Journal of Clinical Densitometry RSS feed: Current Issue. The official journal of the International Society for Clinical Densitometry (ISCD) , the Journal of Clinical Densitometry: Assessment of Skeletal Health publishes the latest clinical research on the uses of bone mass and density measurements in medical practice, as well as state-of-the-art review articles on critical topics. The Journal is committed to serving ISCD's mission?the education of heterogenous physician specialties and technologists who are involved in the clinical assessment of skeletal health. The focus of JCD is bone mass measurement, including epidemiology of bone mass, how drugs and diseases alter bone mass, new techniques and quality assurance in bone mass imaging technologies, and bone mass health/economics. Combining high quality research and review articles with sound, practice-oriented advice, JCD meets the diverse diagnostic and management needs of radiologists, endocrinologists, nephrologists, rheumatologists, gynecologists, family physicians, internists, and technologists whose patients require diagnostic clinical densitometry for therapeutic management.http://www.clinicaldensitometry.com/?rss=yesElsevier Inc.en © 2010 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved. Journal of Clinical Densitometry1094-6950133July 2010 © 2010 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clinicaldensitometry.com/article/PIIS1094695010001939/abstract?rss=yesAbstract: Bone shape, mass, structural geometry, and material properties determine bone strength. This study describes novel software that uses peripheral quantitative computed tomography (pQCT) images to quantify cortical bone shape and investigates whether the combination of shape-sensitive and manufacturer's software enhances the characterization of tibiae from contrasting populations. Existing tibial pQCT scans (4% and 50% sites) from Gambian (n=38) and British (n=38) women were used. Bone mass, cross-sectional area (CSA), and geometry were determined using manufacturer's software; cross-sectional shape was quantified using shape-sensitive software. At 4% site, Gambian women had lower total bone mineral content (BMC: −15.4%), CSA (−13.4%), and trabecular bone mineral density (BMD: −19%), but higher cortical subcortical BMD (6.1%). At 50% site, Gambian women had lower cortical BMC (−7.6%), cortical CSA (−12.6%), and mean cortical thickness (−15.0%), but higher cortical BMD (4.9%) and endosteal circumference (8.0%). Shape-sensitive software supported the finding that Gambian women had larger tibial endosteal circumference (9.8%), thinner mean cortical thickness (−26.5%) but smaller periosteal circumference (−5.6%). Shape-sensitive software revealed that Gambian women had tibiae with shorter maximum width (−7.6%) and thinner cortices (−22% to −41.2%) and more closely resembled a circle or ellipse. Significant differences remained after adjusting for age, height, and weight. In conclusion, shape-sensitive software enhanced the characterization of tibiae in 2 contrasting groups of women.Evidence for Enhanced Characterization of Cortical Bone Using Novel pQCT Shape SoftwareMargaret Ann Laskey, Stephanie de Bono, Daan Zhu, Colin N. Shaw, Peter J. Laskey, Kate A. Ward, Ann Prentice10.1016/j.jocd.2010.05.005Journal of Clinical Densitometry 13, 3 (2010)2010-07-01Journal of Clinical Densitometry2010-07-01133S1094-6950(10)X0004-XOriginal Articles247255http://www.clinicaldensitometry.com/article/PIIS1094695010001927/abstract?rss=yesAbstract: The purposes of this study were to determine the role of bone mineral density (BMD) and mood in influencing health-related behaviors of serious leisure male athletes (cyclists and triathletes) at risk for osteoporosis. A cross-sectional design evaluated BMD in 18–60-yr-old serious leisure male cyclists by dual-energy X-ray adsorptiometry (DXA). Activity was measured using the International Physical Activity Questionnaire; personality was assessed using the NEO-60; and quality of life using Short-Form Health 12 (SF-12). Participants completed an online survey questionnaire after completing their DXA testing a minimum of 3mo before assessing health-related behaviors