Doppelphotonen-Absorptiometrie: Eine neue Methode zur Bestimmung des Knochenmineralgehaltes. I. Grundlagen

Abstract

Today dual-photon absorptiometry (DPA) is recommended as the best procedure for diagnosing osteoporosis at an early stage considering its low cost, low radiation exposure and reasonable reliability. Cortical (neck of femur) and trabecular (L 2-4) bone mass has been determined repeatedly with DPA using 153Gd (NOVO Lab 22 a) in 545 females and 112 males with no evidence of bone diseases. Measured “normal” (age-and sex-related average) values for bone mineral content (BMC) differed significantly (p <0.01) from those of US inhabitants determined by the same equipment, i. e., they were on average about 30% lower, but matched well with corresponding results from Belgium. BMC-area was found the most suitable parameter both for cross-sectional and longitudinal studies, since it is independent of height and weight. But there is still need to reduce the overlap and improve accuracy and reproducibility for making decisions after shorter intervals. - Assessment of the individual mineral loss and fracture risk by comparison with average values remains problematical due to the wide range of “normal” BMC values, and in women additionally due to the variable onset of menopause. For estimations of the individual fracture risk of elderly patients BMC should not be normalized on age, because at the age of 65 half of the women had “pathologic” values, i.e. were below the so-called “osteoporosis threshold”. Comparison of the individually measured postmenopausal BMC with average values of premenopausal women and with BMC values normalized to their menopausal age may be helpful approaches to overcoming these difficulties. Because of the lack of earlier individual data in most cases repeated BMC measurements are still required for assessment of demineralization speed.