Major Discordance in the Diagnosis of Osteoporosis Among Participants  With Degenerative Lumbar Spine Using Spine and Hip  Dual-Energy X-ray Absorptiometry

Alisara Wongsuttilert; Kasem Chaiklongkit; Sutasinee Kongpromsuk; Wanlop Jaidee

doi:10.14456/rmj.2018.33

Authors

Alisara Wongsuttilert Division of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand
Kasem Chaiklongkit Faculty of Sport Science, Burapha University, Chonburi, Thailand
Sutasinee Kongpromsuk Division of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand
Wanlop Jaidee Division of Fundamentals of Public Health, Faculty of Public Health, Burapha University, Chonburi, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.33

Keywords:

Bone mineral density, DXA, Lumbar spine, Degenerative spine disease

Abstract

Background: Major T-score discordance in the diagnosis of osteoporosis at spine and the hip may induce misinterpretation in people with degenerative lumbar spine.

Objective: To investigate major T-score discordance in the diagnosis of osteoporosis using bone mineral density (BMD) at the lumbar spine and the hip among people with degenerative lumbar spine.

Methods: Demographic data, anthropometric measurements, and dual-energy X-ray absorptiometry (DXA) scans at the lumbar spine and the hip were retrieved from a database of Burapha University Hospital. The interrater reliabilities of image interpretation were performed. The correlation between degenerative lumbar spine lesions with T-scores at the lumbar spine and the hip was analyzed. Major discordance was defined when one site is osteoporotic and the other site is osteopenia or normal.

Results: Major T-score discordance of the lumbar spine and the hip was 28.6% and the hip BMD detected in participants with osteoporosis was less than the lumbar spine BMD (15.7% vs 36.5%). T-score at lumbar spine showed a false negative rate of 25.0%. Degenerative lumbar spine lesions showed a poor correlation with T-score at the lumbar spine (R² = 0.21, P < 0.01) and the hip (R² at femoral neck = 0.24, P < 0.01; R² at total hip = 0.32, P < 0.01).

Conclusions: Twenty-six percent of participants with degenerative lumbar spine were not evaluated L1-L4 BMD. While the hip seems to be the best measurement site, 28.6% of T-score discordance between lumbar spine and hip was still observed. T-score at lumbar spine showed a false negative rate of 25.0% and associated with older age. This study suggested that it would not be suitable to use the hip BMD alone to diagnose osteoporosis in older adults with degenerative spine disease.

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