Precision of dual energy x-ray absorptiometry in the upper extremities

Dual energy x-ray absorptiometry (DEXA) has been shown to be a precise method for measuring bone mineral density (BMD) and content (BMC) in lumbar spine and proximal femur, but it has not been widely used in other skeletal sites. The in vivo day-to-day precision of DEXA (Norland XR-26) for seven anatomic sites in the upper extremities was evaluated by twice measuring both the right and left sides in ten subjects. For consistently defined regions-of-interest, the following precision values (coefficient of variation) were obtained for BMD and BMC: 0.8% and 1.0% (proximal humerus); 0.5% and 0.5% (humeral shaft); 0.7% and 0.5% (radial shaft); 1.3% and 1.1% (ulnar shaft); 0.7% and 1.0% (distal radius); 0.7% and 1.2% (distal ulna); 0.4% and 0.6% (hand). The initially observed relative side-to-side differences did not change significantly in the repeated measurements. Our results indicate that DEXA is a precise method for assessment of BMD and BMC also in the upper extremities.     

Prediction of percent body fat in adult males using dual energy x-ray absorptiometry, skinfolds, and hydrostatic weighing

The purpose of this study was to compare the prediction of percent body fat (%FAT) by dual energy x-ray absorptiometry (DXA), skinfolds (SF), and hydrostatic weighing (HW) in adult males. Subjects were 35 adult male Caucasians (mean +/- SD; age: 39.1 +/- 14.0 yr, height: 180.6 +/- 5.3 cm, weight: 81.0 +/- 11.1 kg). %FAT, determined by HW with residual volume determined via O2 dilution, served as the criterion. DXA %FAT was determined by the Norland XR-26 (XR-26) bone densitometer and by the SF equations of Jackson and Pollock (JP) (1978), and Lohman (LOH) (1981). Criterion referenced validation included analyzing mean (+/- SD) %FAT values using a one-way ANOVA for significance, comparison of mean differences (MD), correlations (r), standard error of estimates (SEE), and total errors (TE). Significant differences were found between means of each method. The r (0.91) and SEE (3.0 %FAT) for DXA compare favorably with the established SF methods of JP and LOH for predicting %FAT; however, DXA demonstrated the largest MD (3.9 %FAT) and TE (5.2 %FAT). Regression analysis yields HW = 0.79* DXA + 0.56. The results do not support earlier research that found no significant difference between HW and DXA %FAT in males. The study suggests the density of the fat-free body (DFFB) is not constant, and that the variation in bone mineral content affects the DFFB, which contributes to the differences between DXA and HW %FAT. We recommend further research to identify inconsistencies between manufacturers of DXA equipment in prediction of %FAT in males.     

Total body studies in normal British women using dual energy X-ray absorptiometry

We report dual energy X-ray absorptiometry (DXA) studies of total body bone mineral and body composition performed in 111 normal caucasian women (aged 42-61). Conventional DXA scans of the lumbar spine and femoral neck were also obtained and each woman completed a detailed questionnaire. Significant correlations were found between total body BMD and BMD in the lumbar spine (r = 0.76) and femoral neck (r = 0.72). We present reference range data for BMD in the total body and in seven subregions of the skeleton. Multiple linear regressions of total body BMD and BMC on weight, height and age showed that the inclusion of height compared with weight and age alone was not statistically significant. The dependence of total body BMD on weight and age was: total body BMD (g cm-2) = 1.043 + 0.0042 x weight (kg) - 0.0039 x age (years) (R = 0.46, SEE = 0.074 g cm2). Body mass derived from DXA scans correlated well with weight measured on scales (r = 0.996, SEE = 0.77 kg). Body composition measurements agreed closely with % body fat estimated from skinfold measurements (r = 0.93), body fat mass estimated from a predictive equation based on weight, height and age (r = 0.91) and % body fat estimated from a predictive equation based on body mass index (r = 0.76). Study precision gave coefficients of variation of 0.6% for total body BMD and 0.7% for % body fat.     

