Effect of increasing vertebral marrow fat content on BMD measurement, T-Score status and fracture risk prediction by DXA
Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ( 1H-MRS) show that subjects with lower spine T-scores have significantly...
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| Published in | Bone (New York, N.Y.) Vol. 44; no. 3; pp. 495 - 501 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Amsterdam
Elsevier Inc
01.03.2009
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 8756-3282 1873-2763 1873-2763 |
| DOI | 10.1016/j.bone.2008.11.003 |
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| Abstract | Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy (
1H-MRS) show that subjects with lower spine
T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine
T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and
1H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine
T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected
T-scores, and the relationship between marrow fat and
T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per
T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1–L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm
2 (1.3
T-score units) in women and 0.16 g/cm
2 (1.3
T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing
T-score with a slope of −
1.2
±
0.7% per
T-score unit (
p
=
0.078) for women and −
1.4
±
0.6% per
T-score unit (
p
=
0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. |
|---|---|
| AbstractList | Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ( super(1)H-MRS) show that subjects with lower spine T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and super(1)H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T-scores, and the relationship between marrow fat and T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1-L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g /cm super(2) (1.3 T-score units) in women and 0.16 g/cm super(2) (1.3 T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T-score with a slope of -1.2+/-0.7% per T-score unit (p=0.078) for women and -1.4+/-0.6% per T-score unit (p=0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ( 1H-MRS) show that subjects with lower spine T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and 1H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T-scores, and the relationship between marrow fat and T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1–L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm 2 (1.3 T-score units) in women and 0.16 g/cm 2 (1.3 T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T-score with a slope of − 1.2 ± 0.7% per T-score unit ( p = 0.078) for women and − 1.4 ± 0.6% per T-score unit ( p = 0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. Abstract Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy (1 H-MRS) show that subjects with lower spine T -scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T -score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and1 H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T -scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T -scores, and the relationship between marrow fat and T -score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T -score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1–L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm2 (1.3 T -score units) in women and 0.16 g/cm2 (1.3 T -score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T -score with a slope of − 1.2 ± 0.7% per T -score unit ( p = 0.078) for women and − 1.4 ± 0.6% per T -score unit ( p = 0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ((1)H-MRS) show that subjects with lower spine T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and (1)H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T-scores, and the relationship between marrow fat and T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1-L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm(2) (1.3 T-score units) in women and 0.16 g/cm(2) (1.3 T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T-score with a slope of -1.2+/-0.7% per T-score unit (p=0.078) for women and -1.4+/-0.6% per T-score unit (p=0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ((1)H-MRS) show that subjects with lower spine T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and (1)H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T-scores, and the relationship between marrow fat and T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1-L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm(2) (1.3 T-score units) in women and 0.16 g/cm(2) (1.3 T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T-score with a slope of -1.2+/-0.7% per T-score unit (p=0.078) for women and -1.4+/-0.6% per T-score unit (p=0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk.Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of vertebral marrow fat using nuclear magnetic resonance spectroscopy ((1)H-MRS) show that subjects with lower spine T-scores have significantly higher marrow fat content. These findings suggest that the ability of DXA scans to determine fracture risk may be partly explained by the effect of increased marrow fat on BMD. However, a proper evaluation of the relationship between WHO spine T-score status and marrow fat content requires that the BMD data are first corrected for the bias caused by a selection effect in which subjects with higher marrow fat are more likely to be identified as having osteoporosis. In this study we have therefore reanalysed previously published data for 185 elderly Hong Kong Chinese subjects (103 women, mean age 73 y; 82 men, mean age 73 y) who had spine DXA scans and (1)H-MRS measurements of L3 marrow fat. The effect of varying marrow fat on BMD was modelled using vertebral body thicknesses measured in 50 men and women. Spine T-scores in each individual were adjusted for the measured marrow fat. Subjects were assigned to WHO categories based on their corrected T-scores, and the relationship between marrow fat and T-score status evaluated using regression analysis and analysis of variance. The average change in percent marrow fat per T-score unit was used to infer the fraction of the spine BMD fracture discrimination explained by marrow composition. The mean (SD) of the L1-L4 vertebral body thickness was 30.2 (2.1) mm for Hong Kong women and 33.4 (2.5) mm for men. A change in marrow fat content from 0 to 100% was estimated to produce a BMD decrease of 0.14 g/cm(2) (1.3 T-score units) in women and 0.16 g/cm(2) (1.3 T-score units) in men. Although adjusting spine BMD for marrow fat reduced the significance of the correlation, there was still a trend for marrow fat to increase with decreasing T-score with a slope of -1.2+/-0.7% per T-score unit (p=0.078) for women and -1.4+/-0.6% per T-score unit (p=0.023) for men. When the effect of marrow composition on fracture discrimination was evaluated the results showed that the higher vertebral marrow fat content found in osteoporotic subjects made a negligible contribution to the ability of spine BMD measurements to predict fracture risk. |
| Author | Griffith, J.F. Blake, G.M. Fogelman, I. Yeung, D.K.W. Leung, P.C. |
| Author_xml | – sequence: 1 givenname: G.M. surname: Blake fullname: Blake, G.M. email: glen.blake@kcl.ac.uk organization: Osteoporosis Scanning and Research Unit, King's College London School of Medicine, London, UK – sequence: 2 givenname: J.F. surname: Griffith fullname: Griffith, J.F. organization: Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China – sequence: 3 givenname: D.K.W. surname: Yeung fullname: Yeung, D.K.W. organization: Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China – sequence: 4 givenname: P.C. surname: Leung fullname: Leung, P.C. organization: Jockey Club Centre for Osteoporosis Care and Control, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China – sequence: 5 givenname: I. surname: Fogelman fullname: Fogelman, I. organization: Osteoporosis Scanning and Research Unit, King's College London School of Medicine, London, UK |
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| Keywords | Dual energy X-ray absorptiometry Osteoporosis Nuclear magnetic resonance spectroscopy Bone mineral density Fracture risk Marrow fat Evaluation scale Diseases of the osteoarticular system Vertebra Fracture NMR spectrometry Trauma X ray absorption spectrometry Morphology Dual energy absorptiometry Risk factor Fat Predictive factor |
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| Snippet | Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue. Studies of... Abstract Quantitative examination of iliac crest bone biopsies shows that as subjects become older bone and functional marrow are replaced by adipose tissue.... |
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| SubjectTerms | Absorptiometry, Photon Aged Biological and medical sciences Bone Density Bone Marrow - anatomy & histology Bone mineral density Dual energy X-ray absorptiometry Female Fracture risk Fundamental and applied biological sciences. Psychology Humans Injuries of the limb. Injuries of the spine Investigative techniques, diagnostic techniques (general aspects) Lumbar Vertebrae - anatomy & histology Lumbar Vertebrae - pathology Male Marrow fat Medical sciences Nuclear magnetic resonance spectroscopy Orthopedics Osteoarticular system. Muscles Osteoporosis Radiodiagnosis. Nmr imagery. Nmr spectrometry Risk Factors Spinal Fractures Traumas. Diseases due to physical agents Vertebrates: anatomy and physiology, studies on body, several organs or systems |
| Title | Effect of increasing vertebral marrow fat content on BMD measurement, T-Score status and fracture risk prediction by DXA |
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