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Dual-energy x-ray absorptiometry scanner mismatch in follow-up bone mineral density testing

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Abstract

Summary

Scanner mismatch occurs frequently with follow-up dual-energy x-ray absorptiometry (DXA) scans. Nearly one-in-five follow-up DXA scans were conducted on non-cross-calibrated scanners (scanner mismatch) and more than a quarter of patients who had a follow-up DXA scan had experienced scanner mismatch.

Introduction

Detecting significant changes in bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) scanners relies on the least significant change (LSC). Results from two different DXA scanners can only be compared, albeit with decreased sensitivity for change, if the LSC between the two scanners has been directly determined through cross-calibration. Performing follow-up DXA scans on non-cross-calibrated scanners (scanner mismatch) has safety and economic implications. This study aims to determine the proportion of scanner mismatch occurring at a population level.

Methods

All patients who completed at least two DXA scans between 1 April 2009 and 31 December 2018 in the province of Alberta, Canada, were identified using population-based health services databases. Scanner mismatch was defined as a follow-up DXA scan completed on a DXA scanner that differed from and was not cross-calibrated to the previous DXA scanner. Multivariate logistic regression models were used to assess predictive factors that may contribute to scanner mismatch.

Results

A total of 264,866 patients with 470,641 follow-up DXA scans were identified. Scanner mismatch occurred in 18.9% of follow-up DXA scans; 28.7% of patients experienced at least one scanner mismatch. Longer duration between scans (OR 1.25, 95% CI 1.24–1.26) and major osteoporotic fracture history before index scan (OR 1.06, 95% CI 1.03–1.08) increased risk of scanner mismatch. Osteoporosis medication use before index scan (OR 0.89; 95% CI 0.88–0.91), recency of follow-up scans (OR 0.98, 95% CI 0.73–0.98), female sex (OR 0.97, 95% CI 0.94–1.00), and age at last scan (OR 0.99, 95% CI 0.99–1.00) were associated with lower risk of scanner mismatch.

Conclusion

Scanner mismatch is a common problem, occurring in one-in-five follow-up DXA scans and affecting more than a quarter of patients. Interventions to reduce this large proportion of scanner mismatch are necessary.

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Data may be available on request.

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Author information

Authors and Affiliations

  1. Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    K. Lee

  2. Division of Core Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    K. Lee & K. Al Jumaily

  3. Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada

    M. Lin

  4. Dpartment of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    K. Siminoski

  5. Division of Rheumatology, Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2G3, Canada

    C. Ye

Authors
  1. K. Lee
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  2. K. Al Jumaily
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  3. M. Lin
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  4. K. Siminoski
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  5. C. Ye
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Contributions

Study concept and design: CY, KA. Data acquisition: KA, ML. Statistical analysis: ML. Main drafting and editing of paper: KL, KS, CY. All authors critically reviewed, revised, and approved the final manuscript for publication.

Corresponding author

Correspondence to C. Ye.

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Ethics approval was granted by the ethics board at the University of Alberta (Pro00088759). Waiver of individual consent was also granted as we analyzed de-identified data from numerous patients.

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Lee, K., Al Jumaily, K., Lin, M. et al. Dual-energy x-ray absorptiometry scanner mismatch in follow-up bone mineral density testing. Osteoporos Int 33, 1981–1988 (2022). https://doi.org/10.1007/s00198-022-06438-3

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  • DOI: https://doi.org/10.1007/s00198-022-06438-3

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