Evaluation of peripheral dual energy X-ray absorptiometry: comparison with single photon absorptiometry of the forearm and dual energy X-ray absorptiometry of the spine or femur

An evaluation of the Osteoscan peripheral dual energy X-ray absorptiometer (pDXA) was carried out to compare its performance with those of a single photon absorptiometer (SPA) (Molsgaard Medical ND1100A) and a dual energy X-ray absorptiometer (DXA) (Lunar DPX alpha) of the spine or femur. In 57 patients, correlation between bone mineral content (BMC) of the forearm at the ultradistal (UD) site by pDXA and by SPA was high (r = 0.94). Comparisons were also made with spine and femur bone mineral density (BMD) DXA measurements. The correlation of z-scores of UD BMD with z-scores for lumbar spine L2-L4 was r = 0.63 (n = 73 patients); and with z-scores for neck of femur was r = 0.72 (n = 33). With the Osteoscan the measurement error coefficient of variation in vivo was 2.6% for BMC, 1.8% for BMD at the ultradistal site; 2.1% for BMC and 1.9% for BMD at the mid-distal site. Repeat measurements were made of the European forearm phantom; precision for SPA was slightly better than either pDXA or Lunar DXA. The Osteoscan has the potential for a rapid throughput of patients and is not affected by calcification and degenerative changes that can corrupt DXA measurements on the anteroposterior spine in older women.     

A Monte Carlo model for bone mineral measurement using dual energy X-ray absorptiometry

We discuss the surgical approach used for and outcome in 11 infants (< or =3 years) who were treated at our institution for ependymomas arising in the cerebellar-pontine (C-P) angle. The median age of the group was 19 months (range: 6-26 months). Of these 11 patients, the initial surgery for 8 was performed at our center and achieved a gross total resection (GTR) in 4 patients and a subtotal resection (STR) in the remaining 4. The 3 patients who had tumor debulking performed elsewhere were subsequently referred to our institution and had definitive surgery after receiving 3-4 courses of chemotherapy; one of these children had a GTR, whereas the remaining 2 had an STR. During the immediate postoperative period, 9 patients had cranial nerve deficits that necessitated placement of a tracheostomy and a gastrostomy feeding tube; these were discontinued in 6 of the 9 patients as the deficits resolved. The majority of the permanent cranial nerve deficits involved the sixth and seventh cranial nerves. Of the 11 patients, 4 have died (progressive disease, n = 1; accidental death, n = 2; withdrawal of life support, n = 1); the remaining 7 patients are alive, with a median follow-up of 37 months (range: 20-73 months). Aggressive surgical resection for tumors arising in the C-P region is associated with postoperative deficits, which resolve over time with appropriate supportive care. This approach may increase the number of children in whom GTR is achieved, thereby potentially increasing the cure rate for these patients.     

Measurement of bone mineral density using dual energy X-ray absorptiometry in asthmatic patients receiving prednisolone therapy

Bone mineral density (BMD) of the lumbar spine (L2-L4) was measured using dual-energy X-ray absorptiometry (DEXA), and its relationship to total dose of prednisolone and duration of prednisolone therapy was studied in 57 patients with bronchial asthma. There was a significant negative correlation between BMD and total dose of prednisolone (r = -0.463, p < 0.001) and between BMD and duration of prednisolone treatment (r = -0.30, p < 0.05). The half-yearly percent decrease of BMD measured in 17 asthmatic patients was 0.83% (p < 0.01) after correction for age-associated decline. These findings suggest that the reduction of BMD was related to the total dose of prednisolone and the duration of therapy in asthmatics.     

