An update on the diagnosis and assessment of osteoporosis with densitometry

wbldb

Kanis, J. A.¹; Glüer, C.-C.²

An update on the diagnosis and assessment of osteoporosis with densitometry

Osteoporos Int. March 2000;11(3):192-202

©2000 International Osteoporosis Foundation and National Osteoporosis Foundation

Affiliations

¹Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, UK

²Medizinische Physik Klinikum fur Diagnosche Radiologie, Universitatsklinik Keil, Germany, , DE
Abstract and keywords

In 1994 the WHO proposed guidelines for the diagnosis of osteoporosis based on measurement of bone mineral density. They have been widely used for epidemiological studies, clinical research and for treatment strategies. Despite the widespread acceptance of the diagnostic criteria, several problems remain with their use. Uncertainties concern the optimal site for assessment, thresholds for men and diagnostic inaccuracies at different sites. In addition, the development of many new technologies to assess the amount or quality of bone poses problems in placing these new tools within a diagnostic and assessment setting. This review considers the recent literature that has highlighted the strengths and weaknesses of diagnostic thresholds and their use in the assessment of fracture risk, and makes recommendations for actions to resolve these difficulties.

Keywords: Definition of osteoporosis; Densitometry; Diagnosis; Risk assessment; Risk factors
Links

DOI: 10.1007/s001980050281

PubMed: 10824234

WoS: 000086769700002

Cited Works (16)

Year	Entry
1997	Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. July 1997;7(4):390-406.
1994	Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. August 1994;9(8):1137-1141.
1993	Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. June 1993;94(6):646-650.
1998	Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468-489.
1997	Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. November 1997;12(11):1761-1768.
1997	Grampp S, Genant HK, Mathur A, Lang P, Jergas M, Takada M, Glüer C-C, Lu Y, Chavez M. Comparisons of noninvasive bone mineral measurements in assessing age-related loss, fracture discrimination, and diagnostic classification. J Bone Miner Res. May 1997;12(5):697-711.
1997	De Laet CEDH, van Hout BA, Burger H, Hofman A, Pols HAP. Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ. July 26, 1997;315(7102):221-225.
1992	Johnell O, Gullberg B, Allander E, Kanis JA; MEDOS Study Group. The apparent incidence of hip fracture in europe: a study of national register sources. Osteoporos Int. November 1992;2(6):298-302.
1998	Melton LJ III, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. December 1998;13(12):1915-1923.
1998	Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, Delmas PD, Ribot C, Sebert JL, Breart G, Meunier PJ; EPIDOS Group. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int. May 1998;8(3):247-254.
1993	Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman J. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. October 30, 1993;307(6912):1111-1115.
1995	Ensrud KE, Palermo L, Black DM, Cauley J, Jergas M, Orwoll ES, Nevitt MC, Fox KM, Cummings SR. Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. J Bone Miner Res. November 1995;10(11):1778-1787.
1997	Arlot ME, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas PD. Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res. April 1997;12(4):683-690.
1994	Genant HK, Grampp S, Glüer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, Kuijk Cv. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res. October 1994;9(10):1503-1514.
1996	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.
1988	Hui SL, Slemenda CW, Johnston CC Jr. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. June 1988;81(6):1804-1809.

Cited By (31)

Year	Entry
2017	Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N; The National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. December 2017;12(1):1-24.
2000	Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. November 2000;27(5):585-590.
2008	Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N. A reference standard for the description of osteoporosis. Bone. March 2008;42(3):467-475.
2020	Rios-Arce ND, Schepper JD, Dagenais A, Schaefer L, Daly-Seiler CS, Gardinier JD, Britton RA, McCabe LR, Parameswaran N. Post-antibiotic gut dysbiosis-induced trabecular bone loss is dependent on lymphocytes. Bone. May 2020;134:115269.
2002	Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.
2005	Felsenberg D, Boonen S. The bone quality framework: determinants of bone strength and their interrelationships, and implications for osteoporosis management. Clin Ther. January 2005;27(1):1-11.
2002	Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. October 16, 2002;288(15):1889-1897.
2006	Nickolas TL, McMahon DJ, Shane E. Relationship between moderate to severe kidney disease and hip fracture in the United States. J Am Soc Nephrol. November 2006;17(11):3223-3232.
2002	Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. July 2002;17(7):1237-1244.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
2022	Costantini A, Mäkitie RE, Hartmann MA, Fratzl-Zelman N, Zillikens MC, Kornak U, Søe K, Mäkitie O. Early-onset osteoporosis: rare monogenic forms elucidate the complexity of disease pathogenesis beyond type I collagen. J Bone Miner Res. September 2022;37(9):1623-1641.
2005	Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, Hochberg MC, Vogt MT, Orwoll ES; Study of Osteoporotic Fractures Research Group. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. May 2005;90(5):2787-2793.
2009	KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney Int. August 2009;76(suppl 113):S1-S130.
2002	Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. June 1, 2002;359(9321):1929-1936.
2001	Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. December 2001;12(12):989-995.
2005	Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int. March 2005;16(3):229-238.
2005	Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int. June 2005;16(6):581-589.
2008	Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. April 2008;19(4):385-397.
2008	Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R; European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. April 2008;19(4):399-428.
2012	Dall’Ara E, Pahr D, Varga P, Kainberger F, Zysset P. QCT-based finite element models predict human vertebral strength in vitro significantly better than simulated DEXA. Osteoporos Int. February 2012;23(2):563-572.
2013	Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO); Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2013;24(1):23-57.
2019	Kanis JA, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO); Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2019;30(1):3-44.
2021	Larsson BAM, Johansson L, Johansson H, Axelsson KF, Harvey N, Vandenput L, Magnusson P, McCloskey E, Liu E, Kanis JA, Sundh D, Lorentzon M. The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density. Osteoporos Int. January 2021;32(1):75-84.
2007	Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. August 2007;83(982):509-517.
2012	Moayyeri A. Risk Assessment for Osteoporotic Fractures Among Men and Women from a Prospective Population Study: The EPIC-Norfolk Study [PhD thesis]. Cambridge, UK: University of Cambridge; 2012.
2010	Müller T. Bioimaging and Biomechanics of Bone Competence and Implant Stability [PhD thesis]. Swiss Federal Institute of Technology Zürich; 2010.
2008	Weeks BK. Improving Bone Health With Physical Activity: The Power PE Study and Development of the Bone-Specific Physical Activity Questionnaire (BPAQ) [PhD thesis]. Brisbane, Australia: Griffith University; January 2008.
2012	Dall'Ara E. QCT Based Finite Element Models of the Human Vertebra and Femur: Validation With Experiments and Comparison With Bone Densitometry [PhD thesis]. Vienna University of Technology; October 2012.
2020	Patton DM. Changes in Femoral Structure and Function Following Anterior Cruciate Ligament Injury and With Aging [PhD thesis]. University of Michigan; 2020.
2013	Gajic-Veljanoski O. Quantifying Uncertainty in the Efficacy of Vitamin K on Fractures in Postmenopausal Women: Economic Evaluation, Evidence Synthesis and Bayesian Meta-Analysis [PhD thesis]. University of Toronto; 2013.
2013	Liu CC. Effects of a New Conjugate Drug in a Rat Model of Postmenopausal Osteoporosis [Master's thesis]. University of Toronto; 2013.