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Background <p>The Dual-energy X-ray absorptiometry (DXA) scan is considered the current gold standard for the estimation of bone mineral density (BMD). Normative BMD data for the generation of T scores is based on data pertaining to young Caucasian white women from the NHANES-III study. However, there have been reports of significant ethnic variations in the normal BMD values, which could under/over-diagnose osteoporosis. The Indian Council of Medical Research (ICMR) has given the normative BMD data for Indians. Our study compares machine-generated T-scores (T<sub>std</sub>) based on Caucasian BMD reference data with calculated T-scores based on ICMR reference data (T<sub>ICMR</sub>).</p> Methods <p><b>ETHNICA</b> was a retrospective study involving 1144 individuals who underwent DXA study (<i>Hologic</i><sup>®</sup>) at our centre. 835 females and 309 males aged between 18 and 95 were included. A total of 3420 BMD values at bilateral hips and L1-L4 levels of spine were analysed. The age distribution differed from that of the NHANES-III and ICMR reference dataset, which primarily includes younger individuals (20–29 years) as it was done to standardize T score. Gender-specific ICMR BMD and standard deviation (SD) for each site were used to calculate T<sub>ICMR</sub>. This was compared with <i>Hologic-</i>generated T<sub>std</sub>, and the differences were analysed.</p> Results <p>The prevalence of osteoporosis was significantly lower using ICMR data compared to NHANES-III data, with a greater reduction seen in males (16.8 to 7.1%) than in females (26.6 to 18%). Similarly, a larger increase in individuals classified with normal BMD was seen in males (59.5 to 76.1%) compared to females (41.2 to 59.6%).</p> Conclusion <p>We conclude that if we use NHANES-III BMD reference data, there is a significant overdiagnosis of osteoporosis and osteopenia in India. We recommend the adoption of representative regional reference standards for the diagnosis.</p>

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Estimation of T scores with Hologic using NatIve vs. Caucasian data in IndiAns (ETHNICA): a single center retrospective study

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  • 发表日期：

    2025年5月7日

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  • Narayanan Kandasamy,
  • Sri Lasya Karjala,
  • Divyalakshmi Jayakumar,
  • Phani Krishna Machiraju,
  • Hari Krishna Kalathur,
  • Logesh Balakrishnan

摘要

Background

The Dual-energy X-ray absorptiometry (DXA) scan is considered the current gold standard for the estimation of bone mineral density (BMD). Normative BMD data for the generation of T scores is based on data pertaining to young Caucasian white women from the NHANES-III study. However, there have been reports of significant ethnic variations in the normal BMD values, which could under/over-diagnose osteoporosis. The Indian Council of Medical Research (ICMR) has given the normative BMD data for Indians. Our study compares machine-generated T-scores (Tstd) based on Caucasian BMD reference data with calculated T-scores based on ICMR reference data (TICMR).

Methods

ETHNICA was a retrospective study involving 1144 individuals who underwent DXA study (Hologic®) at our centre. 835 females and 309 males aged between 18 and 95 were included. A total of 3420 BMD values at bilateral hips and L1-L4 levels of spine were analysed. The age distribution differed from that of the NHANES-III and ICMR reference dataset, which primarily includes younger individuals (20–29 years) as it was done to standardize T score. Gender-specific ICMR BMD and standard deviation (SD) for each site were used to calculate TICMR. This was compared with Hologic-generated Tstd, and the differences were analysed.

Results

The prevalence of osteoporosis was significantly lower using ICMR data compared to NHANES-III data, with a greater reduction seen in males (16.8 to 7.1%) than in females (26.6 to 18%). Similarly, a larger increase in individuals classified with normal BMD was seen in males (59.5 to 76.1%) compared to females (41.2 to 59.6%).

Conclusion

We conclude that if we use NHANES-III BMD reference data, there is a significant overdiagnosis of osteoporosis and osteopenia in India. We recommend the adoption of representative regional reference standards for the diagnosis.