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Changes in bone mineral content evaluated by photon absorptiometry before the start of active uremia treatment.

Bone mineral content (BMC) in the forearm was evaluated by photon absorptiometry in 74 out of 198 patients who were started on active uremia treatment between 1973 and 1979. The BMC was measured repeatedly up to 24 months prior to and 15 months after the start of regular hemodialysis (RDT). The mean change per month was -0.43% before the start and +0.08% after the start, showing that RDT patients have low BMC chiefly because they lose mineral before the start of active uremia treatment. Patients not given extra calcium and/or vitamin D seemed to lose mineral faster than those given this treatment. The mineral content was lower in patients with polycystic kidney disease than in patients with glomerulonephritis.

Adult↗

Demineralization in cystic fibrosis detected by direct photon absorptiometry.

Bone mineral content, bone width, and their ratio were measured in patients with cystic fibrosis (CF) using monoenergetic photon absorptiometry. Serial measurements of the radius and ulna were made in 27 patients with CF and were compared with 968 age-matched controls. Demineralization was found in 37% of the boys and 63% of the girls. Patients under age 10 years had normal bone mineral content and nine of 15 patients aged 13 or older were demineralized (P less than .01). Demineralization correlated with the extent of weight reduction in patients (P less than .001). Patients most likely to be demineralized were adolescent girls. To our knowledge, this is the first report of bone mineral status of children with CF, and the results indicate that a sizable proportion of these patients may be demineralized without overt rickets.

Adolescent↗

Measurement of lean body mass and total body fat using dual photon absorptiometry.

We describe a method for measuring the lean body mass (LBM) and total body fat (FAT) by dual photon absorptiometry (DPA). A total body rectilinear scan was employed with a radiation source of 1 Ci 153Gd. The reliability of estimating the lean percent was assessed in vitro using limb phantoms consisting of ox muscle, lard, and human bone. The precision and accuracy in vitro of the lean percent determination were 1.5% and 1.9%, respectively. The accuracy error in vivo of measuring the total mass of soft tissues (TMST) was approximately 1.4%, thus yielding an overall accuracy error of the LBM of about 2.5%. The precision in vivo of the lean percent and the LBM in kg of duplicate measurements on five healthy subjects was 2.5% and 2.2%, respectively. Other estimates of the LBM and FAT, ie, the calculation according to Boddy et al6 and the skinfold thickness measurement (triceps and subscapular), were compared to the DPA measurement in 100 healthy subjects. High correlations were found between the FAT or FAT% by DPA versus (1) the FAT or FAT% calculated according to the formulae of Boddy et al, and (2) the skinfold thickness. The correlations between the FAT and FAT% by Boddy et al and the skinfold thickness were, however, moderate. The correlation between LBM by DPA and LBM by Boddy et al was highly significant (r = 0.96, SEE = 4.4%). We conclude that LBM and FAT measurements using DPA have precision and accuracy errors that are commensurate with a reliable estimation of the gross body composition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

Prediction of vertebral strength by dual photon absorptiometry and quantitative computed tomography.

We measured the lumbar bone mineral of 19 cadavers (10 women, 9 men) by dual photon absorptiometry (DPA) and quantitative computed tomography (QCT). In addition, we determined the ultimate load and stress of each vertebra, and finally ash content and volumetric ash density of the vertebral body. We found that single energy QCT was inferior to DPA and dual energy QCT in the prediction of the ultimate load or stress of vertebrae (P less than 0.001). The ultimate stress was best predicted by using the dual energy QCT results (r = 0.71; SEE = 36.3 N/cm2) whereas the ultimate vertebral load was best predicted by using the DPA (BMC) results (r = 0.80; SEE = 740 N). If the QCT finding was multiplied with the surface area of the vertebral body it could be used to predict the ultimate load with good accuracy (r = 0.74; SEE = 841 N). All the above correlations were higher in women than in men. The frequency of vertebral compression fractures in the material was well correlated with the bone mineral findings. A nonlinear (third degree) relationship between mineral content and mechanical characteristics is proposed but within the area of measurement used in clinical practice a linear (first degree) equation is preferred.

Aged↗

The effect of lactation on the mineral distribution profile of the rat femur by single photon absorptiometry.

The distribution of bone mineral in excised femurs from lactating and nonlactating control rats was localized and quantitated using single photon absorptiometry. Bone mineral content was measured proximodistally in nine sequential 0.32 cm increments along the femur length and then plotted as a function of the distance from the proximal end of the femur. The plots described a mineral distribution profile and revealed that bone loss following lactation was site specific, being greater in the metaphyseal regions (23-36%) than in the diaphyseal area (14-20%). The change in total bone mineral of femur caused by lactation was estimated by integrating the mineral distribution profile plots. The 28% lower bone mineral determined by this method was in close agreement with the 27% difference determined from femur dry weight measurements. Reproducibility of measurements with 10 repositionings of a single femur was within 4% at all but the 2 most distal sites. Variation in the estimated total bone mineral was 1.3%.