and general attitudes toward general health and well-being. Forty-two (61.9%) participants responded to the follow-up questionnaire. Serious leisure male athletes are more likely to initiate significant health-related behavioral changes after learning of their bone density results including calcium supplementation and weight-bearing exercise. Men with low BMD (LBMD) had higher openness subscales on NEO-60 compared with men with normal BMD. SF-12 mental and physical health scores were significantly lower in men with LBMD. Perhaps, the interaction and interplay of genetics, activity and behaviors, and aspects of mental and psychological functions contribute to their reduction in BMD and heightened risk for fracture. Findings from this study suggest that early BMD testing in “serious athletes” has important clinical relevance for their potential risk for osteoporosis in the future.Bone Mineral Density Results Influencing Health-Related Behaviors in Male Athletes at Risk for OsteoporosisLeah FitzGerald, Catherine Carpenter10.1016/j.jocd.2010.05.004Journal of Clinical Densitometry 13, 3 (2010)2010-07-01Journal of Clinical Densitometry2010-07-01133S1094-6950(10)X0004-XOriginal Articles256262http://www.clinicaldensitometry.com/article/PIIS1094695010001897/abstract?rss=yesAbstract: The percent fat in soft tissues adjacent to the lumbar spine and proximal femur, which are required parameters in the calculation of bone mineral by conventional dual-energy X-ray absorptiometry (DXA) of the spine and hip, were analyzed for their relationship with the total-body soft tissue–scanning derivatives. The cohort (N=149), consisting of stable actively treated male human immunodeficiency virus HIV-positive patients, was split in half to obtain prediction equations with one half to be validated by the other half. Prediction equations for the dependent variables total-body fat, total-body lean mass, trunk fat, total arm+leg fat, and leg fat were derived by step-down multiple regression. A Bland-Altman comparison of the predicted and observed values showed that the limits of agreement were too large to be clinically helpful. The correlations of the ratio of adjacent spine/hip fat with ratios of trunk/arm+leg fat and trunk/leg fat, markers of peripheral lipoatrophy in HIV, were 0.725 and 0.780, respectively. The 3 ratios were compared with the clinical diagnosis of the presence or absence of peripheral lipoatrophy by receiver operating characteristic analysis. The area under the curve was 0.720 for adjacent spine/hip fat ratio and 0.655 and 0.699 for trunk/arm+leg fat and trunk/leg fat, respectively; they were not significantly different. In conclusion, for male HIV-positive patients, the difference between predicted values and actual values rendered limits of agreement that were too wide to be clinically acceptable. The ratio of percent fat in the lumbar spine region to percent fat in the proximal femur region reflected the presence of peripheral lipoatrophy as effectively as the trunk/peripheral fat ratio that was derived from the total-body scan.Estimation of Total-Body and Regional Soft Tissue Composition From DXA Bone Densitometry of the Lumbar Spine and HipLeonard Rosenthall, Julian Falutz10.1016/j.jocd.2010.05.001Journal of Clinical Densitometry 13, 3 (2010)2010-07-01Journal of Clinical Densitometry2010-07-01133S1094-6950(10)X0004-XOriginal Articles263266http://www.clinicaldensitometry.com/article/PIIS1094695010001873/abstract?rss=yesAbstract: The objectives of the study were to develop bone mineral density (BMD) reference norms and BMD Z-scores at various skeletal sites, to determine whether prior fracture and/or asthma were related to BMD, and to assess possible geographic variation of BMD among Canadian youth aged 16–24yr. Z-Scores were defined as the number of standard deviations from the mean BMD of a healthy population of the same age, race, and sex. Z-Scores were calculated using the reference sample defined as Canadian Caucasian participants without asthma or prior fracture. Reference standards were created for lumbar spine (L1–L4), femoral neck, total hip, and greater trochanter, by each year of age (16–24yr), and by sex. The Z-score