Abstract
The aim of this study was to investigate a new bone densitometric technology based on digital radiogrammetry (DXR) with respect to its ability to measure severity-dependent variations of bone mineralization in patients with rheumatoid arthritis. One hundred six randomly selected patients suffering from verified rheumatoid arthritis underwent digitally performed plain radiographs of the non-dominant hand and measurements of dual-energy X-ray absorptiometry (DXA) regarding total femur and lumbar spine. Using DXR the radiographs were analyzed retrospectively for bone mineral density (BMD) calculation. The severity was classified using Larsen score and Steinbroker stage blinded by two radiologists. A third radiologist reviewed the incongruently scored cases. Mean values of calculated parameters changed as follows from Larsen 1 to Larsen 5: Bone mineral density (DXR–BMD) decreased from 0.55 to 0.44 g/cm2 (p=0.000), DXR–MCI decreased from 0.44 to 0.33 (p=0.001), DXA–BMD (total femur) decreased from 0.92 to 0.78 g/cm2 (p=0.090) and DXA–BMD (lumbar spine) decreased from 0.91 to 0.84 g/cm2 (p=0.595). Similar results were verified for the Steinbroker stage. The relative decrease of BMD measured by DXR between the highest and lowest score was 20% for Steinbroker stage and Larsen score (p<0.05). The relative decrease of BMD using DXA revealed not such a significant result. Similar results were verified for metacarpal index (estimated by DXR). Correlations between BMD determined by DXR and by DXA were all significant (R=0.45 for lumbar spine and R=0.59 for total femur). Consequently, less than 35% of the DXR–BMD value is explainable by corresponding DXA values. The DXR-based BMD calculation seems to be able to distinguish severity and progress of the disease in contrast to those of DXA at lumbar spine and total femur.
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References
Miehle W (1999) Rheumatoide arthritis. Thieme, Stuttgart, pp 1–9
Larsen A, Thoen J (1987) Hand radiography of 200 patients with rheumatoid arthritis repeated after an interval of one year. Scand J Rheumatol 16:395–401
Cortet B, Flipo RM, Duquesnoy B, Delcambre B (1995) Bone tissue in rheumatoid arthritis. Bone mineral density and fracture risk. Rev Rhum Engl Ed 62:197–204
Rosholm A, Hylsdrup L, Baeksgaard L, Grunkin M, Thodberg HH (2001) Estimation of bone mineral density by digital X-ray radiogrammetry: theoretical background and clinical testing. Osteoporos Int 12:961–969
Baran DT, Faulkner KG, Genant HK, Miller PD, Pacifici R (1997) Diagnosis and management of osteoporosis: guidelines for the utilization of bone densitometry. Calcif Tissue Int 61:433–440
Wassenberg S (2000) Methoden zur messung röntgenologischer veränderungen. In: Rau R (ed) Basistherapie der rheumatoiden arthritis. Uni-Med Verlag, Bremen, pp 102–111
Barnett E, Nordin B (1960) The radiological diagnosis of osteoporosis: a new approach. Clin Radiol 11:166–174
Virtama P, Mahonen H (1960) Thickness of the cortical layer as an estimate of mineral content of human finger bones. Br J Radiol 6:60–62
Wishart JM, Horowitz M, Bochner M, Need AG, Nordin B (1993) Relationship between metacarpal morphometry, forearm and vertebral bone density and fractures in postmenopausal women. Br J Radiol 66:435–440
Mau W, Zink A (2000) Epidemiologie. In: Rau R (ed) Basistherapie der rheumatoiden arthritis. Uni-Med Verlag, Bremen, pp 24–29
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fies FJ, Cooper NS (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Derisquebourg T, Dubois P, Devogelaer JP et al. (1994) Automated computerized radiogrammetry of the second metacarpal and its correlation with absorptiometry of forearm and spine. Calcif Tissue Int 54:461–465
Maggio D, Pacifici R, Cherubini A et al. (1997) Age-related cortical bone loss at the metacarpal. Calcif Tissue Int 60:94–97
Martini F, Tröndle S, Sell S, Mayer F, Willms R, Teschner M (1999) Einfluss der arthrose, osteoporose und chronischen polyarthritis auf die präzision der osteodensitometrischen messungen an der lendenwirbelsäule und am ward’schen dreieck. Z Rheumatol 58:283–288
Cameron EC, Boyd RM, Luk D, McIntosh HW, Walker VR (1997) Cortical thickness measurements and photon absorptiometry for determination of bone quantity. CMAJ 116:145–147
