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DEXA sensitivity analysis in patients with adult spinal deformity
- Source :
- The Spine Journal. 20:174-180
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- BACKGROUND Adult spinal deformity (ASD) is a debilitating condition that commonly requires surgical intervention. However, ASD patients may also present with osteoporosis, predisposing them to surgical complications and failure of instrumentation. As a result, proper detection of low bone mineral density (BMD) is critical in order to ensure proper patient care. Typically dual-energy x-ray absorptiometry (DEXA) scans are performed on the hip and spine. Unfortunately, in ASD patients, the latter is often inaccurate PURPOSE In this study, we consider the value of obtaining a forearm DEXA scan in addition to a hip scan in patients suffering from ASD and osteoporosis in order to accurately detect low BMD. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patient data between 2016 and 2018 from a single academic medical center was utilized. Two hundred eighty-six patients met the initial search criteria. OUTCOME MEASURES No outcomes measures related to self-reporting, physiology, or functionality were evaluated in this study. Primary outcome measures analyzed included T-scores across various anatomic locations and diagnoses relating to low bone density (ie, osteopenia and osteoporosis). METHODS This retrospective study examines patients that underwent DEXA studies between 2016 and 2018 and were previously diagnosed with both osteoporosis and adult spinal deformity. For each patient, age, gender, body mass index, and smoking history were noted, as well as whether there was long-term prednisone use. T-scores from both the forearm and hip were recorded and analyzed. Diagnoses from hip DEXA scans were compared with those obtained from forearm scans to identify which region was more sensitive in detecting low BMD. From this data, the frequency of a missed diagnosis, due to reliance on hip or spine T-scores for detection of low BMD, was extrapolated. No external funding source was received in support of this study. RESULTS Two hundred eighty-six patients matched the initial search criteria. Only 68% had one T-score value. However, 24.8% of patients had data for both the hip and forearm, whereas 7.1% had data for the forearm, hip, and spine. Among the 85 patients with more than one anatomical site of study, the forearm was more sensitive than the hip in its ability to detect osteopenia or osteoporosis 41.2% of the time. A two-tailed t test showed no statistically significant difference between hip T-scores and forearm T-scores. However, for more than 17% of patients, the forearm allowed clinicians to detect osteoporosis or osteopenia in a setting where using only the hip data would have missed such a diagnosis. CONCLUSIONS Clinicians need to ensure they survey at least two locations when conducting DEXA studies before precluding a diagnosis of osteopenia or osteoporosis. All ASD patients being evaluated for low bone density should receive DEXA scans that survey at least the hip and the forearm. Misdiagnoses can be costly in the setting of ASD. They occur frequently when only a single hip scan is relied upon to assess BMD.
- Subjects :
- Adult
Male
musculoskeletal diseases
medicine.medical_specialty
Bone density
Osteoporosis
Scoliosis
Sensitivity and Specificity
Spinal Curvatures
03 medical and health sciences
Absorptiometry, Photon
0302 clinical medicine
Forearm
Bone Density
Humans
Medicine
Orthopedics and Sports Medicine
Medical diagnosis
Aged
030222 orthopedics
Hip
business.industry
Retrospective cohort study
Middle Aged
medicine.disease
Spine
Osteopenia
medicine.anatomical_structure
Female
Surgery
Neurology (clinical)
Radiology
business
Body mass index
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15299430
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- The Spine Journal
- Accession number :
- edsair.doi.dedup.....b3e5648f5cd22ff3bdbd65901cde74b2