PubMed · 5363019
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B Lindström, B Philipson. 1969. Densitometric evaluation at quantitative microradiography.. https://doi.org/10.1007/bf00309863
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OBJECTIVE: To assess the prevalence of vertebral deformities in men and women aged 55 years and over. DESIGN: Cross-sectional study. SETTING: A quarter in Rotterdam, The Netherlands. METHODS: As part of the 'Rotterdam elderly study', 750 responding men and 750 women underwent lateral radiography of the spine and subsequent morphometry of the vertebrae to detect presence of vertebral deformities. Grade 1 and grade 2 deformities were scored on the basis of the results of the morphometry. The entire vertebral column was classified as normal (no deformities), moderate spinal deformity (grade 1 deformities) or severe spinal deformity (grade 2 deformities). Dual Energy X-ray Absorptiometry (DXA) was used to assess the bone mineral density (BMD) at the femoral neck. RESULTS: The prevalence of moderate or severe spinal deformity was estimated to be 18% in men (12% moderate and 6% severe) and 22% in women (11% moderate and 11% severe) after adjustment for the present age distribution of the Dutch population. The prevalence of deformities increased with age, in particular for severe deformities in women aged 70 years and over. A decreasing BMD was observed with increasing severity of vertebral deformities. Men with severe spinal deformity had a 4% lower BMD whereas women with severe spinal deformity had a 6% lower BMD. CONCLUSION: Vertebral deformities are frequently present in the general population, mostly in the higher age groups. There was an association with decreased BMD. In view of the ongoing aging of the population, a future increase in the prevalence of vertebral deformities is to be expected.
The enhanced precision of dual-energy X-ray absorptiometry (DXA) allows the detection of very small changes in bone mineral density (BMD). True clinical changes in BMD in patients must be evaluated with the appropriate error of variance. We evaluated the responsiveness of our measures to true bone loss using a statistical variance components model that characterizes the variability associated with error introduced by the machine, operator, and subjects. Our techniques were applied to data from a prospective study of BMD measurements on spine phantoms and on pre- and postmenopausal women performed on the same day or up to 4 weeks apart with DXA (QDR 1000W, Hologic). Our model determined that most of the error in measurements was introduced by operators' and subjects' variability rather than machine performance. The false-positive rates for true bone change are significantly reduced when the appropriate CV% is used to estimate the significance of bone loss over time. Our study underscores the need to use the appropriate precision error to evaluate the clinical significance of changes in bone mass in individual subjects over time.