Effect of treadmill exercise on tibial cortical bone in aged female rats: a histomorphometry and dual energy x-ray absorptiometry study

We report the results of 41 consecutive renal transplantations performed on 39 children (median age 2.7 years). Twenty-six recipients were less than 5 years old. Twenty-one recipients (13 under the age of 5 years) received cadaver (CAD) grafts. All grafts except 2 were from adult donors and were placed extraperitoneally. Patients were on triple immunosuppression (cyclosporine plus azathioprine plus methylprednisolone). Mean follow-up time was 2.3 years. No vascular and only one ureteral complication was seen. Acute tubular necrosis occurred in 3 patients (7.3%). No grafts were lost due to acute rejection. Three-year patient survival and 1-year graft survival were 100%. The overall 3-year actuarial graft survival was 86%. Three-year survival of grafts from living-related donors (LRD) was 92% and that of CAD grafts 75%. In recipients younger than 5 years, 3-year LRD graft survival was '89% and CAD graft survival 73%. No significant differences in graft survival between recipients of different age groups or between LRD and CAD grafts were found. We conclude that results of renal transplantation in children under 5 years of age are comparable to those of older children, even using CAD grafts, when adult donors and triple immunosuppression are used.     

Comparison of ultrasound and dual energy X-ray absorptiometry measurements in the calcaneus

Ultrasound measurements have been proposed as a means of providing structural information on bone but have also been shown to correlate with density. High correlation coefficients have been obtained in vitro, but are lower for in vivo work. The aim of this study was to investigate the relationship of broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness, to bone mineral density (BMD) measured in the calcaneus at a closely matched region of interest (ROI). Measurements were made in 55 post-menopausal and 20 young, normal women. Calcaneus BMD measurements were made using an ROI (fixed by reference to external axes) to represent the area and location of the ultrasound transducers and an ROI based on anatomical markers, positioned in the posterior part of the calcaneus. BUA was significantly correlated with calcaneus BMD in the fixed ROI (r = 0.77, p < 0.0001) and the anatomical ROI (r = 0.78, p < 0.0001). Correlation of BUA with axial BMD was lower at r = 0.63, p < 0.0001 for the spine (L2-L4) and r = 0.59, p < 0.0001 for the femoral neck. Results for SOS and stiffness were very similar. From the calcaneus dual energy X-ray absorptiometry (DXA) scan images the region representing the ultrasound measurement area was found to contain cortical bone edges in 60% of cases. In 16% of scans a small part (4.5 +/- 4.0%) of the ROI measurement area fell partially outside the heel. However, there was no obvious discrepancy in the ultrasound results in the individual cases where this occurred. The correlation between calcaneus BMD and BUA was improved from r = 0.72 to r = 0.86 when scans with a cortical edge in the measurement ROI were excluded. The values for SOS were similar. In summary, BMD of the calcaneus, when closely matched to the site of ultrasound measurement shows significant correlation with ultrasound measurements. By excluding scans in which the ultrasound measurement appeared to include bone edges, correlations of approximately r = 0.86 were obtained. However, the BMD result still does not explain all of the variance in the ultrasound results.     

Anatomic considerations of anterior transarticular screw fixation for atlantoaxial instability

