Analysis on the characteristics of lumbar vertebrae and hip bone mineral density in patients with degenerative lumbar scoliosis_West China Medical Journal

Authors：

HU Xingxin ^1,2,3 , SONG Yueming ¹ ,  LIU Limin ¹ , LING Tingxian ¹ , ZHOU Bangjian ¹ , QIANG Zhe ¹ , ZHOU Chunguang ¹

1. Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Spine Surgery, Taihe Hospital of Shiyan City, Shiyan, Hubei 442000, P. R. China;
3. Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China;

Corresponding author：

LIU Limin, Email: liu_spine@163.com

Keywords：

Degenerative lumbar scoliosis; Dual energy X-ray absorptiometry; Bone mineral density; Osteoporosis

DOI：

10.7507/1002-0179.201507051

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Objective To summarize and analyze the characteristics of L₁-L₄ vertebrae and hip bone mineral density (BMD) in patients with degenerative lumbar scoliosis under dual energy X-ray absorptiometry (DEXA). Methods We collected all the preoperative total spine frontal and lateral X-ray images and DEXA examination results of patients with degenerative lumbar scoliosis who were hospitalized in the Department of Orthopedic Surgery in West China Hospital between August 2013 and August 2014. SPSS 21.0 was used to analyze patients’ age, height and body weight; BMD of each vertebra of L₁-L₄ vertebrae and L₁-L₄ vertebrae as a whole, and the T score; BMD of left femoral neck, Ward triangle, greater trochanter, and femoral shaft, and the general BMD of femoral neck, and the T score. Results Thirty-eight patients with an average age of (67.4±8.2) years were enrolled in this study. DEXA examination results showed that 23.7% (9/38) and 28.9% (11/38) of the patients were osteoporotic in the spine and the hip, respectively; the examination results of total lumbar vertebrae and total femoral neck bones were concordant in 60.5% (23/38) of the patients. For lumbar vertebrae, the BMD from high to low was listed as: L₄ vertebra, L₃ vertebra, total L₁-L₄ vertebrae, L₂ vertebra, and L₁ vertebra. The BMD of L₄ vertebra was significantly higher than that of L₁ vertebra, and the BMD of lumbar vertebrae from L₁ to L₄ in turn presented a step-like increasing trend. For hip bones, the BMD from high to low was listed as: femoral shaft, total femoral neck area, femoral neck, greater trochanter, and Ward triangle. The BMD of the femoral shaft was significantly higher than that of Ward triangle. In the whole DEXA examination, the BMD of total L₁-L₄ lumbar vertebrae and its T score were higher than the BMD of left femoral neck area and its T score, respectively. Conclusions Degenerative changes of the lumbar spine may lead to misinterpretation of BMD measurements and cause underdiagnosis of osteoporosis with DEXA. Routine reporting of spine BMD at L₁ can add valuable information for reassessment and monitoring. The BMD of hip is less affected by osteoarthritis, osteophytes than the lumbar spine, and thus, it will be more meaningful in diagnosing and monitoring of the disease.

Citation： HUXingxin, SONGYueming, LIULimin, LINGTingxian, ZHOUBangjian, QIANGZhe, ZHOUChunguang. Analysis on the characteristics of lumbar vertebrae and hip bone mineral density in patients with degenerative lumbar scoliosis. West China Medical Journal, 2017, 32(2): 190-195. doi: 10.7507/1002-0179.201507051 Copy