norms were developed for groups noted earlier. Mean Z-scores between the asthma or fracture subgroups compared with the mean Z-scores in the reference sample were not different. There were minor differences in mean BMD across different Canadian geographic regions. This study provides age, sex, and skeletal site-specific Caucasian reference norms and formulae for the calculation of BMD Z-scores for Canadian youth aged 16–24yr. This information will be valuable to help to identify individuals with clinically meaningful low BMD.Normative Bone Mineral Density Z-Scores for Canadians Aged 16 to 24 Years: The Canadian Multicenter Osteoporosis StudyWei Zhou, Lisa Langsetmo, Claudie Berger, Jonathan D. Adachi, Alexandra Papaioannou, George Ioannidis, Colin Webber, Stephanie A. Atkinson, Wojciech P. Olszynski, Jacques P. Brown, David A. Hanley, Robert Josse, Nancy Kreiger, Jerilynn Prior, Stephanie Kaiser, Susan Kirkland, David Goltzman, Kenneth Shawn Davison, CaMos Research Group10.1016/j.jocd.2010.04.005Journal of Clinical Densitometry 13, 3 (2010)2010-05-31Journal of Clinical Densitometry2010-05-31133S1094-6950(10)X0004-XOriginal Articles267276http://www.clinicaldensitometry.com/article/PIIS1094695010001769/abstract?rss=yesAbstract: Bone formation and resorption are influenced by inflammatory processes. We examined the relationships among inflammatory markers and bone mineral content (BMC) and density (BMD) and determined the contribution of inflammatory markers to 1-yr changes in BMC and BMD in healthy postmenopausal women. This analysis included 242 women at baseline from our parent Soy Isoflavones for Reducing Bone Loss project who were randomly assigned to 1 of 3 treatment groups: placebo, 80mg/d soy isoflavones, or 120mg/d soy isoflavones. BMD and BMC from the lumbar spine (LS), total proximal femur (hip), and whole body were measured by dual energy X-ray absorptiometry and the 4% distal tibia by peripheral quantitative computed tomography. Serum inflammatory markers (C-reactive protein, interleukin [IL]-1β, IL-6, tumor necrosis factor-alpha [TNF-α], and white blood cell count [WBC]) were measured at baseline, 6, and 12mo. Because of attrition or missing values, data analysis at 12mo includes only 235 women. Significant associations among IL-6, TNF-α, and WBC were observed with percent change in LS, hip, and whole body BMC and BMD. Multiple regression analysis indicated that in combination inflammatory markers accounted for 1.1–6.1% of the variance to the observed 12-mo changes in BMC and BMD. Our results suggest that modifying inflammatory markers, even in healthy postmenopausal women, may possibly reduce bone loss.Contribution of Serum Inflammatory Markers to Changes in Bone Mineral Content and Density in Postmenopausal Women: A 1-Year InvestigationE.R. Gertz, N.E. Silverman, K.S. Wise, K.B. Hanson, D.L. Alekel, J.W. Stewart, C.D. Perry, S.N. Bhupathiraju, M.L. Kohut, M.D. Van Loan10.1016/j.jocd.2010.04.003Journal of Clinical Densitometry 13, 3 (2010)2010-06-07Journal of Clinical Densitometry2010-06-07133S1094-6950(10)X0004-XOriginal Articles277282http://www.clinicaldensitometry.com/article/PIIS1094695010001721/abstract?rss=yesAbstract: Muscular function declines with advancing age and is associated with increased risk for falls and fragility fractures. No single methodology ideally quantitatively evaluates this decline. Jumping mechanography (JM) may prove useful to quantitatively measure muscular function in older adults. This study begins to evaluate the safety of JM and the relationship of jump power and lean mass in older adults. Eighty adults, 40 aged 20–30yr and 40 aged 60yr or older, distributed equally by gender, participated. They performed countermovement jumps to assess jump power and height. Self-reported pain before and after jumping and need for assistance was recorded. In the older group, dual-energy X-ray absorptiometry was used to measure bone mineral density, to estimate lean body mass, and to determine vertebral fracture status. Jumping was well tolerated without injury or increased pain. No new vertebral fractures occurred with jumping in the older group. Young individuals had greater jump power and height