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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2001 Jan;60(1):8–13. doi: 10.1136/ard.60.1.8

Validated measurement of periarticular bone mineral density at the knee joint by dual energy x ray absorptiometry

E Murphy 1, B Bresnihan 1, O FitzGerald 1
PMCID: PMC1753370  PMID: 11114275

Abstract

OBJECTIVE—The association of inflammatory arthritis with loss of periarticular bone mineral density (BMD) has been well established. However, changes in bone density cannot be quantified by conventional radiography. This study aimed at developing a new technique for measurement of periarticular bone density at the knee joint by dual energy x ray absorptiometry (DXA) and assessing the precision of this technique for selected areas around the knee.
METHODS—To validate this technique for bone density assessment in both patient and control subjects, knee joints from healthy subjects and patients with inflammatory arthritis were selected for study. Posteroanterior (PA) and lateral scans of both knees were acquired with the Hologic 4500 elite bone densitometer. Each scan was repeated three times, with repositioning between scans. Knee scans were obtained with the forearm software and evaluated by subregion analysis. Seven femoral and seven tibial subregions of interest (ROIs) were selected on PA scans. Six ROIs were selected on lateral scans. Precision was determined for each ROI selected.
RESULTS—14 knee joints were studied in each group. Precision, expressed as percentage coefficient of variation (CV%), varied widely between subregions. PA scans were most appropriate for measurement of femoral bone density (CV% = 1.89-2.64%), whereas the best value obtained for ROIs within the tibia was on the lateral scan, where CV% for measurement of the proximal 5 mm was 2.67% in the patient group. CV% for BMD of the patella was excellent at 0.84% in the patient group.
CONCLUSION—This new application of DXA can be used to measure periarticular bone density at the knee joint. Regions within the distal femur and patella have been identified as the optimal areas to study



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Figure 1  .

Figure 1  

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Posteroanterior knee scan. The subregion area increases from R1 to R7. The lower border of the regions of interest (ROIs) is distal to the femur and remains constant for all ROIs. The upper border of R1 is placed 1 mm above the intercondylar notch. The height of subsequent subregions is increased in 1 mm increments from this reference point. Thus R1 represents the distal 1 mm of femur and R7 represents the distal 7 mm of femur. Labels for each ROI are randomly placed by the computer at different points on the ROI boxes. Table 1 shows the results for bone mineral content and bone mineral density for each of the subregions.

Figure 2  .

Figure 2  

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Lateral knee scan with six subregions of interest—R1, R2 (distal 2 mm and 5 mm femur respectively), R3, R4 (proximal 2 mm and 5 mm tibia respectively), R5 (region of interest includes an area 5 mm above and below the joint line), R6 (patella). Table 2 shows the results for bone mineral content and bone mineral density for each of the subregions.

Figure 3  .

Figure 3  

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Individual bone mineral density (BMD) measurements for R4 femur on posteroanterior scans—healthy subjects. Where BMD values are similar, points may be superimposed on each other.

Figure 4  .

Figure 4  

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Individual bone mineral density measurements for patella on lateral scans— healthy subjects. Where BMD values are similar, points may be superimposed on each other.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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