Journal of Clinical Densitometry
Volume 10, Issue 4 , Pages 351-358 , October 2007

DXA-Generated Z-Scores and T-Scores May Differ Substantially and Significantly in Young Adults

  • John J. Carey

      Affiliations

    • Center for Osteoporosis and Metabolic Bone Diseases, Cleveland Clinic, Cleveland, OH, USA
    • Corresponding Author InformationAddress correspondence to: John Joseph Carey, MB, MS, Department of Rheumatology, Merlin Park Hospital, N.U.I. Galway, Galway, Ireland.
  • ,
  • Miriam F. Delaney

      Affiliations

    • Center for Osteoporosis and Metabolic Bone Diseases, Cleveland Clinic, Cleveland, OH, USA
  • ,
  • Thomas E. Love

      Affiliations

    • Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA
  • ,
  • Bradford J. Richmond

      Affiliations

    • Center for Osteoporosis and Metabolic Bone Diseases, Cleveland Clinic, Cleveland, OH, USA
  • ,
  • Barbara A. Cromer

      Affiliations

    • Division of Adolescent Medicine, MetroHealth Medical Center, Cleveland, OH, USA
  • ,
  • Paul D. Miller

      Affiliations

    • Colorado Center for Bone Research, Lakewood, CO, USA
  • ,
  • Martha Manilla-McIntosh

      Affiliations

    • Center for Osteoporosis and Metabolic Bone Diseases, Cleveland Clinic, Cleveland, OH, USA
  • ,
  • Steven A. Lewis

      Affiliations

    • Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA
  • ,
  • Charles L. Thomas

      Affiliations

    • Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA
  • ,
  • Angelo A. Licata

      Affiliations

    • Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA

Received 22 March 2007 ,Revised 31 May 2007 ,Accepted 5 June 2007.

