Effect of increased axial rotation angle on bone mineral density measurements of the lumbar spine

Abstract Background context Osteoporosis frequently occurs in elderly people and is commonly associated with neuromuscular diseases or severe cerebral palsy. Osteoporosis can cause pain via compression fractures or secondary neurologic deficits; thus, accurate evaluation of bone mineral density (BMD) is essential for the prevention and treatment of osteoporosis. However, spinal axial rotation caused by scoliosis may affect the outcome of BMD tests, such that BMD measurements may be significantly greater than actual BMD in patients with severe scoliosis of the spine. Purpose We investigated the effect of axial rotation angle on BMD measurements of the phantom spine. Study design/setting Investigation for the effect of axial rotation with aluminum phantom spine. Methods A GE-Lunar Aluminum Spine Phantom was used to assess BMD. Bone mineral content (BMC), BMD, and cross-sectional area were measured 100 times at L1–L4 using a GE Lunar Prodigy Vision system. Dual-energy X-ray absorptiometry was performed at axial rotation angles of 0° to 25° (5° intervals). Results Cross-sectional area decreased and BMD values increased as the axial rotation angle increased, whereas BMC did not change significantly. A fitting function was obtained to evaluate the relationships among axial rotation angle, cross-sectional area, and BMD. We obtained an equation to estimate BMD at L1–L4: 1.000−0.001674x+0.0001043x2 −0.000005333x3 , where x denotes the axial rotation angle. We found that the observed BMD needed adjustment when the angle was more than 5°. Conclusions Bone mineral density values may be overestimated in patients with even slight (>5°) axial rotation. When osteoporosis is suspected in a clinical setting, the degree of axial rotation should be measured on a lumbar spine X-ray.