Bell KL, Loveridge N, Power J et al. (1999) Structure of the total femur in hip fracture: cortical bone loss in the inferioanterior to superioposterior axis. JBMR 14:111–119
Lazenby RA (1997) Bias and agreement for radiogrammetric estimates of cortical bone geometry. Invest Radiol 32:12–18
Meema HE, Meindok H (1992) Advantages of peripheral radiogrammetry over dual-photon absorptiometry of the spine in the assessment of prevalence of osteoporotic vertebral fractures in women. JBMR 7:897–903
Bloom RA (1980) A comparative estimation of the combined cortical thickness of various bone sites. Skeletal Radiol 5:167–170
Black DM, Palermo L, Sorensen T et al. (2001) A normative reference database study for the Pronosco X-posure radiogrammetry system. J Clin Densitom 4:5–12
EXPO/DK-04 (2000) A clinical study to establish a normative reference database for the Pronosco X-posure system for Scandinavian caucasian women. Clinical Report, version 2
Wüster C, Wenzler M, Kappes J, Rehm C, Gühring T, Arnbjerg C (2000) Digital X-ray radiogrammetry as a clinical method for estimating bone mineral density: a German reference database. JBMR 15:298
Maffei L; Venarotti H, Treviso J, Sorensen TK, Nissen D (2000) Digital X-ray radiogrammetry: a Hispanic normative reference database for the Pronosco X-posure system. JBMR 15:304–305
Yan J, Li M, Zhonhou L (2000) Normal values of forearm bone BMD and incidence of primary osteoporosis in Chinese women. Chin J Osteoporosis 6:30–32
Thodberg HH, Jensen JK, Rosholm A (1999) BMD from digital X-ray radiogrammetry: sensitivity to details of the image capture. Presented at ASBMR 21st annual meeting, St. Louis, Missouri. JBMR 14:369
EXPO/TECH-016 (2000) Reproducibility study for X-posure V.2 conventional image capture: technical report, version 2
Mazess RB (1987) Bone density in diagnosis of osteoporosis: thresholds and breakpoints. Calcif Tissue Int 41:117–118
Boonen S, Cheng X, Nicholson PH, Verbeke G, Broos P, Dequeker J (1997) The accuracy of peripheral skeletal assessment at the radius in estimating femoral bone density as measured by dual-energy X-ray absorptiometry: a comparative study of single-photon absorptiometry and computed tomography. J Intern Med 242:323–328
Heilmann P, Wuster C, Prolingheuer C, Gotz M, Ziegler R (1998) Measurement of forearm bone mineral density: comparison of five different instruments. Calcif Tissue Int 62:383–387
Russo CR (1988) Correlation of radial SPA and pQCT with the femoral DEXA measurement in elderly women. J Intern Med 244:358–359
Trivitayaratana W, Trivitayaratana P (2001) Diagnostic agreement of combined radiogrammetric analysis with texture analysis in the evaluation of bone density: a comparison with dual energy X-ray absorptiometry. J Med Assoc Thai 84:599–604
Adami S, Zamberlan N, Gatti D et al. (1996) Computer radiographic absorption and morphometry in the assessment of postmenopausal bone loss. Osteoporos Int 6:8–13
Nordin B (1976) Calcium, phosphate and magnesium metabolism. In: Clinical physiology and diagnostic procedures. Churchill Livingston, Edinburgh London New York, pp 391–397, 512–516, 570–572
Jorgensen JT, Andersen PB, Rosholm A, Bjarnason NH (2000) Digital X-ray radiogrammetry: a new appendicular bone densitometric method with high precision. Clin Physiol 20:330–335
Baadegaard N, Linde R, Wendt O, Rosholm A (2001) Digital X-ray radiogrammetry on hand X-rays. Bone 28:176
Enokida M, Yamasaki D, Okano T, Hagino H, Morio Y, Teshima R (2001) Bone mass changes of tibia and vertebral bones in young and adult rats with collagen-induced arthritis. Bone 28:87–93
Dequeker J (1976) Quantitative radiology: radiogrammetry of cortical bone. Br J Radiol 49:912–920
Ozgocmen S, Karaoglan B, Kocako E (1999) Correlation of hand bone mineral density with the metacarpal cortical index and carpometacarpal ratio in patients with rheumatoid arthritis. Yonsei Med J 23:478–482
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Böttcher, J., Malich, A., Pfeil, A. et al. Potential clinical relevance of digital radiogrammetry for quantification of periarticular bone demineralization in patients suffering from rheumatoid arthritis depending on severity and compared with DXA. Eur Radiol 14, 631–637 (2004). https://doi.org/10.1007/s00330-003-2087-1
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DOI: https://doi.org/10.1007/s00330-003-2087-1