Animals↗

Precision error in dual-photon absorptiometry related to source age.

An average, variable precision error of up to 6% related to source age was observed for dual-photon absorptiometry of the spine in a longitudinal study of bone mineral content involving 393 women. Application of a software correction for source decay compensated for only a portion of this error. The authors conclude that measurement of bone-loss rates using serial dual-photon bone mineral measurements must be interpreted with caution.

Adult↗

Bone mineral content in the forearm measured by photon absorptiometry. Principles and reliability.

A method for estimating total bone calcium is reported. The method is based on two-dimensional scanning photon absorptiometry on the distal part of the forearm. The following factors are investigated: precision of measurements on standards and human subjects; linearity; the effect of varying bone orientation; amount of fat and soft tissue; and the relation between weight and content of calcium and phosphate. The results show that the method is eminently suitable for rapid, easy, and atraumatic measurement of local bone calcium in vivo.

Adult↗

Total body bone mineral and lean body mass by dual-photon absorptiometry. II. Comparison with total body calcium by neutron activation analysis.

Total body bone mineral (TBBM) was measured in vivo using dual-photon absorptiometry (DPA) in 10 subjects. The total body calcium (TBCa) was measured in the same subjects using neutron activation analysis. The correlation between the two methods was very high (r greater than 0.99) and the standard error of estimate was low. The TBCa relative to TBBM was about 39%. The two noninvasive methods provided nearly identical indications of skeletal mass, but the radiation exposure with DPA was 500 to 5000 times smaller (0.6 mrem vs 300 to 3000 mrem). The radius shaft bone mineral content was highly correlated with the TBBM (0.97) and the TBCa (0.98) and could be used to estimate the latter variables with errors (1 SEE) of 9% and 6%, respectively.

Body Composition↗

Spine and femur density using dual-photon absorptiometry in US white women.

Bone mineral density (BMD) of the spine (n = 892) and femur (n = 634) was measured using dual-photon absorptiometry in normal white women from seven diverse locations. The same model commercial scanner with a 153Gd source was used in all locations (SD = 1.3% among locations). There was not an age-associated decrease of spinal BMD during young adulthood (20-40 years); the correlation of age and femoral BMD in this period was low but significant (r = -0.21). There was a narrow range of intra-population variation at all ages (10-12%). The cross-sectional data showed an average diminution of about 20% in the spine and 25% in the femur between 40 and 70 years of age, followed by a continued but slower, decrease of density in older women. Adjustment of values for height and weight was called for mainly at extremes of body size.

Aging↗

Accuracy of lumbar spine bone mineral content by dual photon absorptiometry.

The accuracy of measurement of the bone mineral content (BMC, g) and bone mineral density (BMD, g/cm2) of the lumbar spine by dual photon absorptiometry (DPA) was estimated by means of two different spine scanners (a Nuclear Data 2100 and a Lunar Radiation DP3). The lumbar spines of 13 cadavers were used. BMC and BMD were measured in situ and on the excised vertebrae in a solution of water/ethanol; and covered with ox muscle/porcine muscle/lard. The actual mineral weight and areal density were determined after chemical maceration, fat extraction, drying to a constant weight, ashing for 24 hr at 600 degrees C, and correction for the transverse processes. The true are was measured by parallax free X rays and planimetry. All measurements of BMC or BMD were highly interrelated (r = 0.94-0.99). The standard error of estimate (s.e.e.) of BMC in situ versus BMC in water/ethanol was 5.2%. The agreement between the BMD values of the two scanners was very good (s.e.e. = 2.9%). BMC in situ predicted the actual vertebral mineral mass with an s.e.e. of 8.1%. BMD in situ and BMD in water/ethanol predicted the actual area density with s.e.e.s of 10.3% and 5.0%, respectively. This study discloses the correlation and accuracy error of spinal DPA measurements in situ in whole cadavers versus the actual BMC and BMD. The error, which is underestimated in in vitro studies, amounts to 10%.

Adult↗

Fracture prevalence and bone mineral mass in osteoporosis measured with computed tomography and dual energy photon absorptiometry.

