Transcript 48x72 poster template - University of Alabama at Birmingham

How Often Does Nonprogression of Vertebral Area or Bone Mineral Content (BMC)
Translate into A Compression Fracture?
S.L. Morgan, MD, RD, CCD, R. Lopez-Ben, MD, CCD, N. Nunnally RT (R), CDT, L. Burroughs RT (R), CDT, R. Desmond DVM, Ph.D.
The University of Alabama at Birmingham Departments of Nutrition Sciences and Medicine and Radiology.
The UAB Osteoporosis Prevention and Treatment Clinic
MATERIALS AND METHODS
BACKGROUND
The 2003 ISCD consensus guidelines
recommended the exclusion of vertebral
bodies for:
1) “Evidence of a focal structural
abnormality;
2) Unusual discrepancy in bone mineral
content or area between adjacent vertebrae.
Both measures should increase from L1 to
L4; and
3) Individual T-scores should be within 1
S.D. of adjacent vertebrae
•It is unclear how often nonprogression in
area, BMC, and differences in one standard
deviation in T-score are predictive of
abnormal vertebral morphology such as
compression fractures.
HYPOTHESIS
We hypothesized that nonprogression of
vertebral area or bone mineral content from
L1-L4 on a PA dual energy x-ray
absorptiometry scan (DXA) would be
predictive of vertebral compression fractures
as determined by lateral vertebral assessment
(LVA).
Supported by a 2005 ISCD Special
Projects Grant
printed by
www.postersession.com
•Individuals DXA scanned at the Kirklin Clinic were asked to have a VFA, if they either
had a nonprogressive increase in the areas of vertebral bodies from L1-L4 or a
nonprogressive increase in BMC from L1-L4.
•With informed consent, the patient had an PA spine DXA scan and a PA and lateral
VFA on a Hologic Discovery W #80392 (software 12.1.7) or a Hologic Discover A
#45197 (12.1.3 software).
•The VFAs were jointly interpreted by a radiologist and an internist and when a
compression fracture in L1-L4 was noted, 6 point morphometry was completed to
quantitate the type and extent of the fracture.
•The presence and angle of scoliosis was noted in the lumbar sine, if present.
•The presence of vertebral compression fractures and/or scoliosis of the spine by VFA
were correlated with nonprogression of area of BMC.
•The presence of compression fractures and scoliosis were also correlated with a
difference of > 1 standard deviation between levels.
•Descriptive statistics were used to evaluate the demographics.
•The presence of compression and scoliosis was correlated with nonprogression of
area, BMC, or > 1 SD difference in T-scores by Fisher’s Exact Test.
RESULTS
•109 subjects were screened, 1 patient declined and 7 subjects were omitted because
of the presence of artifacts or confounding findings (N = 101).
•The mean age was 65.6 ± 12.4 (S.D.) years and the mean BMI was 27.5 ± 5.8.
•37 compression fractures were identified in 17 different patients.
•22 of the fractures were in L1-L4 and occurred in 15 different subjects.
•There was scoliosis in 28.7% of the population.
•The apex of the scoliosis was at T12-L1 in 13.8%, L1-L2 in 27.6%, L3-L4 in 37.8%,
and L4-L5 in 10.7%.
Table 2
Fracture
No Fracture
Scoliosis
No Scoliosis
aP
Area progresses Nonprogression of BMC progresses
between Levels N area between
between Levels
(%)
Levels N (%)
N (%)
5 (31.3)a
11 (68.7)a
5 (31.3)b
34 (40.0)a
51 (60.0)a
14 (16.5)b
11 (37.9)d
28 (38.9)d
18 (62.1)d
44 (61.1)d
8 (27.6)b
11 (15.3)b
Table 1
Characteristic
N (%)
Ethnicity
Caucasian
African American
Hispanic
85 (85)
13 (13)
3 (3.0)
Gender
Male
Female
21 (20.8)
80 (79.2)
Postmenopausal
76 (93.8)
Hysterectomy or
oophorectomy
24 (32.4)
Currently on hormones
16 (19.5)
Currently on steroids
20 (20.2)
Fracture as an adult
Spine (n)
Forearm (n)
Hip (n)
Other (n)
51 (50.5)
7
11
5
28
Previous surgery on the
lower back
3 (3.0)
Previous vertebroplasty
or kyphoplasty
1 (1.0)
Current medications
Fosamax
Actonel
Miacalcin
Evista
Forteo
Aredia
Boniva
23 (22.7)
8 (9.5)
1 (1.2)
5 (6.0)
5 (6.0)
0 (0.0)
0 (0.0)
Hyperparathyroidism
1 (1.0)
Other comorbidity
Renal transplant
Heart/ lung transplant
Asthma
Lupus
Rheumatoid arthritis
3 (3.0)
1 (1.0)
8 (8.0)
3 (3.0)
12 (12.)
Presence of scoliosis
Apex T12 – L1
L1 – L2
L3 – L4
L4- L5
29 (28.7)
4 (13.8)
8 (27.6)
11 (37.9)
6 (20.7)
Nonprogression of
BMC Between
Levels N (%)
CONCLUSIONS
1) Nonprogression of vertebral area of
BMC or discrepancies in T-scores > 1
S.D. is not a sensitive predictor of the
presence of vertebral fractures in L1L4 by VFA.
2) The presence of scoliosis was
significantly related to a > 1 S.D.
difference in T-scores between levels
at L1-L4.
3) VFA is a more sensitive way to
evaluate the presence of a
compression fracture than arithmetic
progression cues from the PA DXA
scan.
< 1 S.D. in T> 1 S.D. in Tscore Between score Between
levels N (%)
levels N (%)
11 (68.7)b
71 (83.5)b
13 (81.3)c
63 (74.1)c
3 (18.7)c
22 (25.9)c
21 (72.4)b
61 (84.7)b
17 (58.6)e
59 (81.9)e
12 (41.4)e
13 (18.1)e
= 0.58 Fisher’s exact test, bP = 0.17 Fisher’s exact test; cP = 0.75 Fisher’s exact test, dP = 1.0 Fisher’s exact test; eP = 0.02 Fisher’s
exact test