| 제목 |
Effects of Traction on Lumbar Bone Mineral Density in Patients Duchenne Muscular Dystrophy |
| 소속 |
Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Department of Rehabilitation Medicine1, Pusan National University Hospital, Department of Nuclear Medicine and Biomedical Research Institute2, Pusan National University Hospital, Pusan National University School of Medicine, Division of Endocrinology, Department of Internal Medicine3, Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital4 |
| 저자 |
Da Hwi Jung1, Ra Yu Yun1, Mikyung Choi1, Keunyoung Kim2, Yun Kyung Jeon 3, Jinmi Kim 4, Sang Hun Kim MDa1, Myung Jun Shin1, Yong Beom Shin 1, Je-Sang Lee1*† |
Introduction
We compared the performance of dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) in evaluating the bone mineral density (BMD) of patients with Duchenne muscular dystrophy (DMD) and scoliosis. Here, we propose a new measurement method and diagnostic criteria that are more accurate than current options.
Methods
This study included 29 patients with DMD (mean age 19.72 ± 6.13 years) (Table 1). Participants underwent whole spine radiograph and DXA before and after traction (to render distance between shoulder and its ipsilateral anterior-superior iliac spine equal in all imaging tests). They underwent QCT only without traction. The scoliosis and vertebral rotation angles obtained before and after traction were compared, and the BMD values obtained by DXA were compared to those obtained by QCT, known to be unaffected by the effects of spinal deformity, to analyze the association among these parameters. The scoliosis angle was presented as Cobb’s angle. In addition to the degree of curvature for each patient, the Cobb’s angle of L1 to L4, which is used for bone density analysis in DXA, was also measured.
Results
The Cobb’s angle significantly decreased from 30.38±24.83° before to 22.78±20.41° after traction (p < .0001), and Z-score from -1.88 ± 1.59 to -2.86 ± 2.16 (p < .0001) (Table 2). Changes in rotation angle, BMD, and bone mineral content were not significant. Post-traction BMD values and Z-scores showed a higher correlation with QCT measurements than pre-traction. We also found that the pre- and post-traction Z-scores (≤ -1.1 and -1.36, respectively) used in the DXA measurements as cut-off values for the diagnosis of osteoporosis were more accurate in identifying patients with osteoporosis according to QCT scans compared with the pre-existing Z-score of -2 or less (Table 3).
Conclusion
Lumbar BMD measured by DXA in patients with DMD and scoliosis allowed a more accurate diagnosis of osteoporosis when traction was applied. |
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Table 1. Clinical data of the participants
Table 2. Comparison of pre-traction and post-traction variables
Table 3. Optimal cutoff point of the Z-score measured with pre-traction and post-traction DXA to predict an abnormal QCT finding using the Youden index
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