Seminars in Nuclear Medicine
Volume 40, Issue 1 , Pages 62-73 , January 2010

An Update on Dual-Energy X-Ray Absorptiometry

  • Glen M. Blake, PhD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Glen M. Blake, PhD, Osteoporosis Research Unit, 1st Floor, Tower Wing, Guy's Hospital, London SE1 9RT, United Kingdom
    • ,
  • Ignac Fogelman, MD

References 

  1. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–1767
  2. Kanis JA, Black D, Cooper C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int. 2002;13:527–536
  3. National Osteoporosis Foundation. Fast facts on osteoporosis. http://www.nof.org/professionals/Clinicians_Guide.htmAccessed February 20, 2009
  4. Dolan P, Torgerson DJ. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int. 1998;8:611–617
  5. Melton LJ, Gabriel SE, Crowson CS, et al. Cost-equivalence of different osteoporotic fractures. Osteoporos Int. 2003;14:383–388
  6. Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–1005
  7. Centre JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fractures in men and women: an observational study. Lancet. 1999;353:878–882
  8. Genant HK, Engelke K, Fuerst T, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res. 1996;11:707–730
  9. Storm T, Thamsborg G, Steiniche T, et al. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med. 1990;322:1265–1271
  10. WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: technical report series 843. Geneva, Switzerland: WHO; 1994;
  11. Kanis JA, Gluer CC Committee of scientific advisors. International Osteoporosis Foundation: an update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. 2000;11:192–202
  12. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of the effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348:1535–1541
  13. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077–2082
  14. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis. JAMA. 1999;282:1344–1352
  15. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate treatment on hip fracture risk in elderly women. N Engl J Med. 2001;344:333–340
  16. Chesnut CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19:1241–1249
  17. Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356:1809–1822
  18. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomised clinical trial. JAMA. 1999;282:637–645
  19. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1-34) fragment on spine and non-spine fractures and bone mineral density in postmenopausal osteoporosis. N Engl J Med. 2001;344:1434–1441
  20. Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004;350:459–468
  21. Reginster JY, Seeman E, De Vernejoul MC, et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: TROPOS study. J Clin Endocrinol Metab. 2005;90:2816–2822
  22. Seeman E, Vellas B, Benhamou C, et al. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res. 2006;21:1113–1120
  23. FRAX-WHO Fracture Risk Assessment Tool. http://www.shef.ac.uk/FRAXAccessed February 20, 2009
  24. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581–589
  25. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. http://www.nof.org/professionals/index.htmAccessed February 20, 2009
  26. Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of facture probability in men and women from the UK. Osteoporos Int. 2008;19:385–397
  27. Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19:1395–1408
  28. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8:468–489
  29. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–1259
  30. Stone KL, Seeley DG, Lui LY, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003;18:1947–1954
  31. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20:1185–1194
  32. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med. 1998;338:736–746
  33. Gluer CC. Monitoring skeletal change by radiological techniques. J Bone Miner Res. 1999;14:1952–1962
  34. Official positions of the International Society for Clinical Densitometry: updated 2007. http://www.iscd.org/visitors/positions/official.cfmAccessed February 20, 2009
  35. Adams JE, Ahmed SF, Alsop C, et al. A Practical Guide to Bone Densitometry in Children. Bath, UK: National Osteoporosis Society; 2004;