STUDY DESIGN: Anatomic parameters of C1 and C2 were measured in 30 dried human cervical spines. Anterior transarticular C1-C2 screws were placed in 15 cadaveric spines. OBJECTIVE: To provide anatomic data for anterior transarticular atlantoaxial screw or C1-C2 screw and plate fixation. SUMMARY OF BACKGROUND DATA: A posterior approach to fixation in the atlantoaxial joint has been well described. Damage to the vertebral artery is documented as a rare complication of posterior atlantoaxial transarticular screw fixation. An anterior surgical approach to exposing the upper cervical spine for internal fixation and bone graft recently has been developed. No anatomic information regarding the anterior transarticular atlantoaxial screw or screw and plate fixation between C1 and C2 is available in the literature. METHODS: Direct measurements using digital calipers and a goniometer were taken from 30 pairs of dried human C1 and C2 vertebrae. The anterior transarticular C1-C2 screw insertion point is at the junction of the lateral edge of the C2 vertebral body to 4 mm above the inferior edge of the C2 anterior arch. The parameters related to anterior transarticular atlantoaxial screw fixation or screw and plate fixation between the C1 lateral mass and the C2 vertebral body were measured. Fifteen embalmed cadavers were used for anterior C1-C2 transarticular screw placement. Longer screws (30-40 mm) were used to detect whether the screw tips violated the upper cervical canal or vertebral arteries. RESULTS: In the anterior transarticular atlantoaxial screw placement, lateral angulation of the screw placement relative to sagittal plane ranged from 4.8 +/- 1.8 degrees to 25.3 +/- 2.6 degrees. The posterior angulation of the screw placement relative to the coronal plane ranged from 12.8 +/- 3.1 degrees to 22.6 +/- 3.2 degrees. The length of the medial screw path ranged from 14.7 +/- 1.5 mm to 25.4 +/- 2.8 mm. In the anterior screw and plate fixation, the anteroposterior diameter of the inferior facet articular surface ranged from 16.2 +/- 1.6 mm to 17.1 +/- 1.8 mm. The anteroposterior diameter of the C2 vertebral body ranged from 9.3 +/- 1 mm to 16.2 +/- 1.8 mm. The anterior prevascular retropharyngeal approach appropriately exposed the atlantoaxial joint for anterior transarticular C1-C2 screw placement. No screws violated the vertebral artery and cervical canal. CONCLUSIONS: An anterior transarticular atlantoaxial screw 15-25 mm long can be inserted with a lateral angulation of 5-25 degrees relative to the sagittal plane and a posterior angulation of 10-25 degrees relative to the coronal plane. Additionally, in C1-C2 anterior plate fixation screws 15 mm long could be anchored in the inferior facet of the C1, and screws 9-15 mm long could be anchored in the C2 vertebral body.     

All-inside anterior cruciate ligament reconstruction using semitendinosus tendon and soft threaded biodegradable interference screw fixation

A modification of anterior cruciate ligament (ACL) reconstruction using a minimally invasive and endoscopic all-inside technique is presented. Both the femoral and tibial socket are approached through the joint so that there is no open tibial tunnel, which otherwise often causes significant pain and discomfort during early rehabilitation. The autologous semitendinosus tendon is harvested with a bone plug attached to its tibial insertion. The triple-stranded semitendinosus tendon is looped around the adjacent bone plug and fixed at the original tibial attachment site of the ACL using a soft threaded biodegradable poly-(D,L-lactide) interference screw. The screw is inserted endoscopically in an inside-out direction. In the femoral socket the graft is fixed without a bone plug directly to the tunnel wall using the biodegradable screw. The free part of the graft is thus not longer than the intra-articular distance, which may increase stiffness of the construct.     

Body composition analysis by dual energy X-ray absorptiometry in female diabetics differ between manufacturers

OBJECTIVE: Comparison of body composition results by two dual energy X-ray absorptiometry (DXA) instruments, namely QDR-2000 from Hologic Inc and from Lunar in subpopulations of lean and obese subjects. DESIGN: Cross-sectional study with 85 female diabetics (BMI 18-43 kg/m2) measured with both DXA instruments. RESULTS: The regression lines for fat tissue mass (FTM), FAT% and total body bone mineral content (TBMC), but not lean tissue mass (LTM), were different from the line of identity (P < 0.01). However, the relationships were high (r2 > 0.95), and the corresponding SEE%'s were low (0.8-4.8%), and were independent of BMI. FTM and FAT% measured by the QDR-2000 were 10% higher, and LTM and TBMC 6% lower, than by DPX (P < 0.001). CONCLUSIONS: There were lack of agreements between total body composition results by DPX Lunar, and QDR-2000 Hologic Inc. Individual results on the two systems cannot be directly compared. Standardization of body composition measurements by DXA is strongly needed.     

