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Preventing Functional Decline

Bone mineral density reference values in Singaporean adults and comparisons for asteoporosis establishment - The Yishun Study

25 September 2020

​Background
While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a sever lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults.

Methods
We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. We computed T-scores (denoted by TSG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (TDXA), NHANES database (TNHANES), and China (TCHN), and the differences in prevalence compared. We then compared the concordance between TSG and TDXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the Wolrd Health Organization (WHO).

Results
Peak lumbar spine BMD was 1.093 ± 0.168g/cm2 in women, and 1.041 ± 0.098g/cm2 for men. Peak whole-body BMD was 1.193 ± 0.93g/cm2 in women at, and 1.224 ± 0.112g/cm2 for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in post menopausal women, and 0.7% in men after 50 years of age. the percentage difference in prevalence range from 60.5-163.6%, when using reference values from TDXA, TNHANES, and TCHN. Comparing diagnoses using TDXA and TSG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. The kappa statistics was 0.81 for women and 0.85 for men.

Conclusion
Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may results in unnecessary treatment in some individuals.

SOURCE:
BMC Musculosketeal Disorders

DOI:
https://doi.org/10.1186/s12891-020-03646-y

AUTHOR(S):
Chen KK, Wee SL, Pang BWJ, Lau LK, Jabbar KA, Seah WT, Srinivasan S, Mallya J, Ng TP

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