  36. Ward KA, Ashby RL, Roberts SA, et al. UK reference data for the Hologic QDR Discovery dual-energy x-ray absorptiometry scanner in healthy children and young adults aged 6-17 years. Arch Dis Child. 2007;92:53–59
  37. Blake GM, Fogelman I. Technical principles of dual-energy x-ray absorptiometry. Semin Nucl Med. 1997;27:210–228
  38. Lehmann LA, Alvaez RE, Macovski A, et al. Generalized image combinations in dual KVP digital radiography. Med Phys. 1981;8:659–667
  39. Webber CE. The effect of fat on bone mineral measurements in normal subjects with recommended values of bone, muscle and fat attenuation coefficients. Clin Phys Physiol Meas. 1987;8:143–157
  40. Svendsen OL, Hassager C, Skodt V, et al. Impact of soft tissue on in vivo accuracy of bone mineral measurements in the spine, hip and forearm: a human cadaver study. J Bone Miner Res. 1995;10:868–873
  41. Kuiper JW, van Kuijk C, Grashusi JL, et al. Accuracy and the influence of marrow fat on quantitative CT and dual-energy x-ray absorptiometry measurements of the femoral neck in vitro. Osteoporos Int. 1996;6:25–30
  42. Blake GM, Fogelman I. How important are BMD accuracy errors for the clinical interpretation of DXA scans?. J Bone Miner Res. 2008;23:457–462
  43. Bonnick SL, Johnston CC, Kleerekoper M, et al. Importance of precision in bone density measurements. J Clin Densitom. 2001;4:105–110
  44. Gluer CC, Blake G, Lu Y, et al. Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int. 1995;5:262–270
  45. Patel R, Blake GM, Rymer J, et al. Long-term precision of DXA scanning assessed over seven years in forty postmenopausal women. Osteoporos Int. 2000;11:68–75
  46. Tothill P, Pye DW. Errors due to non-uniform distribution of fat in dual x-ray absorptiometry of the lumbar spine. Br J Radiol. 1992;65:807–813
  47. Griffith JF, Yeung DK, Antonio GE, et al. Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation. Radiology. 2006;241:831–838
  48. Wahner HW, Dunn WL, Mazess RB, et al. Dual photon Gd-153 absorptiometry of bone. Radiology. 1985;156:203–206
  49. Eriksson S, Isberg B, Lindgren U. Vertebral bone mineral measurement using dual photon absorptiometry and computed tomography. Acta Radiol. 1988;29:89–94
  50. Gotfredsen A, Podenphant J, Norgaard H, et al. Accuracy of lumbar spine bone mineral content by dual photon absorptiometry. J Nucl Med. 1988;29:248–254
  51. Ho CP, Kim RW, Schaffler MB, et al. Accuracy of dual-energy radiography of the lumbar spine: a cadaver study. Radiology. 1990;176:171–173
  52. Sabin MA, Blake GM, MacLaughlin-Black SM, et al. The accuracy of volumetric bone density measurements in dual X-ray absorptiometry. Calcif Tiss Int. 1995;56:210–214
  53. Tothill P, Pye DW, Teper J. The influence of extra-skeletal fat on the accuracy of dual photon absorptiometry of the spine. In:  Ring EFJ,  Evans WD,  Dixon AS editor. Osteoporosis and Bone Mineral Measurement. York, United Kingdom: ISPM; 1989;p. 48–53
  54. Lee DC, Wren TAL, Gilanz V. Correcting DXA pediatric bone mineral density measurements to account for fat inhomogeneity. J Bone Miner Res. 2007;22(suppl 1):S494–S495
  55. Fogeman I, Blake GM. Different approaches to bone densitometry. J Nucl Med. 2000;41:2015–2025
  56. Guglielmi G, Lang TF. Quantitative computed tomography. Semin Musculoskelet Radiol. 2002;6:219–227
  57. Lang TF, Guglielmi G, Van Kuijk C, et al. Measurement of vertebral bone mineral density at the spine and proximal femur by volumetric quantitative computed tomograph and dual-energy X-ray absorptiometry in elderly women with and without vertebral fractures. Bone. 2002;30:247–250
  58. Blake GM, Fogelman I. Clinical use of instruments that measure peripheral bone mass. Curr Opin Endocrinol Diabetes. 2002;9:502–511
  59. Stewart A, Reid DM. Quantitative ultrasound in osteoporosis. Semin Musculoskelet Radiol. 2002;6:229–232
  60. Lu Y, Genant HK, Shepherd J, et al. Classification of osteoporosis based on bone mineral densities. J Bone Miner Res. 2001;16:901–910
  61. Faulkner KG, Von Stetton E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom. 1999;2:343–350
  62. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. Lancet. 1993;341:72–75
  63. Blake GM, Fogelman I. Peripheral or central densitometry: does it matter which technique we use?. J Clin Densitom. 2001;4:83–96
