We greatly appreciate the thoughtful perspective by Kanis and colleagues regarding the Official Positions of the International Society for Clinical Densitometry (ISCD), published in their entirety in the Journal of Clinical Densitometry (1) and summarized in the Journal of Clinical Endocrinology and Metabolism (2) and Osteoporosis International (3). A robust scientific debate on the clinical applications of bone density testing is desirable and necessary. It is only through open discussion of diverse viewpoints that we will coherently define the clinical utility of bone densitometry. The development of practical standards by which health care practitioners can be guided is a major step toward improving patient care worldwide.
[Show abstract][Hide abstract] ABSTRACT: Bone mineral density (BMD) can be measured by a variety of techniques at several skeletal sites. Once measured, the manufacturers’
software uses the BMD to calculate a T-score and/or Z-score. Both T-scores and Z-scores are derived by comparison to a reference population on a standard deviation scale. The recommended reference group
for the T-score is a young gender-matched population at peak bone mass, while the Z-score should be derived from an age-matched reference population. T-scores and Z-scores are widely quoted in scientific publications on osteoporosis and BMD studies, and are the values used for DXA diagnostic
criteria and current clinical guidelines for the management of osteoporosis. Errors in BMD measurement, differences in reference
populations, and variations in calculation methods used, can all affect the actual T-score and Z-score value. Attempts to standardize these values have made considerable progress, but inconsistencies remain within and
across BMD technologies. This can be a source of confusion for clinicians interpreting BMD results. A clear understanding
of T-scores and Z-scores is essential for correct interpretation of BMD studies in clinical practice.
KeywordsDXA-Bone mineral density-
Clinical Reviews in Bone and Mineral Metabolism 09/2009; 8(3):113-121. DOI:10.1007/s12018-009-9064-4
[Show abstract][Hide abstract] ABSTRACT: Prevalence estimates of osteopenia and osteoporosis (reduced bone mineral density; BMD) in HIV-infected patients and the role of antiretroviral therapy (ART) varies in the literature.
We conducted a meta-analytical review of cross-sectional studies published in English to determine the pooled odds ratios (OR) of reduced BMD and osteoporosis in the following groups: HIV-positive versus HIV-negative; ART-treated versus ART-naive; protease inhibitor (PI)-treated versus PI-untreated. We searched the MEDLINE, PubMed, and EMBASE databases for eligible references between January 1966 and November 2005. Random effects models were used to generate pooled OR estimates and confidence intervals.
Of 37 articles identified, 20 met the inclusion criteria. Of the 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis, yielding a pooled OR of 6.4 and 3.7, respectively, compared with HIV-uninfected controls (n = 654) using 11 studies with available data. Compared with ART-naive patients (n = 202, 10 studies), ART-treated individuals (n = 824) had a 2.5-fold increased odds of prevalent reduced BMD. The risk of prevalent osteoporosis (seven studies) was similarly elevated in ART-treated individuals. Compared with non-PI-treated HIV patients (n = 410, 14 studies), PI-treated patients (n = 791) had increased odds of reduced BMD and osteoporosis (12 studies). Few studies adjusted for important covariates such as HIV disease severity or treatment duration.
The prevalence of osteoporosis in HIV-infected individuals is more than three times greater compared with HIV-uninfected controls. ART-exposed and PI-exposed individuals had a higher prevalence of reduced BMD and osteoporosis compared with their respective controls. The influence of other disease and treatment variables on these estimates could not be determined.
AIDS 12/2006; 20(17):2165-74. DOI:10.1097/QAD.0b013e32801022eb · 5.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postmenopausal osteoporosis (PMO) is a progressive disease of bone loss, fractures, or both. The progression of osteoporosis leads to increased mortality and morbidity and impairs quality of life. There are effective treatments that prevent bone loss, increase bone strength, and reduce fracture risk. Improvement in persistence and adherence to therapy leads to better clinical outcomes. The management of PMO is facilitated by measuring surrogate markers of the efficacy of PMO treatments: 1) bone mineral density, 2) bone turnover markers, and 3) assessment of spinal integrity by vertebral fracture assessment by dual-energy x-ray absorptiometry. Appropriate use of markers measures the patient's baseline fracture risk and monitors response to treatments. Clinicians must interpret markers in the context of a patient's fracture risk and determine the effectiveness of therapy. Integrating these markers enhances overall patient care. The surrogate markers help the clinician to achieve the goal of managing PMO; attempting to manage PMO without markers reduces the clinical management to guesswork.
Current Osteoporosis Reports 04/2007; 5(1):38-43. DOI:10.1007/BF02938621
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