title: Standardization of BMD T-Scores in the first five years after the menopause: do femoral neck-equivalent and older normative range T-Scores improve diagnostic agreement?
abstract: Calculating T-scores using an older reference population reduces inconsistency between measurement sites when osteoporosis is diagnosed in the elderly. The present analysis in a younger, early postmenopausal cohort examined 5-yr consistency of normalization by local and femoral neck-equivalent T-scores. NHANES (femur) and Hologic (spine and forearm) references were applied to baseline, 1-, 2-, 3-, and 5-yr scans in 925 untreated women in a national cohort study, and alternative local and neck-equivalent scores calculated. The baseline prevalence of osteopenia/osteoporosis was 35.5%/4.1% (spine), 31.0%/1.2% (neck), 31.3%/1.2% (total hip), and 37.2%/2.5% (forearm). It increased to 54.6%/7% by combining sites. The prevalences at 5-yr were 57.2%/12.4% (spine), 51.9%/5.0% (neck), 46.6%/3.7% (total hip), 52.5%/7.4% (forearm), and 77.3%/17.8% (any). A T-score cut-off at the lowest of four sites of -1.65 for osteopenia and -3.37 for osteoporosis was equivalent in patient numbers to T<-1 and T<-2.5 at the femoral neck. The proportion of inconsistently classified subjects decreased from 48% to 42% (p<0.05) with neck-equivalent scores. No improvement remained after 5 yr. Kappa scores did not improve by the use of local or femoral neck scores. In conclusion, adjusted thresholds cannot remove the anatomic discrepancy between T-scores. To overcome this problem, risk-based diagnostic cut-offs must therefore be calculated separately for each measurement site and fracture localization.
authors.affiliation: Dept of Endocrinology, Odense University Hospital, Denmark. B.abrahamsen@dadlnet.dk
authors.forename: Bo
authors.initials: B
authors.lastname: Abrahamsen
authors.forename: Charlotte Landbo
authors.initials: CL
authors.lastname: Tofteng
authors.forename: Olaf
authors.initials: O
authors.lastname: Bärenholdt
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.forename: Lis Saalbach
authors.initials: LS
authors.lastname: Stilgren
authors.forename: Henning
authors.initials: H
authors.lastname: Beck-Nielsen
authors.forename: Stig Pors
authors.initials: SP
authors.lastname: Nielsen
authors.forename: Ole Helmer
authors.initials: OH
authors.lastname: Sørensen
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis*; D003720:Densitometry; D005260:Female; D005272:Femur Neck / Q000502:physiology*; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D012372:ROC Curve; D012016:Reference Values