J Korean Med Sci.  2012 Jun;27(6):686-690. 10.3346/jkms.2012.27.6.686.

Differences in Bone Mineral Density between the Right and Left Hips in Postmenopausal Women

• Hwang HJ
• Park SY
• Lee SH
• Han SB
• Ro KH

• KMID: 1421623
• DOI: http://doi.org/10.3346/jkms.2012.27.6.686

Abstract

Bone mineral density (BMD) using dual energy radiography absorptiometry are commonly used for the diagnosis of osteoporosis. It is usually measured at the spine and also at one hip joint. Controversy still exists regarding the use of bilateral hip scanning. We analyzed the difference of BMD at bilateral hips in 384 postmenopausal women, retrospectively. The concordance and discordance rates of the lowest T-score and BMD between both hips were evaluated. The BMDs of the femoral neck and trochanter were significantly different between both hips (P < 0.05). There were also discrepancies between the lowest T-scores of both hips (P < 0.05). The discordance rates were about 30%. Due to significant differences in BMD between both hips at the femoral neck and trochanter and high discordance rate, bilateral hip measurements using DEXA are recommended to avoid underestimating osteoporosis.

Keyword

Osteoporosis; Diagnosis; Bone Mineral Density; Hip

MeSH Terms

Absorptiometry, Photon
Aged
Body Mass Index
*Bone Density
Female
Femur/chemistry
Femur Neck/chemistry
Hip/*radiography
Humans
Middle Aged
Osteoporosis/diagnosis
Postmenopause
Retrospective Studies

Figure

• 

  Fig. 1 Box and whisker plot. A box-whisker plot, based on Table 2, that shows median values, interquartile range, spread, and outlying values for the lowest T-scores in the three groups. There are differences of interquartile range at each group. The median values are increasing with the increasing of BMI.

Reference

1. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994. 843:1–129.

2. Lessig HJ, Meltzer MS, Siegel JA. The symmetry of hip bone mineral density. A dual photon absorptiometry approach. Clin Nucl Med. 1987. 12:811–812.

3. Balseiro J, Fahey FH, Ziessman HA, Le TV. Comparison of bone mineral density in both hips. Radiology. 1988. 167:151–153.

4. Yang RS, Chieng PU, Tsai KS, Liu TK. Symmetry of bone mineral density in the hips is not affected by age. Nucl Med Commun. 1996. 17:711–716.

5. Brownbill RA, Lindsey C, Crncevic-Orlic Z, Ilich JZ. Dual hip bone mineral density in postmenopausal women: geometry and effect of physical activity. Calcif Tissue Int. 2003. 73:217–224.

6. Hall ML, Heavens J, Ell PJ. Variation between femurs as measured by dual energy X-ray absorptiometry (DEXA). Eur J Nucl Med. 1991. 18:38–40.

7. Lilley J, Walters BG, Heath DA, Drolc Z. Comparison and investigation of bone mineral density in opposing femora by dual-energy X-ray absorptiometry. Osteoporos Int. 1992. 2:274–278.

8. Gotfredsen A, Riis BJ, Christiansen C, Rødbro P. Does a single local absorptiometric bone measurement indicate the overall skeletal status? Implications for osteoporosis and osteoarthritis of the hip. Clin Rheumatol. 1990. 9:193–203.

9. Takamoto S, Masuyama T, Nakajima M, Seikiya K, Kosaka H, Morimoto S, Ogihara T, Onishi T. Alterations of bone mineral density of the femurs in hemiplegia. Calcif Tissue Int. 1995. 56:259–262.

10. Franck H, Munz M, Scherrer M. Bone mineral density of opposing hips using dual energy X-Ray absorptiometry in single-beam and fan-beam design. Calcif Tissue Int. 1997. 61:445–447.

11. Prince RL, Price RI, Ho S. Forearm bone loss in hemiplegia: a model for the study of immobilization osteoporosis. J Bone Miner Res. 1988. 3:305–310.

12. Hamdy RC, Krishnaswamy G, Cancellaro V, Whalen K, Harvill L. Changes in bone mineral content and density after stroke. Am J Phys Med Rehabil. 1993. 72:188–191.

13. Krahl H, Michaelis U, Pieper HG, Quack G, Montag M. Stimulation of bone growth through sports. A radiologic investigation of the upper extremities in professional tennis players. Am J Sports Med. 1994. 22:751–757.

14. Petley GW, Taylor PA, Murrills AJ, Dennison E, Pearson G, Cooper C. An investigation of the diagnostic value of bilateral femoral neck bone mineral density measurements. Osteoporos Int. 2000. 11:675–679.

15. Mazess RB, Nord R, Hanson JA, Barden HS. Bilateral measurement of femoral bone mineral density. J Clin Densitom. 2000. 3:133–140.

16. Wong JC, McEwan L, Lee N, Griffiths MR, Pocock NA. The diagnostic role of dual femur bone density measurement in low-impact fractures. Osteoporos Int. 2003. 14:339–344.

17. Hamdy R, Kiebzak GM, Seier E, Watts NB. The prevalence of significant left-right differences in hip bone mineral density. Osteoporos Int. 2006. 17:1772–1780.

18. Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, Howe TS. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 2007. 89:349–353.

19. Puhaindran ME, Farooki A, Steensma MR, Hameed M, Healey JH, Boland PJ. Atypical subtrochanteric femoral fractures in patients with skeletal malignant involvement treated with intravenous bisphosphonates. J Bone Joint Surg Am. 2011. 93:1235–1242.

20. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, et al. Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996. 348:1535–1541.

21. Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009. 91:2556–2561.

22. Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Eisman JA, McCloskey EV, Mellstrom D, Melton LJ 3rd, Pols HA, et al. A family history of fracture and fracture risk: a meta-analysis. Bone. 2004. 35:1029–1037.

23. Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton IL III, Tenenhouse A, Reeve J, Silman AJ, Pols HA, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004. 19:893–899.

24. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int. 2005. 16:581–589.

25. Kim SR, Ha YC, Park YG, Lee SR, Koo KH. Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study. J Korean Med Sci. 2011. 26:1501–1507.

26. Lee DY, Lim SJ, Moon YW, Min YK, Choi D, Yoon BK, Park YS. Determination of an applicable FRAX model in Korean women. J Korean Med Sci. 2010. 25:1657–1660.