References 

  1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy . Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785–795
  2. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–1194
  3. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The study of osteoporotic fractures research group. Lancet. 1993;341(8837):72–75
  4. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–1259
  5. Melton LJ, Atkinson EJ, O'Fallon WM, Wahner HW, Riggs BL. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res. 1993;8(10):1227–1233
  6. Hui SL, Slemenda CW, Johnston CC. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. 1988;81(6):1804–1809
  7. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. N Engl J Med. 1995;332(12):767–773
  8. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919–923
  9. Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164(10):1108–1112
  10. WHO Study Group . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva, Switzerland: World Health Organization; 1994;[Report No.: 843]
  11. Johnston CC, Slemenda CW, Melton LJ. Clinical use of bone densitometry. N Engl J Med. 1991;324(16):1105–1109
  12. Bates DW, Black DM, Cummings SR. Clinical use of bone densitometry: clinical applications. JAMA. 2002;288(15):1898–1900
  13. American College of Obstetricians and Gynecologists, Women's Health Care Physicians . ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2004;103(1):203–216
  14. Bonnick SL. Bone densitometry in clinical practice. Totowa, NJ: Humana Press; 2004;
  15. Cauley JA, Lui LY, Ensrud KE, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293(17):2102–2108
  16. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761–1767
  17. Hodgson SF, Watts NB, Bilezikian JP, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003;9(6):544–564
  18. International Society for Clinical Densitometry . Updated 2005 official positions for the international society for clinical densitometry. Available at: http://www.iscd.org/Visitors/positions/OfficialPositionsText.cfmAccessed November 1, 2006
  19. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929–1936
  20. 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. 2001;12(12):989–995
  21. Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137–1141
  22. Miller PD, Bonnick SL, Rosen CJ. Consensus of an international panel on the clinical utility of bone mass measurements in the detection of low bone mass in the adult population. Calcif Tissue Int. 1996;58(4):207–214
  23. National Osteoporosis Foundation . Physician's guide to prevention and treatment of osteoporosis. Available at: http://www.nof.org/physguide/index.htm2003;Accessed December 6, 2006
  24. Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. preventive services task force. Ann Intern Med. 2002;137(6):529–541
  25. Shepherd J, Njeh C, Genant H. Use of bone densitometry in the clinical management of osteoporosis. In:  Orwoll ES,  Bliziotes M editor. Osteoporosis: pathophysiology and clinical management. Totowa, NJ: Humana; 2003;p. 105–119
  26. United States Public Health Service, Office of the Surgeon General . Bone health and osteoporosis: a report of the surgeon general. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004;
  27. International Society for Clinical Densitometry . Introduction to understanding bone densitometry. Available at: http://www.iscd.org/visitors/resources/IntroBoneDens.pptAccessed December 6, 2005
  28. Faulkner KG. 2001 Clinical use of bone densitometry. In:  Marcus R,  Feldman D,  Kelsey J editor. Osteoporosis. San Diego, CA: Academic Press; 1900;p. 433–459
  29. National Osteoporosis Foundation . BMD testing: what the numbers mean. Available at: http://www.nof.org/osteoporosis/bmdtest.htm2005;Accessed December 6, 2006
  30. Leslie WD, Adler RA, El-Hajj Fuleihan G, et al. Application of the 1994 WHO classification to populations other than postmenopausal caucasian women: the 2005 ISCD official positions. J Clin Densitom. 2006;9(1):22–30
  31. International Osteoporosis Foundation . Facts and statistics about osteoporosis and its impact. Available at: http://www.osteofound.org/press_centre/fact_sheet.html2005;Accessed July 14, 2005
  32. Binkley N, Kiebzak GM, Lewiecki EM, et al. Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res. 2005;20(2):195–201
  33. Genant HK, Grampp S, Gluer CC, et al. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res. 1994;9(10):1503–1514
  34. Kanis JA, Seeman E, Johnell O, Rizzoli R, Delmas P. The perspective of the International Osteoporosis Foundation on the official positions of the International Society for Clinical Densitometry. J Clin Densitom. 2005;8(2):145–147
  35. Lewiecki EM, Miller PD, Leib ES, Bilezikian JP. Response to “the perspective of the International Osteoporosis Foundation on the official positions of the International Society for Clinical Densitometry,” by John A. Kanis et al.. J Clin Densitom. 2005;8(2):143–144
  36. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468–489
  37. Faulkner KG, Roberts LA, McClung MR. Discrepancies in normative data between lunar and hologic DXA systems. Osteoporos Int. 1996;6(6):432–436
  38. Carey JJ, Delaney MF, Richmond BF, et al. Equivalence of technology generated T-scores and Z-scores in young adult bone densitometry. J Back Musculoskelet Rehabil. 2006;21(9 Suppl):S361
  39. Carey JJ, Richmond BJ, Licata AA, et al. The impact of subject demographics on young adult DXA Z-scores. Proc 13th Meeting International Society for Clinical Densitometry, Tampa, FL, 2007. Available at: http://www.iscd.org/Abstract Submitter/Accepted07Abstracts.cfm.
  40. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–310
  41. Passing H, Bablok . A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, part I. J Clin Chem Clin Biochem. 1983;21(11):709–720
  42. Richmond BJ, Carey JJ, Delaney MF, et al. 2006. The impact of body weight on DXA generated Z-scores in young adults. Proc 17th Meeting International Bone Densitometry Workshop, Kyoto, Japan [abstract: 01-09].
  43. Carey JJ, Delaney MF, Licata AA, et al. 2006. Diagnostic agreement between DXA generated T-scores and Z-scores in young adults. Proc 17th Meeting International Bone Densitometry Workshop, Kyoto, Japan [abstract 01-08].
  44. Hui SL, Zhou L, Evans R, et al. Rates of growth and loss of bone mineral in the spine and femoral neck in white females. Osteoporos Int. 1999;9(3):200–205
  45. Finkelstein JS, Lee ML, Sowers M, et al. Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab. 2002;87(7):3057–3067
  46. Felson DT, Zhang Y, Hannan MT, Anderson JJ. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res. 1993;8(5):567–573
  47. Robbins J, Schott AM, Azari R, Kronmal R. Body mass index is not a good predictor of bone density: results from WHI, CHS, and EPIDOS. J Clin Densitom. 2006;9(3):329–334
  48. De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330–1338

PII: S1094-6950(07)00178-3

doi: 10.1016/j.jocd.2007.06.001

Journal of Clinical Densitometry
Volume 10, Issue 4 , Pages 351-358 , October 2007