Original Research
Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

https://doi.org/10.1016/j.jcm.2017.08.001Get rights and content

Abstract

Objectives

The purpose of the current study was to compare central and peripheral bone mineral density at different regions including spine, hip, and wrist in postmenopausal women.

Methods

Forty postmenopausal women participated in this study. Their mean age, body mass, height, and body mass index were 53.5 ± 2.75 y, 68.6 ± 8.68 kg, 167.8 ± 6.46 cm, and 24.31 ± 1.69 kg/m2, respectively. Bone mineral density (BMD) T-scores of spine, hip, and wrist regions were measured for all participants with a dual-energy X-ray absorptiometry scan.

Results

All measured regions (spine, hip, and wrist) had low BMD T-scores. Bone mineral density of the wrist was significantly lower (–2.58 ± 2.18) than that of both spine (–1.79 ± 0.98) and hip (–1.69 ± 1.37). In addition, there were no statistically significant differences in BMD between the spine and hip.

Conclusions

In this group of postmenopausal women, wrist BMD decreased more than spine and hip BMD. Both spine and hip BMD decreased by nearly the same percentage in postmenopausal women. Peripheral sites may be more representative of osteoporosis than central sites. Trial Registration: PACTR201602001478123.

Introduction

Bone mineral content is the amount of hydroxyapatite relative to the area of bone1 and is an excellent predictor of fracture risk. Bone mineral density (BMD) is similar to serum cholesterol as a predictor of heart disease and blood pressure as a predictor of stroke.2 Bone turnover is a dynamic process and is important when considering the management of osteoporosis.3 Bone turnover involves degradation of the bone matrix by osteoclasts and the formation of new matrix by osteoblasts.4 Normally, these 2 processes are tightly balanced in a manner ensuring that formation adequately restores resorption.5 Imbalance between these 2 processes leads to pathologies, such as low bone mass and quality, as seen in osteoporosis.6

Osteoporosis is the most common metabolic bone disease7 and is an increasingly common disease in aging societies. Osteopenia is a condition of decreased BMD and is considered a precursor to osteoporosis. Osteopenia is analogous to prehypertension as it relates to cardiovascular disease.8 During aging, muscle mass, force, and power and BMD decrease.9 When BMD decreases, osteoporosis occurs. This problem typically has no signs or symptoms until a fracture occurs so it has often been referred to as a silent condition.10

Fractures are associated with osteoporosis, and the hip, spine, forearm, and shoulder are the most common sites.11 However, the age-adjusted incidence of hip fractures in females is about twice that in males, which has been attributed to greater age-related bone loss. A higher incidence of falls is documented in females.12, 13 A 50-year-old white woman has a 15% to 20% lifetime risk of sustaining a hip fracture associated with long-term morbidity and a 20% to 33% mortality rate 1 year after fracture.14 Osteoporosis is important to consider when developing a treatment plan such as when considering manual therapies or therapeutic exercise. When applying force to patients with osteoporosis (eg, high-velocity, low-amplitude manipulation), the caution that must be observed depends on the degree of osteoporosis and the fragility of the patient’s bones.15

Dual-energy X-ray absorptiometry (DEXA) scans of the central skeleton of the hip, spine, and pelvis is used to measure BMD T-scores to screen for osteoporosis, predict fracture risk, and determine the need for treatment. Evaluation of the BMD of other sites, like the forearm, calcaneus, and hand (peripheral DEXA), is also recommended. This information may help in predicting the regions most susceptible to fracture. Current osteoporosis management guidelines recommend routine BMD screening with the use of DEXA scans.16 Central DEXA of the lumbar spine and proximal femur is the preferred method for BMD testing.17, 18

The World Health Organization (WHO)19 has proposed a diagnostic classification for BMD based on the T-scores measured by DEXA scan. The T-score is the number of standard deviations above or below the normal mean value of BMD for young adults. The BMD was classified as follows: normal, T-score ≥–1; osteopenia, T-score between –1 and –2.5; osteoporosis; T-score ≤–2.5. Because the widely accepted WHO definition for osteoporosis is based on the BMD T-score, this measure must serve as the reference standard against which other BMD modalities are compared and validated.17 Many researchers have concentrated on assessing BMD via central DEXA scan and did not pay considerable attention to the peripheral sites such as forearm (wrist) and calcaneus. Therefore, the purpose of the current study was to measure both central and peripheral BMD at different regions including lumbar spine, hip (femur), and wrist (distal radius) and to compare the measured outcome among these regions.

Section snippets

Participants

Forty postmenopausal women from 50 to 60 years of age participated in this study. All participants did not engage in regular sports or athletic activities. They were admitted to El-Haram Hospital, Giza, Egypt, to assess their BMD with DEXA scans. The participants’ mean age, body mass, height, and body mass index were 53.5 ± 2.75 y, 68.6 ± 8.68 kg, 167.8 ± 6.46 cm, and 24.31 ± 1.69 kg/m2, respectively. All participants gave written consent on agreement to participate in the study. The Research

Results

The results revealed that all measured regions in the postmenopausal women had low BMD T-scores based on the normal standard BMD values mentioned in the Introduction. Descriptive statistics (mean ± standard deviation [SD]) for BMD T-scores of the spine, hip, and wrist were –1.79 ± 0.98, –1.69 ± 1.37, and –2.58 ± 2.18, respectively. These values indicate that the same women who had spine and hip osteopenia also had wrist osteoporosis. The wrist BMD T-score was found to be significantly lower

Discussion

Early diagnosis and management of osteoporosis are important. The high prevalence and staggering costs of osteoporosis-related fractures in postmenopausal women mean that prevention and management of this disease are very important.21 New pharmacologic treatments during recent years have encouraged physicians to screen patients at risk of fragile fractures by BMD measurement.22

In the current study, the results revealed that postmenopausal women had spine and hip osteopenia and wrist

Conclusions

This study reports that wrist BMD decreases more than spine and hip BMD, whereas both spine and hip BMD decreased nearly the same percentage in postmenopausal women. Peripheral sites of the body such as the wrist (distal radius) and calcaneus should be assessed for BMD as they may be more representative of osteoporosis than central sites.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): A.M.A.

Design (planned the methods to generate the results): A.M.A.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): A.M.A.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): A.M.A.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): A.M.A.

Literature search (performed

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