Is a Fixed Value for the Least Significant Change Appropriate?
Abstract
The least significant change (LSC) represents the smallest difference between successive measurements of bone mineral density (BMD) that can be considered to be a real change and not attributable to chance. The LSC is derived from same-day in vivo BMD precision measurements. Our first objective was to determine if the LSC differs between technologists. Our second objective was to determine if patient body size influenced the LSC. Each of 8 technologists measured same-day precision in groups of 30 patients for the lumbar spine and the total trochanter and neck regions of the proximal femur. At the spine, precision ranged from 0.008 to 0.011g/cm(2) and did not differ between technologists. Precision for the total region of the left proximal femur ranged from 0.006 to 0.016g/cm(2) and did differ between technologists. For the trochanter and neck regions, precision ranged from 0.008 to 0.013g/cm(2) for the former and from 0.010 to 0.020g/cm(2) for the latter, again, with inter-technologist differences. The LSC for the lumbar spine increased linearly from 0.022 to 0.031g/cm(2) when body mass index (BMI) increased from 19.5 to 31.3kg/m(2). In contrast, there was no discernable impact of BMI on the LSC for any of the proximal femur regions. The LSC at the spine is determined by the patient, whereas the LSC at the femur is determined by the technologist. Use of a single value for the LSC will lead to misinterpretations of the significance of BMD changes at both the spine and the prox…
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DXA-derived aBMD precision declines with increasing BMI and paraspinal fat, which may negatively impact the correlation with spectral localizer radiograph-derived aBMD.
“It is known that DXA-derived aBMD precision declines with increasing BMI and paraspinal fat,23,24 which may negatively impact the correlation with spectral localizer radiograph-derived aBMD.”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [24]
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Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT
Yu, E. W., Thomas, B. J., Brown, J. K., & Finkelstein, J. S. (2012) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.506 · Cited by 300 · see citing works
Obesity increases precision errors in dual-energy X-ray absorptiometry measurements
Knapp, K. M., Welsman, J. R., Hopkins, S. J., Fogelman, I., & Blake, G. M. (2012) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2012.01.002 · Cited by 87 · see citing works
Moser, L. J., Klambauer, K., Diaz Machicado, M. C., Frey, D., Mergen, V., Eberhard, M., Nowak, T., Schmidt, B., Flohr, T., Distler, O., et al. (2025) · Investigative Radiology · doi:10.1097/rli.0000000000001159 · Cited by 8 · see citing works
- Authors
- Nelson, L., Gulenchyn, K. Y., Atthey, M., & Webber, C. E.
- Affiliations
- Hamilton Health Sciences (CA)
- Corresponding author
- Webber, Colin E.
- ORCID
- Webber, Colin E.
- Venue
- Journal of Clinical Densitometry
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 13
- Issue
- 1
- Pages
- 18-23
- ISSN
- 1094-6950 (ISSN-L)
- OpenAlex
- W2101352588
- Cited by
- 35
- References
- 0
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 5 · 2013: 5 · 2012: 2
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Densitometry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- least significant change, bone mineral density, measurement precision, body mass index, lumbar spine, proximal femur, femoral neck, femoral trochanter, osteoporosis assessment
- MeSH terms
- Aged, Femur, Humans, Lumbar Vertebrae, Middle Aged, Reproducibility of Results, Absorptiometry, Photon, Bone Density, Body Size
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