Reference values of body composition obtained by dual energy X-ray absorptiometry in preterm and term neonates

We have recently reported the cDNA cloning of rat spermatidal protein TP2 and its expression in Escherichia coli using pTrc 99A as the expression vector. However, the expression level was very low. We have now improved the expression of TP2 over fivefold by (1) optimizing the codons for lysine, arginine, proline, leucine, glycine, valine, threonine, alanine, and tyrosine and (2) by engineering the vector-encoded 5' UTR. The expressed protein was in the soluble phase and could be purified to homogeneity by successive chromatography on Zinc-NTA-agarose affinity matrix and heparin agarose. Serendipitously, we have also observed a concomitant hyperinduction of vector encoded beta-lactamase gene along with TP2 in the E. coli BL21 (DE3) cells.     

One-stage internal fixation and anterior fusion in complex cervical spinal disorders

The authors describe their experience with the Morscher titanium cervical plate with cancellous locking screws in the management of complex cervical spine disorders. Fifty patients (32 males and 18 females) with a mean age of 54 years (range 10 to 84 years) underwent anterior spinal fixation that extended two to five vertebral bodies, using a titanium cervical plate and autogenous bone graft. Surgeries were performed for a variety of reasons: one for a congenital lesion, five for spinal neoplasms, nine for trauma, and 35 for degenerative arthritides. Ten patients had symptomatic kyphoses due to previous laminectomy, failed anterior surgery, or trauma. Satisfactory fixation and fusion with no neurological deterioration was obtained in all but two cases. Specific complications included six cases of dysphagia, one of sepsis, one of Horner's syndrome, and one case in which the patient had a fatal myocardial infarction the night after surgery. At the end of the follow-up period, fusion was found to have occurred in all remaining cases with no outstanding implant-related problems.     

Changes in body fat: measurements by neutron activation, densitometry and dual energy X-ray absorptiometry

The measurement of body fat in ten subjects (BMI from 22 to 43 kg/m2), and in particular the changes arising from a ketogenic diet, by the techniques of in vivo neutron activation analysis (NAA), densitometry (using two- and four-compartment models) by under water weighing (UWW) and dual energy X-ray absorptiometry (DXA) was compared. The association between techniques for the fat changes was generally high (r = 0.70 to 0.98) and significant (p < 0.05). Assessment of agreement between DXA and the other techniques revealed discrepancies with significant slope and high association (r = -0.81 and -0.64). Whilst NAA and UWW appeared to measure similar changes, DXA underestimated small changes.     

Dual energy x-ray absorptiometry of implanted femora after cemented and press-fit total hip arthroplasty in a canine model

Thiols, dialkylsulfides, and dialkyldisulfides are known to be chemisorbed with high affinity on gold. We have prepared DNAs of specific length and sequence carrying thiol groups at each end. For this purpose, primers with an HS-(CH2)6-arm at the 5'-end were used to amplify segments of plasmid DNA via the polymerase chain reaction. These thiolated DNAs bind strongly to the large, ultraflat Au surfaces which we have recently described [Hegner, M. et al. (1993) Surface Sci. 291, 39-46], and can be imaged by AFM in liquids (aqueous solutions or propanol). The lengths obtained in the AFM images are consistent with the DNA being in a native B-conformation.     

The relation between osteoporosis of the spine and osteoarthritis of the knee. A study using dual energy X-ray absorptiometry and radiographs

We investigated the relation between osteoporosis of the spine and osteoarthritis of the knee using dual energy X-ray absorptiometry of the lumbar spine to measure bone mineral density and radiographs of the knee in 82 randomly selected females (mean age 77.5 years). Radiographs of the knee were divided into a normal and severe group. The bone mineral density of the severe group was significantly more than that of the normal group.     

Bone lesion in multiple myeloma--bone mineral density measured by dual energy X-ray absorptiometry in multiple myeloma]

The paper discusses some of the factors that affect the onset of osteoporosis, and provides an original model for rehabilitation procedure in this disorder. The type of motor exercises used are indicated, and the sequence in which they are done. There is also a discussion of the significance of the application of physiotherapy equipment. Attention is also drawn in the paper to the possibility of the patient applying rehabilitation procedures independently, under only periodic supervision by the physician.