The Effect of Factors Affecting Bone Mineral Density Measurement Results on Osteoporosis Diagnosis and Treatment Decision

Overview

This is a single-center prospective cross-sectional study with a follow-up period of 6 months. All patients met the inclusion criteria and requested DXA at the outpatient clinics of Ankara Etlik City Hospital Physical Therapy and Rehabilitation Hospital. Sample size was performed using the statistical power analysis program for G\*Power 3.1.9.6 Mac. Based on the study by Tuna et al. aiming to evaluate the rate of poor positioning of patients during DXA and the accuracy of the analysis, the minimum required number of patients (with a 95% working power and 95% confidence interval with a 5% Type 1 and 20% Type 2 margin of error and a 95% working power and 95% confidence interval) was found to be 530. It was decided to include at least 530 patients in the study.

Osteoporosis is a progressive disease characterized by low bone mass and deterioration of bone microarchitecture. With aging, a decrease in bone strength and an increased risk of fractures occur. Osteoporosis is considered a silent disease, as it usually presents no symptoms until the first fracture occurs. The World Health Organization defines osteoporosis using a T-score derived from dual-energy X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the hip and spine. The T-score represents a standard deviation that indicates how much a result differs from the average or mean bone mineral density. DXA measurements of hip and spinal BMD are crucial clinical tools for assessing and screening individuals at risk for osteoporosis. Dual-energy X-ray absorptiometry is the most appropriate and accessible method used to diagnose osteoporosis, assess the risk of fractures in patients, and ensure effective follow-up. However, numerous studies have pointed out the limitations of this imaging method, demonstrating that factors such as osteoarthritis, surgical implants, scoliosis, and lumbar vertebral positioning can lead to misleading results. Furthermore, previous research has reported that one of the most significant sources of error is improper patient positioning during the scan. Although DXA provides high accuracy in measuring bone mineral density, its sensitivity depends on operators, equipment, and various patient-related factors. There are numerous devices in use for DXA scanning in our country. However, the training of radiology technicians performing these scans has not yet been standardized. Some studies have reported that the rate of erroneous DXA scans is considerably high. Therefore, information regarding the impact of these erroneous scans on the diagnosis and treatment of osteoporosis remains limited. The aim of this study is to identify errors in DXA scans performed in our center and to determine how these errors affect the diagnosis and treatment decisions for osteoporosis. Estimated study duration: 6 months