitometry to monitor them after 2 years. CONCLUSIONS: The indication for bone densitometry is low and its use could be improved. In those cases in which bone densitometry is requested, a pharmacological intervention is more common than a life-style one.

Aged↗
PubMed1998

Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density.

The relationship between low bone mass and risk of fracture is well documented. Although bone densitometry is the method of choice for detecting low bone mass, its use may be limited by the availability of equipment, cost, and reimbursement issues. Improved patient selection for bone densitometry might increase the cost-effectiveness of screening for osteoporosis, a goal we sought to achieve by developing and validating a questionnaire based solely on patient-derived data. Responses to the questionnaire were used to assign postmenopausal women to one of two groups: (1) those unlikely to have low bone mineral density (defined as 2 standard deviations or more below the mean bone mass at the femoral neck in young, healthy white women) and therefore probably not currently candidates for bone densitometry; and (2) those likely to have low bone mineral density and therefore probably candidates for bone densitometry. We asked community-dwelling perimenopausal and postmenopausal women attending one of 106 participating multispecialty centers (both academic and community based) to complete a self-administered questionnaire and undergo bone density measurement using dual x-ray absorptiometry. We used regression modeling to identify factors most predictive of low bone density at the femoral neck in the postmenopausal group. A simple additive scoring system was developed based on the regression model. Results were validated in a separate cohort of postmenopausal women. Data were collected from 1279 postmenopausal women in the development cohort. Using only six questions (age, weight, race, fracture history, rheumatoid arthritis history, and estrogen use), we achieved a target of 89% sensitivity and 50% specificity. The likelihood ratio was 1.78. Validation in a separate group of 207 postmenopausal women yielded 91% sensitivity and 40% specificity. Assuming population characteristics similar to those of our development cohort, use of our questionnaire could decrease the use of bone densitometry by approximately 30%. Sensitivity and specificity can be varied by changing the level for referral for densitometry to provide the most cost-effective use within a particular healthcare setting. Thus use of our questionnaire, an inexpensive prescreening tool, in conjunction with physician assessment can optimize the use of bone densitometry and may lead to substantial savings in many healthcare settings where large numbers of women require evaluation for low bone mass.

Bone Density↗
PubMed1990

Evaluation of near infra-red interactance as a method for predicting body composition.

The ability of near infra-red interactance (NIRI) to predict body composition, as measured by whole-body densitometry, was assessed in a group of 29 healthy volunteers; 15 m, 14 f, aged 18-40 years, body mass index (BMI) 18.3-28.5 kg/m2. The results were compared with those obtained by five other predictive methods: whole-body impedance/resistance, skinfold thicknesses, and methods based on weight and height or BMI. The correlation between densitometry and the alternative methods, including NIRI, were found to be remarkably similar, both with respect to fat (r = 0.90-0.92, s.e.e. = 2.12-2.47 kg), and fat-free mass (r = 0.96-0.97, s.e.e. = 2.13-2.71 kg). Percentage body fat (densitometry) correlated better with the near infrared measurements made in the biceps area than with those made in the triceps or thigh areas, or with a combination of measurements made at two or three sites. The 95 per cent limits of agreement between NIRI and densitometry for the estimation of body constituents were slightly greater than those between densitometry and the other methods. NIRI was also found to underestimate body fat increasingly as the degree of adiposity increased. This under-estimation was found to be particularly marked (16 per cent body weight) in a small and separate group of grossly obese women, BMI greater than 50 kg/m2, whose body composition was assessed by total body potassium as well as by densitometry. This study suggests that, in the healthy group of subjects examined, NIRI has little or no advantage over other simple methods in predicting body composition measured by classical whole-body densitometry.

Adolescent↗
PubMed1998

[Screening for bone disease risk with clinical factors in women after physiologic menopause].

BACKGROUND: Densitometric screening for osteoporosis in postmenopausal women has not been demonstrated cost-effective. We have tried to identify clinical factors for screening previous to densitometry avoiding unnecessary explorations. PATIENTS AND METHODS SETTING: outpatient clinics of a menopausal unit in a 450-bed general hospital. Cross-sectional study, in two steps, of two groups of 140 and 284 women attending for physiological menopause. A clinical questionnaire, physical data and lumbar densitometry (Hologic QDR 1000) were obtained classifying the cases as "normal" or "low bone mass" (osteopenia or osteoporosis) according with the WHO criteria. In the first group a logistic regression analysis was done to identify predictive factors for abnormal densitometry, then validated in the second group. Sensitivity, specificity, predictive values (PV) and classification ability of clinical factors were analyzed. RESULTS: Four factors were independent predictors of abnormal densitometry: age > 51 (odds ratio [OR] = 6.64; 95% CI, 2.36-18.7); body weight < 70 kg (OR = 4.32; 95% CI, 1.71-10.09); years of fertility < 32 (OR = 3.77; 95% CI, 1.36-10.04), and number of live births > 2 (OR = 3.47; 95% CI, 1.27-9.53). Presence of one factor offers: sensitivity 91.9%; specificity 15%; positive PV 66.6%, and negative PV 50%, whereas the presence of two factors offers: sensitivity 62.7%; specificity 70%; positive PV 79.9%, and negative PV 50.3%. Clinical screening allows, when two factors are present, to avoid a 35.5% of densitometries and the false-negative cases represent 18%. CONCLUSIONS: Detection of bone-risk clinical factors (abnormal densitometry) yields a screening, previous to densitometry, that avoids at least one third of explorations in women with physiological menopause, improving the efficiency of the test.

Cross-Sectional Studies↗