Detection of osteoporosis by dual energy X-ray absorptiometry (DXA) of the calcaneus: is the WHO criterion applicable?

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Abstract

The study assessed the precision, sensitivity, and specificity of a recently developed peripheral dual-energy X-ray absorptiometry (DXA) scanner, applied to the calcaneus, in the identification of individuals with osteoporosis at axial sites by DXA. Two hundred and two women, aged 55.2 +/- l3.7 years (mean +/- SD), participated in the study. The precisions (coefficient of variation) of measurements in vitro (0.48%) and in vivo (1.40%) were very good. The in vivo precision was independent of the operator, foot size, foot width, weight, height, and body mass index. Calcaneus BMD correlated moderately (r = 0.494-0.690, P <0.001) with axial BMD measurements by DXA. Using the World Health Organization (WHO) criterion for defining osteoporosis (T score ? -2.5) the specificity of the calcaneus to identify patients with osteoporosis at total hip, femoral neck, spine, or any of these axial sites was excellent (97.0%, 97.0%, 96.5%, and 97.1%, respectively); however, the sensitivity was poor (58.8%, 36.4%, 21.8%, and 20.3%, respectively). Therefore, the WHO criterion is not appropriate for DXA calcaneus. Based on femoral neck BMD for detection of osteoporosis, a more appropriate calcaneus T score threshold would be -1.4 by analyses of receiver-operator characteristic curves; this might serve to select those patients who might appropriately be referred for axial DXA

Keyword(s)

Adult; Aged; Aged,80 and over; Body Mass Index; Bone Density; Calcaneus; Comparative Study; Densitometry,X-Ray; Female; Femur Neck; Hip; Hip Joint; Human; Lumbar Vertebrae; Middle Age; Osteoporosis; Osteoporosis,Postmenopausal; Reproducibility of Results; Sensitivity and Specificity; Spine; Support,Non-U.S.Gov't; World Health; World Health Organization; classification; diagnosis; radiography

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