October 1, 1992
View Full PaperLateral spine densitometry is a more sensitive indicator of glucocorticoid-induced bone loss
Key Result
Lateral DXA scanning detected lower bone mineral density compared to AP scanning (70.8% vs 90.3% of normal values, P<0.001) and identified more patients as osteopenic.
Study Design
Type
Cross-Sectional (n=28)
Structured PICO
Does lateral DXA scanning improve the detection of glucocorticoid-induced osteopenia compared to AP DXA scanning in women on chronic glucocorticoid treatment?
P
Population
28 women receiving chronic glucocorticoid treatment assessed for bone mineral density using lateral and anteroposterior DXA scanning.
E
Exposure
Measurement of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) in the lateral projection
C
Comparator
Measurement of BMD by DXA in the anterioposterior (AP) projection
O
Outcome
Detection of osteopenia/bone loss (BMD values and Z scores)surrogate
Lateral DXA scanning is a more sensitive indicator of glucocorticoid-induced osteopenia than conventional AP projection measurement.
Main Result
Absolute Event Rate: 70.8% vs 90.3%
p-value: p=<0.001
Abstract
Osteoporosis is a common complication of glucocorticoid therapy. Bone density measurement is now commonly used in assessing which steroid-treated patients require specific interventions to reduce fracture risk. The recently developed techniques for the measurement of bone mineral density (BMD) of the vertebral body alone, by dual-energy x-ray absorptiometry (DXA) in the lateral projection, may be particularly useful in this context since steroid-induced bone loss is most marked in trabecular-rich regions like the vertebral body. This possibility has been assessed in the present study by the measurement of BMD in the lateral and anterioposterior (AP) projections in 28 women receiving chronic glucocorticoid treatment. The two BMD measurements were significantly related (r = 0.62, p < 0.001). When expressed in relation to age-appropriate normal values, lateral BMDs were lower than AP BMDs both in percentage terms (70.8 +/- 4.4 versus 90.3 +/- 2.6%, p < 0.001) and in terms of Z scores (-1.42 +/- 0.22 versus -0.91 +/- 0.24, p = 0.027). AP BMD Z scores classified 12 patients as osteopenic, whereas a further 7 were so categorized by lateral BMD Z score. It is concluded that lateral DXA scanning is a more sensitive indicator of glucocorticoid-induced osteopenia than conventional BMD measurement in the AP projection.