Obesity increases precision errors in dual-energy X-ray absorptiometry measurements
Abstract
The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (<25 kg/m(2)) (n=48), overweight (25-30 kg/m(2)) (n=26), and obese (>30 kg/m(2)) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.
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QCT and HR-pQCT measurements may be less affected by changes in body fat than DXA.
“Measurements by QCT34 and high resolution peripheral QCT (HR-pQCT)35 may be less affected by changes in body fat.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [35]
Cites
Bone density at various sites for prediction of hip fractures
Cummings, S. R., Browner, W., Cummings, S. R., Black, D. M., Nevitt, M. C., Browner, W., Genant, H. K., Cauley, J., Ensrud, K., Scott, J., et al. (1993) · The Lancet · doi:10.1016/0140-6736(93)92555-8 · Cited by 2,446 · see citing works
Glüer, C.-C., Blake, G. M., Lü, Y., Blunt, B. A., Jergas, M. D., & Genant, H. K. (1995) · Osteoporosis International · doi:10.1007/bf01774016 · Cited by 1,282 · see citing works
Self-citationBeck, T., Petit, M. A., Wu, G., LeBoff, M. S., Cauley, J. A., & Chen, Z. (2009) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.090307 · Cited by 296 · see citing works
BMI and fracture risk in older men: The osteoporotic fractures in men study (MrOS)
Nielson, C. M., Marshall, L. M., Adams, A. L., LeBlanc, E. S., Cawthon, P. M., Ensrud, K., Stefanick, M. L., Barrett-Connor, E., Orwoll, E. S., & for the Osteoporotic Fractures in Men Study (MrOS) Research Group (2011) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.235 · Cited by 266 · see citing works
Greco, E., Fornari, R., Rossi, F., Santiemma, V., Prossomariti, G., Annoscia, C., Aversa, A., Brama, M., Marini, M., Donini, L., et al. (2010) · International journal of clinical practice · doi:10.1111/j.1742-1241.2009.02301.x · Cited by 228 · see citing works
Kim, K., Shin, D.-H., Lee, S., Im, J., & Lee, D. (2010) · Yonsei Medical Journal · doi:10.3349/ymj.2010.51.6.857 · Cited by 173 · see citing works
Zaninotto, P., Head, J. A., Stamatakis, E. A., Wardle, H., & Mindell, J. S. (2008) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2008.077305 · Cited by 151 · see citing works
Shepherd, J., Lü, Y., Wilson, K. E., Fuerst, T. P., Genant, H. K., Hangartner, T. N., Wilson, C. R., Hans, D. B., & Leib, E. S. (2006) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2006.05.005 · Cited by 149 · see citing works
Pirro, M., Fabbriciani, G., Leli, C., Callarelli, L., Manfredelli, M. R., Fioroni, C., Mannarino, M. R., Scarponi, A. M., & Mannarino, E. (2009) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-009-0108-0 · Cited by 122 · see citing works
Long-Term Precision of DXA Scanning Assessed over Seven Years in Forty Postmenopausal Women
Patel, R., Blake, G. M., RYMER, J. M., & Fogelman, I. (2000) · Osteoporosis International · doi:10.1007/s001980050008 · Cited by 115 · see citing works
Self-citationThe clinical role of dual energy X-ray absorptiometry
Blake, G. M., & Fogelman, I. (2009) · European Journal of Radiology · doi:10.1016/j.ejrad.2008.04.062 · Cited by 110 · see citing works
Self-citationTothill, P., Hannan, W. J., Cowen, S. J., & Freeman, C. P. L. (1997) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1997.12.11.1908 · Cited by 109 · see citing works
An overlying fat panniculus affects femur bone mass measurement
Binkley, N., Krueger, D., & Vallarta-Ast, N. (2003) · Journal of Clinical Densitometry · doi:10.1385/jcd:6:3:199 · Cited by 90 · see citing works
Maghraoui, A. E., Zounon, A. A. D. S., Jroundi, I., Nouijai, A., Ghazi, M., Achemlal, L., Bezza, A., Tazi, M. A., & Abouqual, R. (2005) · Osteoporosis International · doi:10.1007/s00198-005-1916-2 · Cited by 89 · see citing works
Hans, D. B., Shepherd, J., Schwartz, E. N., Reid, D. M., Blake, G. M., Fordham, J. N., Fuerst, T. P., Hadji, P., Itabashi, A., Krieg, M.-A., et al. (2008) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2007.12.012 · Cited by 88 · see citing works
Self-citationQuality and performance measures in bone densitometry
Engelke, K., & Glüer, C.-C. (2006) · Osteoporosis International · doi:10.1007/s00198-005-0039-0 · Cited by 88 · see citing works
