Cited by 90Bone health and osteoporosis researchBody Composition Measurement TechniquesClinical Laboratory Practices and Quality Control

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An Overlying Fat Panniculus Affects Femur Bone Mass Measurement

Binkley, Neil, Krueger, Diane, Vallarta-Ast, Nellie·2003·Journal of Clinical Densitometry

DOI 10.1385/jcd:6:3:199

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Abstract

Dual-energy X-ray absorptiometry (DXA) is currently the gold standard technique for osteoporosis diagnosis. However, DXA has limitations, including artifacts, such as degenerative disease or metallic foreign bodies, that may confound bone mineral density (BMD) results. Because fat folds overlying the proximal femur may alter soft-tissue density in a nonuniform manner, this may be a currently unappreciated confounder of proximal femur BMD measurement. This possibility was evaluated in 127 patients (52 women/75 men) referred for routine BMD measurement who were identified as having a fat panniculus overlying their proximal femur scan area. Presence of a fat panniculus within the scan field was confirmed by visual assessment of images obtained utilizing a GE Lunar Expert-XL. Subsequently, these individuals were rescanned while retracting their fat panniculus away from the femur scan area without other repositioning between scans. In 49% of the men, and 56% of the women, either the femoral neck, trochanter, or total femur BMD differed by more than the least significant change at our facility. No pattern was observed to predict whether BMD would increase or decrease upon fat retraction. Subsequently, 30 patients were scanned using the standard and retracted technique twice, with repositioning between scans to establish precision. Retracted and standard precision was similar. In conclusion, an overlying fat panniculus may alter proximal femur BMD measurement, which would be expected to impair the ability to accurately diagnose low bone mass and monitor osteoporosis therapy. When a fat panniculus overlays the proximal femur scan area, its retraction should be part of routine densitometric practice.

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Authors: Binkley, N., Krueger, D., & Vallarta-Ast, N.
Affiliations: University of Wisconsin–Madison (US)
William S. Middleton Memorial Veterans Hospital (US)
Corresponding author: Binkley, Neil
ORCID: Binkley, Neil
Venue: Journal of Clinical Densitometry
Publisher: Elsevier BV
Published: 2003-09
Volume: 6
Issue: 3
Pages: 199-204
ISSN: 1094-6950 (ISSN-L)
DOI: 10.1385/jcd:6:3:199
OpenAlex: W2016893819
Cited by: 90
References: 18
Citations by year: 2026: 4 · 2025: 5 · 2024: 5 · 2022: 4 · 2021: 4 · 2020: 8 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 4 · 2014: 11 · 2013: 8 · 2012: 10
FWCI: 1.96
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Clinical Densitometry (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Health Sciences › Medicine › Physiology (medical) › Body Composition Measurement Techniques
Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
Keywords: soft tissue artifacts, dual-energy X-ray absorptiometry, osteoporosis diagnosis, measurement precision, femoral neck, trochanter, osteopenia
MeSH terms: Adipose Tissue, Aged, Female, Femur, Humans, Male, Absorptiometry, Photon, Bone Density, Artifacts

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An Overlying Fat Panniculus Affects Femur Bone Mass Measurement

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