Highlights
- •Women attending mammography screening had their bone mass evaluated with digital X-ray radiogrammetry (DXR).
- •Those with the lowest bone mineral density as determined by DXR were referred for standard DXA examination (n = 327).
- •Of these 327 women, 93 had osteoporosis.
- •The diagnosis was new in 79 cases (85%) and a potential underlying cause was identified in 32 cases (34%). Primary hyperparathyroidism was found in 9% and secondary hyperparathyroidism in 14%.
Abstract
Objectives
To identify causes of low age-adjusted bone mass at digital X-ray radiogrammetry (DXR)
in individuals attending an osteoporosis screening program.
Study design
In a descriptive observational cohort study, women aged 40–75 years who attended a
general mammography screening program had their bone mass investigated with DXR and
answered a questionnaire regarding several clinical risk factors for osteoporosis.
Each month the 2% with the lowest Z-scores were selected for further clinical examination
with DXA of the hip and lumbar spine and pre-defined blood tests.
Main outcome measure
Causes of secondary osteoporosis determined by clinical and laboratory evaluation.
Results
14,783 women attended mammography screening and had their bone mass evaluated. In
total, 327 women had a low DXR BMD and 281 accepted further DXA examination. Of these,
93 (33.1%) had osteoporosis. The diagnosis was new in 79 cases (84.9%) and in 32 (34.4%)
a potential underlying cause was identified. Primary hyperparathyroidism was found
in 8.6% and secondary hyperparathyroidism in 13.5%. Several self-reported risk factors
for osteoporosis, including rheumatic disease, insulin-treated diabetes, cortisone
treatment, smoking, reduced mobility, hyperparathyroidism, and malabsorption, were
significantly more common among those selected for DXA referral than in the total
cohort. For example, rheumatic disease and insulin-treated diabetes were reported
3.4 and 2.3 times as often, respectively.
Conclusion
The prevailing potential cause of secondary osteoporosis according to DXR was primary
and secondary hyperparathyroidism. Most of the women with these conditions were previously
undiagnosed, indicating that further follow-up of patients with low age-adjusted DXR
BMD is justified.
Abbreviations:
DXR (digital X-ray Radiogrammetry), DXA (dual-energy X-ray absorptiometry), BMD (bone mineral density)Keywords
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Article info
Publication history
Published online: April 13, 2017
Accepted:
April 3,
2017
Received:
January 24,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