Risk factors for fracture in a UK population: a prospective cohort study
Porthouse, J., Birks, Y. F., Torgerson, D. J., Cockayne, S., Puffer, S., & Watt, I. (2004) · QJM · doi:10.1093/qjmed/hch097 · Cited by 73 · see citing works
A Generalized Least Significant Change for Individuals Measured on Different DXA Systems
Shepherd, J., & Lü, Y. (2007) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2007.05.002 · Cited by 68 · see citing works
Factors Affecting Short-Term Bone Density Precision Assessment and the Effect on Patient Monitoring
Leslie, W. D. (2007) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.071019 · Cited by 57 · see citing works
Formica, C., Loro, M. L., Gilsanz, V., & Seeman, E. (1995) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650101011 · Cited by 52 · see citing works
Tothill, P., & Hannan, W. J. (2007) · Osteoporosis International · doi:10.1007/s00198-007-0382-4 · Cited by 49 · see citing works
Zhai, G., Hart, D. J., Valdes, A. M., Kato, B. S., Richards, J. B., Hakim, A. J., & Spector, T. D. (2008) · Osteoporosis International · doi:10.1007/s00198-008-0562-x · Cited by 48 · see citing works
Ghebre, M. A., Hart, D. J., Hakim, A. J., Kato, B. S., Thompson, V., Arden, N., Spector, T. D., & Zhai, G. (2011) · Calcified Tissue International · doi:10.1007/s00223-011-9518-9 · Cited by 40 · see citing works
Svendsen, O. L., Hendel, H. W., Gotfredsen, A., Pedersen, B. H., & Andersen, T. (2002) · Clinical Physiology and Functional Imaging · doi:10.1046/j.1475-097x.2002.00398.x · Cited by 38 · see citing works
Howel, D. (2010) · Public Health Nutrition · doi:10.1017/s136898001000056x · Cited by 38 · see citing works
Is a Fixed Value for the Least Significant Change Appropriate?
Nelson, L., Gulenchyn, K. Y., Atthey, M., & Webber, C. E. (2010) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2009.10.001 · Cited by 35 · see citing works
The effect of weight and weight change on the long-term precision of spine and hip DXA measurements
Rajamanohara, R., Robinson, J., RYMER, J. M., Patel, R., Fogelman, I., & Blake, G. M. (2010) · Osteoporosis International · doi:10.1007/s00198-010-1339-6 · Cited by 30 · see citing works
Self-citationEvolution of the human life cycle
Bogin, B., & Smith, B. H. (1996) · American Journal of Human Biology · doi:10.1002/(sici)1520-6300(1996)8:6
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Kendler, D. L., Borges, J. L. C., Fielding, R. A., Itabashi, A., Krueger, D., Mulligan, K., Camargos, B. M., Sabowitz, B., Wu, C.-H., Yu, E. W., et al. (2013) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2013.08.020 · Cited by 121 · see citing works
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Gutiérrez-Marín, D., Escribano, J., Closa-Monasterolo, R., Ferré, N., Venables, M., Singh, P., Wells, J. C., Muñoz-Hernando, J., Zaragoza-Jordana, M., Gispert-Llauradó, M., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.02.001 · Cited by 28 · see citing works
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- Authors
- Knapp, K. M., Welsman, J. R., Hopkins, S. J., Fogelman, I., & Blake, G. M.
- Affiliations
- University of Exeter (GB)
- King's College London (GB)
- Corresponding author
- Knapp, Karen M.
- Venue
- Journal of Clinical Densitometry
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 15
- Issue
- 3
- Pages
- 315-319
- ISSN
- 1094-6950 (ISSN-L)
- OpenAlex
- W1965614847
- Cited by
- 87
- References
- 28
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 10 · 2022: 8 · 2021: 8 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 9 · 2016: 6 · 2015: 4 · 2014: 10 · 2013: 6 · 2012: 2
- FWCI
- 7.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Densitometry (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion)
- Figshare (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- obesity, dual-energy X-ray absorptiometry, measurement precision, coefficient of variation, body mass index, bone mineral density, osteoporosis monitoring, femoral neck, lumbar spine, total hip, least significant change
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Middle Aged, Obesity, Osteoporosis, Reproducibility of Results, Absorptiometry, Photon, Comorbidity, Body Mass Index, Young Adult
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