In 174 adults presenting with backache, bone densitometry was performed on the lumbar spine, both femoral necks, and one femoral shaft employing dual energy photon absorptiometry (DPA); in 112 of these, densitometry was undertaken on L4 using single energy quantitative computer assisted tomography (CT). Radiographs of the spine were obtained in all patients and those with known or suspected malignant disease were excluded. The subjects were divided into two groups according to the presence (n = 128) or absence (n = 44) of signs of vertebral collapse or compression. The predictive value of the densitometric results for the presence of vertebral fractures was calculated and used as an estimate of fracture risk. While CT showed somewhat higher predictive values than DPA of the spine or combinations of DPA results from spine and femoral necks, the difference was not significant. It is concluded that with both CT and DPA the probability of the presence or absence of fracture can be raised to 75-80% when the probability prior to the investigation is 50% and when the threshold values of the measurements are chosen so that their sensitivity and specificity are about equal.

Adult↗

Dual photon absorptiometry in lumbar vertebrae. Evaluation of the baseline error.

In connection with determination of the bone mineral content in the third lumbar vertebra by dual photon absorptiometry, the fat in the adipose capsules of the kidneys is assumed to cause erroneous positioning of the baseline, leading to overestimation of the bone mineral content. The bone mineral content in L3 was measured in situ (BMC1) and vitro (BMC2) in 14 cadavers. The difference between BMC1 and BMC2 was significantly greater than zero, the median value being 0.32 g/cm at the confidence level of 94.4 per cent. It is concluded that at correlation between bone mineral content and compressive strength in vitro, the in vivo strength is overestimated by about 250 N.

Absorption↗

Usefulness of bone mass measurements by photon absorptiometry.

We compared three different methods of measuring bone mass for their diagnostic value and their usefulness in follow-up measurements. The three methods were: measurement of (1) bone mineral content in the distal forearm by single photon (125I) absorptiometry, (2) bone mineral content and bone mineral density of the lumbar spine measured by dual photon (153Gd) absorptiometry, and (3) total body bone mineral and total body bone density also measured by dual photon (153Gd) absorptiometry. The diagnostic validity was evaluated from measurements on healthy premenopausal women, and three groups of postmenopausal osteoporotic women (prior forearm fracture (N = 45), prior spine fracture (N = 46), or prior hip fracture (N = 27]. The forearm measurement separated all three osteoporotic groups from the premenopausal women at least as well as the spine measurement. The value of follow-up procedures was estimated using data from a clinical trial on prevention of postmenopausal bone loss by sex hormones. Fewer participants are needed in clinical trials when a forearm scanner is used instead of a spine scanner, because of the better precision of the former. The forearm scanner seems to be the best tool of the three for bone mass measurements, in both clinical practice and for research purposes.

Absorptiometry, Photon↗

Precision of dual photon absorptiometry measurements: comparison of three different methods of selection of the region of interest.

To determine the short-term reproducibility of bone mass calculations with dual photon absorptiometry of the lumbar spine (L2-L4), duplicate measurements in healthy subjects were used. Three different methods for selection of region of interest were compared: a rectangular region with variable height and width, an irregular region to be drawn freely by the operator and the standard calculation software supplied with the bone densitometer. Contributions of changes in size and location of the region of interest on calculated bone mineral mass were also investigated. An increase in height of the region by 2 scan lines caused an increase in bone mineral content (BMC) of 8.4% +/- 1.8%. Enlargement in width by 2 pixels in each scan line caused an increase in BMC of 2.5% +/- 1.3%. The difference between these region of interest changes was significant (P less than 0.0005). The use of a rectangular region, optimized to enclose L2-L4 in each person but of the same size in both measurements, resulted in a reproducibility of 1.4% and 0.7% respectively for 2 observers, with an inter observer variation of 1.2%. The reproducibility of the duplicate measurements was worse for the other methods of region of interest selection. A further series of duplicate DPA measurements in normal subjects, but with a standard meal between the measurements, showed a larger variation in the results. Again the reproducibility of the calculations using the rectangular region was better than with the other methods, with much less inter observer variation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Quantitative digital radiography versus dual photon absorptiometry of the lumbar spine.

