The Impact of GE Lunar vs ICMR Database in Diagnosis of Osteoporosis among South Indian Subjects

OBJECTIVE: To study the effect of choosing ICMR reference values on the classification of bone mineral density in Indian patients. DESIGN: Retrospective analysis of Dual Energy X-ray absorptiometry (DEXA) and clinical data. PATIENTS: Totally, 316 patients aged more than 65 years attending a tertiary care hospital in South India who underwent DEXA scan were included in the study. MEASUREMENTS: DEXA scan at femoral neck and lumbar spine. RESULTS: A total of 316 patients were studied. The mean age was 61.98 ± 7.66 years. There were 46.84% females and 53.16% males. The average BMI was 26.37 ± 4.51. Of these patients, 46 had history of hip fracture (14.55%). The adoption of the ICMR normative data resulted in a significant increase in T scores in both the hip (+0.51, P < 0.05) and the spine (+1.64, P < 0.01). The adoption of ICMR normative values, resulted in reduction of osteoporosis prevalence from 26.58% to 5.06%. CONCLUSIONS: There is a clinically significant reduction in diagnosis of osteoporosis with the adoption of ICMR reference standard. Clinicians should be recommended to use raw BMD values in gm/cm(2) in FRAX calculation and avoid the use of T scores, to avoid overestimation of fracture risk. If our results are replicated, the implications are enormous – Osteoporosis is currently being over diagnosed.