title: Use of lowest single lumbar spine vertebra bone mineral density T-score and other T-score approaches for diagnosing osteoporosis and relationships with vertebral fracture status.
abstract: For diagnosing osteoporosis, International Society for Clinical Densitometry guidelines suggest using the lowest bone mineral density T-score of the lumbar spine (LS), femoral neck (FN), or total hip (TH). For the LS, use of the total spine (L1-L4) T-score is suggested. Although controversial, some authors have suggested using a single lumbar vertebra of L1-L4 with the lowest T-score to diagnose osteoporosis. We compared the ability of various T-score approaches [lowest single LS vertebra of L1-L4; total spine; FN; TH; and the lowest T-score of total spine, FN, or TH to diagnose osteoporosis in 2560 postmenopausal women from the Multiple Outcomes of Raloxifene Evaluation trial placebo group. The discriminatory ability of each T-score approach to identify women with or without vertebral fracture was compared using the area under receiver-operating characteristic curve. When the lowest single LS T-score of L1-L4 and the total spine T-score were used, 77% and 57% of women were categorized as having osteoporosis, respectively. These T-score approaches had similar ability for discriminating between women with or without prevalent vertebral fractures and for predicting the risk of incident vertebral fractures. The lowest single LS vertebra T-score identified a greater proportion of women with osteoporosis than currently accepted approaches. Thus, the WHO diagnostic classification should not be applied to single vertebral T-scores. This analysis supports the current International Society for Clinical Densitometry position to use the total spine T-score for osteoporosis diagnosis.
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Peiqi
authors.initials: P
authors.lastname: Chen
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.forename: Neil C
authors.initials: NC
authors.lastname: Binkley
authors.forename: David L
authors.initials: DL
authors.lastname: Kendler
authors.forename: Mayme
authors.initials: M
authors.lastname: Wong
authors.forename: Kelly
authors.initials: K
authors.lastname: Krohn
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology