T-score discordance between hip and lumbar spine: risk factors and clinical implications

Ming-Hsiu Chiang; Yeu-Chai Jang; Yu-Pin Chen; Wing P Chan; Ying-Chin Lin; Shu-Wei Huang; Yi-Jie Kuo

doi:10.1177/1759720X231177147

T-score discordance between hip and lumbar spine: risk factors and clinical implications

Ther Adv Musculoskelet Dis. 2023 Jun 19:15:1759720X231177147. doi: 10.1177/1759720X231177147. eCollection 2023.

Authors

Ming-Hsiu Chiang¹, Yeu-Chai Jang², Yu-Pin Chen^{3

4}, Wing P Chan^{5

6}, Ying-Chin Lin^{7

8}, Shu-Wei Huang³, Yi-Jie Kuo^{9

4}

Affiliations

¹ Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung.
² Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei.
³ Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei.
⁴ Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
⁵ Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei.
⁶ Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
⁷ Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
⁸ Department of Geriatric Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
⁹ Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Road, Wenshan District, Taipei City, 116.

Abstract

Background: T-score discordance is common in osteoporosis diagnosis and leads to problems for clinicians formulating treatment plans.

Objectives: This study investigated the potential predictors of T-score discordance and compared fracture risk among individuals with varying T-score discordance status.

Design: This was a single-center cross-sectional study conducted at Wan Fang Hospital, Taipei City, between 1 February 2020 and 31 January 2022.

Methods: The present study enrolled patients aged ⩾50 years who received advanced bone health examination. Participants with a history of fracture surgery or underlying musculoskeletal diseases were excluded. Bioelectrical impedance analysis and dual-energy X-ray absorptiometry were used to determine the body composition and T-score, respectively. Discordance was defined as different T-score categories between the lumbar spine and hip. The impact of discordance on an individual's fracture risk was assessed using the Fracture Risk Assessment Tool (FRAX).

Results: This study enrolled 1402 participants (181 men and 1221 women). Of the 912 participants diagnosed with osteoporosis, 47 (5%) and 364 (40%) were categorized as having major and minor discordance, respectively. Multinomial logistic regression revealed that decreased walking speed was significantly correlated with major discordance but not osteoporosis in both the hip and lumbar spine (odds ratio of 0.25, p = 0.04). The adjusted FRAX scores for the major osteoporotic fracture risks of the major and minor discordance groups were approximately 14%, which was significantly lower than that of people having osteoporosis in both the hip and lumbar spine.

Conclusions: Walking speed exhibited the most significant correlation with major discordance in patients with osteoporosis. Although adjusted major fracture risks were similar between the major and minor discordance groups, further longitudinal studies are warranted to confirm this finding.

Registrations: This study was approved by the Ethics Committee of Taipei Medical University on 01/04/2022 (TMU-JIRB N202203088).

Keywords: Aging; Fracture Risk Assessment Tool; T-score discordance; bone; dual-Energy X-ray absorptiometry; epidemiology; fractures; osteoporosis; walking speed.