Lumbar spine bone mineral density (BMD) was measured by quantitative digital radiography, a new dual energy x-ray technique, and by 153Gd dual photon absorptiometry (DPA) in 85 patients. Each patient was measured twice by the new method and once by DPA on the same day, with repositioning between measurements. Serial measurements were made on an hydroxyapatite spine phantom embedded in tissue-equivalent plastic to evaluate the long term reproducibility of each instrument. The spinal BMD measurements with the 2 techniques were linearly related and highly correlated (r = 0.98) over a range from severely osteopenic to high normal. This correlation was not affected by the age, weight, or BMD of the patient measured. Quantitative digital radiography's long-term reproducibility using the spine phantom was stable for 180 days (coefficient of variation, 0.23%); DPA values were 3 times as variable for 170 days (coefficient of variation 0.73%) and increased 1.0% (P less than 0.0001) after a software change. The short term reproducibility of quantitative digital radiography, estimated from paired patient measurements, was 2-fold better than reported values for DPA and was independent of the patient's age, weight, or BMD. Measurement time by quantitative digital radiography was 5-8 min, with a maximum radiation exposure of 3 mrem, significantly lower than the corresponding DPA values. Quantitative digital radiography's image resolution was superior to that of DPA, enabling it to measure more bones. These advantages along with the elimination of 153Gd source changes and Nuclear Regulatory Commission licensing requirements indicate that quantitative digital radiography is the superior method for spinal BMD measurements.

Adult↗

Dual-photon absorptiometry of mandibles: in vitro test of a new method.

A new method for non-invasive in vivo measurement of changes in bone mineral content (BMC) of mandibles, comprising two-dimensional dual-photon absorptiometry (GT45), has been developed and tested in vitro on mandibular specimens. The analysis showed that: 1) in vitro precision and accuracy of the methods are high, 2) effect of fat and soft tissue on photon attenuation is slight when scanning jaws and forearm bones, 3) BMC in units (U/cm2) in standard area, comprising mandibular base and body in left molar region, is representative for BMC in total mandibular base and body, 4) cortical bone constitutes the main part of measured BMC in mandibles, and 5) BMC of molar region is highly correlated to cortical bone mass in mm3/mm2 subperiosteal surface of standard locality anterior to and below mental foramen, measured by histomorphometry. GT45 seems suitable for in vivo estimation of BMC changes in edentulous jaws and in mandibular base and body of dentate mandibles in longitudinal and cross-sectional studies. The radiation dose is negligible.

Adipose Tissue↗

Bone mineral status measured by direct photon absorptiometry in institutionalized adults receiving long-term anticonvulsant therapy and multivitamin supplementation.

The effects of long-term anticonvulsant drug therapy and multivitamin supplementation on bone mineral status were evaluated by direct photon absorptiometry in 53 adult residents of an institution for the mentally disturbed. Results demonstrated a similar amount of osteopenia for control subjects and those on anticonvulsant drugs. Average osteopenia was 8% for control subjects and 6% for subjects taking anticonvulsant drugs. Significant osteopenia was found in 25% of subjects taking anticonvulsant drugs and 20% of control subjects. Multivitamin supplementation had a beneficial effect on bone status in both subject groups. The use of anticonvulsant drugs had a significant effect on levels of alkaline phosphatase. Elevated alkaline phosphatase was found in 37% of subjects taking anticonvulsant drugs and 22% of control subjects. Hypocalcemia was found only in subjects taking anticonvulsant drugs (19%). Average calcium values were similar for both subject groups. Multivitamins were shown to have no significant effect on alkaline phosphatase or calcium values. Because both control subjects and those taking anticonvulsant drugs showed similar levels of osteopenia, factors other than anticonvulsant drug therapy appeared to adversely affect bone mineral status in this population. Conversely, multivitamin supplementation and the dietary control present in the institutionalized setting appear to have ameliorated the osteopenia commonly seen in anticonvulsant-treated populations without greatly modifying elevated alkaline phosphatase and hypocalcemia.

Adult↗

Some effects of basic multicellular unit-based remodelling on photon absorptiometry of trabecular bone.

This article offers algorithms and an algebra for estimating effects of bone turnover, remodelling space, undermineralized bone and trabecular surface-to-volume ratio effects on trabecular bone mass estimation by photon absorptiometry. From published histomorphometric data and other evidence the algorithms suggest the amount of mineral in a given bone sample can suggest to absorptiometry an amount of bone that differs from the truth by over 40% in the extreme, and more commonly by 5-15%. They suggest that by reducing a bone's global mineral content high bone turnover causes underestimation of true bone mass. They suggest that by letting mineral return to the remodelling space and undermineralized bone, reduced bone turnover causes apparent gains in bone mass. The commonly suggested 5-15% magnitude of such errors exceeds those assumed in the past. The algorithms suggest that after a challenge to remodelling those bone mineral changes can take from 6 months to over 3 years to reach steady states. Those features could explain why many osteoporosis treatments judged effective from initial absorptiometric evidence failed when used for long periods in patients. Finally the algorithms suggest that a real increase in ideal bone volume can even appear to absorptiometry as no gain or an initial loss, which has already happened in two human experiments.

Bone Development↗