Distal tibia areal bone mineral density: Use in detecting low aBMD of the hip in young women

Dual-energy X-ray absorptiometry (DXA) is a primary clinical tool for identification of adults with low areal bone mineral density (aBMD) and who are at increased risk for future osteoporosis and fragility fractures. Procedures for several aBMD scans of clinical interest might be limited by artifact, inaccessible anatomical regions, and positioning errors. Sites for scanning that overcome these limitations need further investigation for application to large-scale screening and relevance to clinical decisions regarding diagnosis and treatment. In this study, 146 women (mean ± SE age = 20.1 ± 0.1 yr, height = 163.3 ± 0.2 cm, weight = 60.0 ± 0.2 kg) underwent DXA of the total body (TB) and right and left total proximal femurs (TPF), total forearms (TF), and distal tibiae (DT). Osteopenia was identified in 24 women. Areal BMD was positively related among all measurement sites (r = 0.55-0.81, all p < 0.001). Total body, TF, and DT aBMD each displayed low sensitivity (0.29-0.33) and high specificity (0.95-0.98) to detect osteopenia of the TPF. Addition of TB fat-free mass slightly enhanced the predictive value of DT aBMD. Overall, DT aBMD can discriminate between osteopenic and normal subjects with comparable accuracy to TB or TF aBMD.