![Sample our Health and Social Care journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5938/TOC-Subject-Sample-2021-Health-Social-Care.jpg"})
Abstract
Purpose
To explore the characteristics and reliability of dual-energy x-ray absorptiometry (DXA) measurements in patients undergoing lumbar fusion for lumbar degenerative diseases (LDD).
Patients and Methods
A total of 1041 patients aged ≥50 years undergoing lumbar fusion for LDD were reviewed. The BMDs and T-scores of DXA were retrospectively analysed. The diagnosis of osteoporosis was in accordance with World Health Organization (WHO) criteria. Based on the guidelines of International Society for Clinical Densitometry (ISCD), an abnormal lumbar segment is identified as having unreliable T-scores when there is more than a 1.0 T-score difference between two adjacent vertebrae.
Results
The prevalence of osteoporosis diagnosed on DXA was 42.3%, and it was higher in women than in men (50.2% vs 31.8%, P < 0.001). Increasing age resulted in higher prevalence of osteoporosis in females. The prevalence of osteoporosis significantly declined with increasing BMI. The lowest lumbar T-score was mostly found at L1. Unreliable T-scores were mostly seen in the lower lumbar segment (L3–L4) and were the least common in L1–L2. The average amount of abnormal lumbar segments increased with age (P = 0.003) and BMI (P = 0.021). Furthermore, those with degenerative lumbar scoliosis had more abnormal segments (P < 0.001). Of the 95 patients with at least one fractured vertebra, 39 (41.1%) were not diagnosed as having osteoporosis on lumbar DXA.
Conclusion
Female, older age and low BMI are the risk factors for osteoporosis in patients undergoing lumbar fusion for LDD. Lower lumbar segments, such as L3–L4, are more likely to have unreliable T-scores. Patients with older age, higher BMI or degenerative scoliosis have more abnormal segments with unreliable T-scores. Lumbar DXA measurements are not sensitive enough to identify patients with vertebral fracture.
Abbreviations
DXA, dual-energy X-ray absorptiometry; LDD, lumbar degeneration diseases; LSS, lumbar spinal stenosis; BMD, bone mineral density; BMI, body mass index; WHO, World Health Organization; ISCD, International Society for Clinical Densitometry; SD, standard deviation; ANOVA, analysis of variance; TBS, trabecular bone score; IGF-1, insulin-like growth factors-1; QCT, quantitative computed tomography; CT, computed tomography.
Disclosure
The authors report no conflicts of interest in this work.