compared with the older group. Older age was negatively correlated, whereas lean mass positively correlated with jump power and height. JM appears to be a safe and potentially useful method to assess muscular function in older adults.Jumping Mechanography: A Potential Tool for Sarcopenia Evaluation in Older IndividualsBjoern Buehring, Diane Krueger, Neil Binkley10.1016/j.jocd.2010.04.002Journal of Clinical Densitometry 13, 3 (2010)2010-05-31Journal of Clinical Densitometry2010-05-31133S1094-6950(10)X0004-XOriginal Articles283291http://www.clinicaldensitometry.com/article/PIIS1094695010001617/abstract?rss=yesAbstract: Because osteoporosis is common and usually managed in primary care, there is a requirement for cheap and convenient methods of measuring bone mineral density (BMD). AccuDEXA (Lone Oak Medical Technologies, Doylestown, PA) is a tabletop dual-energy X-ray absorptiometry (DXA) device that performs BMD measurements of the hand in the middle phalanges of the third finger. The aims of this study were to (1) evaluate the use of AccuDEXA in UK women; (2) investigate the concordance between AccuDEXA T-scores and DXA T-scores for central (spine and hip) sites; (3) investigate the comparative response of AccuDEXA measurements to clinical risk factors for osteoporosis. Measurements of phalangeal and central BMD were performed in 620 women referred by their family doctors for bone densitometry (group 1) and 159 healthy female volunteers (group 2). For 65 women in group 2, aged 39yr or younger, the mean Z-scores for AccuDEXA and the central sites calculated from US reference ranges were consistent with the expected value of 0, whereas for the 62 group 2 women, aged 50yr or older, the mean Z-scores for AccuDEXA and the central sites were in the range 0.4–0.7 and were statistically significantly different from 0. In both group 1 and group 2, the AccuDEXA T-scores in older and younger women were systematically higher than those in the central sites by up to 1 unit. Of the 157 women aged 50yr or older, with osteoporosis, based on their central DXA results, only 34 (22%) had an AccuDEXA T-score less than or equal to −2.5, whereas 76 (48%) had osteopenia and 47 (30%) were normal based on their AccuDEXA T-scores. When assessed by the effect of clinical risk factors on Z-scores, both AccuDEXA and central BMD were affected to a similar extent. We conclude that the conventional World Health Organisation T-score criteria for the diagnosis of osteoporosis should not be applied to AccuDEXA measurements in UK women. Clinical risk factors for low BMD were found to affect AccuDEXA measurements to a similar extent as central BMD measurements. AccuDEXA measurements could, therefore, provide an alternative method for identifying individuals with low bone mass, provided care is taken in interpreting T-scores, perhaps, through the use of device-specific thresholds.Clinical Evaluation of a Phalangeal Bone Mineral Density Assessment SystemRajesh Patel, Glen M. Blake, Elleny Panayiotou, Ignac Fogelman10.1016/j.jocd.2010.04.001Journal of Clinical Densitometry 13, 3 (2010)2010-05-31Journal of Clinical Densitometry2010-05-31133S1094-6950(10)X0004-XOriginal Articles292300http://www.clinicaldensitometry.com/article/PIIS1094695010001605/abstract?rss=yesAbstract: The aim of the study was to determine the relative influence of heredity and environment on peak bone density and also to estimate the risk of having low peak bone density if the bone density of parents is low. The study comprised 83 families (48 daughters and 35 sons and their parents). The children were at an age when bone density is at its peak at most skeletal sites (22.2±1.8 girls; 23.1±1.2 boys). Bone mineral density (BMD; g/cm2) was determined by dual-energy X-ray absorptiometry. Anthropometric measurements were made, and calcium intake and physical activity were assessed. Heredity accounted for 22–42% of the variation in BMD of the children, depending on the skeletal site. Heritability for cortical BMD of mid-radius was considerably lower than that for spinal trabecular BMD. Children whose parents had low BMDs (T-score≤−1) were 1.1 times more likely to inherit low BMD. Child BMD depended