1.	Ellwitz J, Gupta M. Adult degenerative scoliosis[M]//Patel VV, Patel A, Harrop JS, et al. Spine surgery basics. Berlin, Heidelberg: Springer, 2014: 247-258.
2.	Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus, 2010, 28(3): E1.
3.	Xu L, Sun X, Huang S, et al. Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J, 2013, 22(6): 1326-1331.
4.	Tenne M, Mcguigan F, Besjakov J, et al. Degenerative changes at the lumbar spine: implications for bone mineral density measurement in elderly women. Osteoporos Int, 2013, 24(4): 1419-1428.
5.	Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis. Spine (Phila Pa 1976), 2006, 31(14): 1614-1620.
6.	Yagi M, King B, Boachie-Adjei O. Characterization of osteopenia/osteoporosis in adult scoliosis: does bone density affect surgical outcome?. Spine (Phila Pa 1976), 2011, 36(20): 1652-1657.
7.	Rumancik S, Routh H, Pathak D, et al. Assessment of bone quantity and distribution in adult lumbar scoliosis: new dual-energy X-ray absorptiometry methodology and analysis. Spine (Phila Pa 1976), 2005, 30(4): 434-439.
8.	Kanis A, Glüer C. An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int, 2000, 11(3): 192-202.
9.	Bandirali M, Messina C, Di Leo G, et al. Bone mineral density differences between femurs of scoliotic patients undergoing dual-energy X-ray absorptiometry. Clin Radiol, 2013, 68(9): e511-e515.
10.	翟睿, 汪学松, 金传峰, 等. 退变性脊柱侧弯与骨质疏松症相关性分析. 中国骨质疏松杂志, 2014, 20(3): 256-259.
11.	Cheng C, Tang P, Guo X, et al. Osteopenia in adolescent idiopathic scoliosis: a histomorphometric study. Spine (Phila Pa 1976), 2001, 26(3): E19-E23.
12.	Cheng C, Sher L, Guo X, et al. The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study. Hong Kong Med J, 2001, 7(3): 241-245.
13.	臧渊, 雷伟, 吴子祥. 脊柱退行性疾病对腰椎前后位骨密度的影响分析. 中国骨质疏松杂志, 2012, 18(2): 179-182.
14.	Downey PA, Siegel MI. Bone biology and the clinical implications for osteoporosis. Phys Ther, 2006, 86(1): 77-91.
15.	朱晓颖, 朱汉民, 张雪梅. 关于 Wards 三角区的探讨. 中国骨质疏松杂志, 2005, 1(4): 460-463.
16.	Lewiecki M, Gordon M, Baim S, et al. International society for clinical densitometry 2007 adult and pediatric official positions. Bone, 2008, 43(6): 1115-1121.

1. Ellwitz J, Gupta M. Adult degenerative scoliosis[M]//Patel VV, Patel A, Harrop JS, et al. Spine surgery basics. Berlin, Heidelberg: Springer, 2014: 247-258.
2. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus, 2010, 28(3): E1.
3. Xu L, Sun X, Huang S, et al. Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J, 2013, 22(6): 1326-1331.
4. Tenne M, Mcguigan F, Besjakov J, et al. Degenerative changes at the lumbar spine: implications for bone mineral density measurement in elderly women. Osteoporos Int, 2013, 24(4): 1419-1428.
5. Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis. Spine (Phila Pa 1976), 2006, 31(14): 1614-1620.
6. Yagi M, King B, Boachie-Adjei O. Characterization of osteopenia/osteoporosis in adult scoliosis: does bone density affect surgical outcome?. Spine (Phila Pa 1976), 2011, 36(20): 1652-1657.
7. Rumancik S, Routh H, Pathak D, et al. Assessment of bone quantity and distribution in adult lumbar scoliosis: new dual-energy X-ray absorptiometry methodology and analysis. Spine (Phila Pa 1976), 2005, 30(4): 434-439.
8. Kanis A, Glüer C. An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int, 2000, 11(3): 192-202.
9. Bandirali M, Messina C, Di Leo G, et al. Bone mineral density differences between femurs of scoliotic patients undergoing dual-energy X-ray absorptiometry. Clin Radiol, 2013, 68(9): e511-e515.
10. 翟睿, 汪学松, 金传峰, 等. 退变性脊柱侧弯与骨质疏松症相关性分析. 中国骨质疏松杂志, 2014, 20(3): 256-259.
11. Cheng C, Tang P, Guo X, et al. Osteopenia in adolescent idiopathic scoliosis: a histomorphometric study. Spine (Phila Pa 1976), 2001, 26(3): E19-E23.
12. Cheng C, Sher L, Guo X, et al. The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study. Hong Kong Med J, 2001, 7(3): 241-245.
13. 臧渊, 雷伟, 吴子祥. 脊柱退行性疾病对腰椎前后位骨密度的影响分析. 中国骨质疏松杂志, 2012, 18(2): 179-182.
14. Downey PA, Siegel MI. Bone biology and the clinical implications for osteoporosis. Phys Ther, 2006, 86(1): 77-91.
15. 朱晓颖, 朱汉民, 张雪梅. 关于 Wards 三角区的探讨. 中国骨质疏松杂志, 2005, 1(4): 460-463.
16. Lewiecki M, Gordon M, Baim S, et al. International society for clinical densitometry 2007 adult and pediatric official positions. Bone, 2008, 43(6): 1115-1121.

West China Medical Journal

Analysis on the characteristics of lumbar vertebrae and hip bone mineral density in patients with degenerative lumbar scoliosis

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