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Bone densitometry in Thalassemia major: a closer look at pitfalls and operator-related errors in a 10-year follow-up population

  • Medical Physics
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Abstract

Purpose

Dual-energy X-ray absorptiometry (DXA) is the gold standard for measuring bone mineral density (BMD) with tolerable error rate, high precision, and excellent consistency. Our objective was to investigate the frequency and distribution of errors in a cohort of patients with Thalassemia major (TM).

Methods

We reviewed the DXA examinations of 340 patients with β-TM followed by our institution, acquired in different imaging centers between 2009 and 2019. We collected sex and age at the time of the first examination and at the last visit, as well as BMD, T-score, and Z-score values. Errors were analyzed by anatomical site (lumbar spine, total hip, femoral neck).

Results

Out of 5099 total DXA scans, 11.85% presented one or more errors. Specifically, the incorrect examinations were 315 out of 1707 (18.45%) at the lumbar spine level, 113 out of 1697 (6.66%) at the total hip, 176 out of 1695 (10.38%) at the femoral neck. Errors in vertebral inclusion were the most frequently registered (45.86%). A significant difference resulted from the comparison of the T-score and Z-score median values of all the lumbar spine DXA examinations and the correct ones (p value 0.037 and 0.0003, respectively).

Conclusion

Although not directly involved in the performance and interpretation of DXA, physicians interested in osteoporosis management should be familiar with the protocols to minimize errors and allow the proper use of bone densitometry. DXA obtained at the spine level is more frequently affected by errors in patients with TM, potentially influencing the diagnostic assessment of bone health status.

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Acknowledgements

We thank Dr Roberto Reverberi for statistical analysis. We are grateful to United Onlus for their assistance and active participation in clinical and educational activities.

Funding

This study received no funding.

Author information

Author notes

  1. Aldo Carnevale and Maria Rosaria Ambrosio equally contributed to this work.

Authors and Affiliations

  1. Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy

    Elisa Lucioni, Damiano Remor, Alberto Cossu, Melchiore Giganti & Aldo Carnevale

  2. Radiology Unit, S. Bonifacio Hospital, 37047, Verona, Italy

    Fabio Pellegrino

  3. Department of Radiology, University of Padova, Via VIII Febbraio, 2, 35122, Padua, Italy

    Desy Niero

  4. Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Sant’Anna University Hospital, 44123, Ferrara, Italy

    Filomena Longo

  5. Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, 44121, Ferrara, Italy

    Maria Chiara Zatelli & Maria Rosaria Ambrosio

Authors
  1. Elisa Lucioni
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  2. Fabio Pellegrino
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  3. Damiano Remor
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  7. Maria Chiara Zatelli
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  9. Aldo Carnevale
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  10. Maria Rosaria Ambrosio
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Corresponding author

Correspondence to Damiano Remor.

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Conflict of interest

Elisa Lucioni, Fabio Pellegrino, Damiano Remor, Desy Niero, Filomena Longo, Maria Chiara Zatelli, Melchiore Giganti, Aldo Carnevale, and Maria Rosaria Ambrosio declare that they have no conflict of interest.

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Lucioni, E., Pellegrino, F., Remor, D. et al. Bone densitometry in Thalassemia major: a closer look at pitfalls and operator-related errors in a 10-year follow-up population. Radiol med 129, 488–496 (2024). https://doi.org/10.1007/s11547-024-01759-1

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