significantly on parent BMD and also on physical activity. In our study, heredity accounted for the total BMD variation more than the environmental factors. This influence was lower in the cortical than in the trabecular parts of the skeleton. Optimal environmental factors, such as physical activity, may influence the risk of inheriting low BMD.Influence of Heredity and Environment on Peak Bone Density: A Parent-Offspring StudySelma Cvijetic, Irena Colic Baric, Zvonimir Satalic10.1016/j.jocd.2010.03.003Journal of Clinical Densitometry 13, 3 (2010)2010-06-14Journal of Clinical Densitometry2010-06-14133S1094-6950(10)X0004-XOriginal Articles301306http://www.clinicaldensitometry.com/article/PIIS1094695010001599/abstract?rss=yesAbstract: In the present study, we analyzed the changes of bone mineral density (BMD) among Polish women age 40–79, as a function of biological aging and body mass index (BMI) class, and compared them with the US sample (National Health and Nutrition Examination Survey III). The null hypothesis of this study was that the rate of BMD change is femoral region, age, ethnicity, and BMI dependent. The studied group was divided into 4 age decades: 40–49, 50–59, 60–69, and 70–79 and 2 BMI classes (normal: 18.5≤BMI≤24.99 and obese: BMI>24.99). Analysis of covariance technique, using a generalized linear model with age and BMI as covariates, was used for data analysis. The influence of weight, height, and BMI on BMD loss was analyzed using multivariate regression analysis. The changes in BMD of femoral neck and trochanter are congruent. BMD decrease is not only age dependent but also, for specific ethnic groups, weight, height, and BMI dependent. The obtained results indicate that the analysis of age-dependent BMD changes should be performed by means of regression analysis using a broad age range rather than an age-decade approach.The Changes of Bone Mineral Density in Relation to Body Mass Index and Aging Among Polish and Different Ethnic Women in the United States: Cross-sectional StudiesMagdalena Wiacek, Anna Skrzek, Zofia Ignasiak, Igor Z. Zubrzycki10.1016/j.jocd.2010.03.002Journal of Clinical Densitometry 13, 3 (2010)2010-05-31Journal of Clinical Densitometry2010-05-31133S1094-6950(10)X0004-XOriginal Articles307314http://www.clinicaldensitometry.com/article/PIIS1094695010001587/abstract?rss=yesAbstract: Since 2001, Geisinger Health System densitometrists have interpreted dual-energy X-ray absorptiometries (DXAs) in a guideline-driven, consultative fashion. We believe that this approach results in more patients receiving appropriate treatment. Recently, one of our DXA centers chose to stop consultative reporting, providing us an opportunity to review the care rendered with 2 different styles of DXA reporting formats: Consultative vs Results Only. In this retrospective chart review, 100 consecutive DXAs with Consultative reporting and 100 consecutive DXAs with Results Only reporting were identified. The electronic health record was reviewed for a 3-mo interval after DXA result to identify whether a prescription medication was prescribed per system guidelines. Logistic regression compared the proportion of patients receiving a prescription treatment between the 2 groups. The Consultative report group received more prescription treatment compared with Results Only format (72% vs 50%) after controlling for patients’ age and gender, odds ratio=2.64, 95% confidence interval=1.45–4.79 (p=0.0014). Our study demonstrates that Consultative DXA reporting results in better care. Importantly, Consultative reporting takes additional time; yet, reimbursement for these efforts and expertise has been dramatically reduced. To appropriately reward the value of DXA testing and interpretation, Consultative reporting should be reimbursed at the previous higher reimbursement rate.Consultative DXA Reporting Improves Guideline-Driven Quality of Care—Implications for Increasing DXA ReimbursementBrian Oppermann, William Ayoub, Eric Newman, G. Craig Wood, Thomas P. Olenginski10.1016/j.jocd.2010.03.001Journal of Clinical Densitometry 13, 3 (2010)2010-06-07Journal of Clinical Densitometry2010-06-07133S1094-6950(10)X0004-XOriginal Articles315319