  64. Black DM, Palermo L, Bauer D. How well does bone mass predict long-term risk of hip fracture?. Osteoporos Int. 2000;11(suppl 2):S59
  65. Barr RJ, Adebajo A, Fraser WD, et al. Can peripheral DXA measurements be used to predict fractures in elderly women living in the community?. Osteoporos Int. 2005;16:1177–1183
  66. Faulkner KG, Roberts LA, McClung MR. Discrepancies in normative data between Lunar and Hologic DXA systems. Osteoporos Int. 1996;6:432–436
  67. Hanson J. Standardization of femur BMD. J Bone Miner Res. 1997;12:1316–1317
  68. Blake GM, Chinn DJ, Steel SA, et al. A list of device specific thresholds for the clinical interpretation of peripheral x-ray absorptiometry examinations. Osteoporos Int. 2005;16:2149–2156
  69. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–1936
  70. De Laet C, Oden A, Johansson H, et al. The impact of the use of multiple risk factors for fracture on case-finding strategies: a mathematical approach. Osteoporos Int. 2005;16:313–318
  71. Kanis JA, Johnell O, Oden A, et al. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989–995
  72. Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of osteoporotic fractures in men and women. Osteoporos Int. 2007;18:1033–1046
  73. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375–382
  74. Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004;19:893–899
  75. Kanis JA, Johansson H, Oden A, et al. A family history of fracture and fracture risk: a meta-analysis. Bone. 2004;35:1029–1037
  76. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005;16:155–162
  77. Kanis JA, Johansson H, Johnell O, et al. Alcohol intake as a risk factor for fracture. Osteoporos Int. 2005;16:737–742
  78. De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–1338
  79. Kanis JA, Johnell O, Oden A, et al. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int. 2006;17:527–534
  80. Blake GM, Patel R, Knapp KM, et al. Does the combination of two BMD measurements improve fracture discrimination?. J Bone Miner Res. 2003;18:1955–1963
  81. Fink HA, Harrison SL, Taylor BC, et al. Differences in site-specific fracture risk among older women with discordant results for osteoporosis at hip and spine: study of osteoporotic fractures. J Clin Densitom. 2008;11:250–259
  82. Johansson H, Oden A, Johnell O, et al. Optimisation of BMD measurements to identify high risk groups for treatment—a test analysis. J Bone Miner Res. 2004;19:906–913
  83. National Osteoporosis Guideline Group. http://www.shef.ac.uk/NOGG/index.htmlAccessed February 20, 2009
  84. Kanis JA, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method of setting intervention thresholds. Osteoporos Int. 2001;12:417–427
  85. Borgstrom F, Johnell O, Kanis JA, et al. At what hip fracture risk is it cost effective to treat? (International intervention thresholds for the treatment of osteoporosis). Osteoporos Int. 2006;17:1459–1471
  86. Kanis JA, Borgstrom F, Zethraeus N, et al. Intervention thresholds for osteoporosis in the UK. Bone. 2005;36:22–32
  87. Zethraeus N, Borgstrom F, Strom O, et al. Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int. 2007;18:9–23
  88. Kanis JA, Borgstrom F, Johnell O, et al. Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int. 2005;16:15–25
  89. Borgstrom F, Carisson A, Sintonen H, et al. Cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective. Osteoporos Int. 2006;17:996–1007
  90. Borgstrom F, Jonsson B, Strom O, et al. An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting based on the results of the SOTI and TROPOS trials. Osteoporos Int. 2006;17:1781–1793
  91. Faulkner KG. Bone densitometry: choosing the proper site to measure. J Clin Densitom. 1998;1:279–285
  92. Blake GM, Herd RJM, Fogelman I. A longitudinal study of supine lateral DXA of the lumbar spine: a comparison with posteroanterior spine, hip and total body DXA. Osteoporos Int. 1996;6:462–470
  93. Blake GM. Scientific flaws of the WHO T-score definition of osteoporosis. J Clin Densitom. 2008;11:450–451

PII: S0001-2998(09)00067-1

doi: 10.1053/j.semnuclmed.2009.08.001

Seminars in Nuclear Medicine
Volume 40, Issue 1 , Pages 62-73 , January 2010

Article Tools

* Image Usage & Resolution