‫‪Bone Densitometry‬‬

‫الدكتور قصي المقبل‬

‫أستاذ مشارك‪ -‬قسم األشعة والطب النووي‬
‫كلية الطب‪-‬جامعة العلوم والتكنولوجيا األردنية‬
Bone Composition

• 45-70% inorganic
– Calcium, phosphorus,
magnesium
– crystalline form of apatite
Ca10(PO4)(OH2)
• 25-30% organic
– collagen
– cellular elements
• 5-25% water

SEM of the
Hydroxyapatite Crystal
 General Structure of Bone
• Cortex: Cortex
– outer portion, compact
bone covered by
periosteum
• Trabeculae: Periosteum
– inner portion of
spongy bone
containing the blood
forming elements Marrow
(myeloid) or fatty
marrow
• Periosteal membrane
 Bone Metabolic Response
• The combination of cortical bone together
with spongy trabecular bone provides both
structural strength and an extended
surface, on which rapid changes in bone
formation or resorption can respond to
fluctuating metabolic needs.
• The metabolic responses of the skeleton
mainly occur on trabecular bone surfaces.
 Aging and bone loss
• Bone loss might be seen in aged people
and postmenopausal women.
• Bone loss affects trabecular bone.
• Although the entire skeleton loses bone
mass with aging, the distribution of bone
loss is not uniform because of the different
proportions of trabecular and cortical bone
in the various parts of skeleton.
 Osteopenia and Osteoporosis
• Osteopenia refers to any condition
involving reduced bone mass.
• Osteoporosis, a form of osteopenia, is
decreased bone mass with normal bone
mineralization.
 Causes of Osteoporosis
• Primary (95%): occurs mainly in
postmenopausal women and the elderly
(above 50 years old men).
• Secondary (5%): to long-term steroids,
chronic renal failure, rheumatoid arthritis
and hyperparathyroidism.
Bone Density
 Fractures
• The most common osteoporotic-related
fractures are those involving:
1-Spine (thoracic and lumbar vertebral
bodies).
2-Femur (the neck and intertrochanteric
regions).
3-Wrist (distal radius).
 Risk Sites
• Femoral neck
• Vertebral bodies
• Distal radius
 Bone Mass and Bone Density
• Bone Mass indicates the amount of
mineralized tissue in bone.
• Bone Density indicates the mass of bone
defined either by length (g/cm), area
(g/cm2) or volume (g/cm3).
• Bone mass measurements are currently
considered to be the most valuable
objective indicator of fracture risk.
 High Risk Patients
• Bone mass is an important determinant of
fractures, and hence bone mass
measurements may help reduce the
number of fractures by identifying high risk
patients, who can then receive effective
prophylaxis.
 Measurement Technique

• Dual Energy X-ray (DEXA)

Dual Energy X-ray
 DEXA
• DEXA stands for dual-energy X-ray
absorptiometry.
• DEXA utilizes an x-ray tube as the
radiation source.
 Scanned Areas
• DEXA equipment allows scanning of the
spine and hip which are the most frequent
sites for fractures.
 WHO
• World Health Organization study group
has established a clinical definition for
osteoporosis based on a BMD (bone
mineral density) measurement of the
spine, hip or forearm expressed in
standard deviation (SD) units called T-
scores.
 T-score, cont..
• T-score indicates the difference between
the patient’s measured BMD and the ideal
peak bone mass achieved by a young
adult.
• WHO has the following definitions
according to T-score value.
 Osteoporosis
• In WHO report, if T-score is < -2.5 at the
spine, hip, or forearm; the patient is
classified as having osteoporosis.
• This patient has high risk for fracture.
 Osteopenia
• In WHO report, if T-score is between -2.5
and -1 at the spine, hip, or forearm; the
patient is classified as having osteopenia.
• This patient has intermediate risk for
fracture.
 Normal
• In WHO report, if T-score is > -1 the
patient is classified as normal.
• This patient has low risk for fracture.
 Z-scores
• Z-score indicates the difference between
the patient’s measured BMD and the ideal
peak bone mass achieved by aged-
matched peers.
• Z-score can not be used to diagnose
osteoporosis.
 Standard Deviation (T-score)

 (Xi - X)
s=
2

n-1
Standard
Deviation
Normal Distribution
400
350
300
250
200
150
100
50
0
 Normal Distribution
400
Mean
350
300
250
Number of
200
Observations
150
1 SD
100
50 2 SD

•Defined by an Average or mean and a Standard Deviation

 Conclusion
• Bone densitometry provide a measure of
fracture risk that is analogous to
assessment of blood pressure with regard
to the risk of stroke or to measurement of
cholesterol with regard to the risk of
developing ischemic heart disease.