The impact of the Hologic vs the ICMR database in diagnosis of osteoporosis among south Indian subjects

Background and Objectives: Recently, the Indian Council of Medical Research (ICMR) has published normative data for bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) scanning. However, the impact this has had on the diagnosis of osteoporosis when compared to currently used Caucasian databases has not been analysed. Hence, this study was undertaken to look at agreement between the Hologic Database (HD) based on BMD normative data in Caucasians and the ICMR database (ICMRD) in defining osteoporosis in subjects with or without hip fracture. Materials and Methods: It is a cross-sectional study of 2976 subjects (men 341, women 2757) (mean age ± SD = 62.2 ± 7.2 years), including 316 subjects with low impact hip fracture: 2199 were from the hospital database, and 461 were healthy postmenopausal women from the community who underwent (DXA) scanning between January 2010 and March 2013. Recalculated T scores from ICMRD were used for the diagnosis of osteoporosis and compared with HD. Results: An almost perfect agreement existed between the two databases for the diagnosis of osteoporosis at the hip (κ -0.82, P < 0.0001) in all subjects, and a moderate relationship existed in those with hip fracture (κ -0.65, P < 0.0001). Seventy-three of 316 hip fracture subjects (23.5%) defined as osteoporosis according to HD were classified as osteopenia according to ICMRD. Conclusion: The threshold of hip BMD T score for treating osteoporosis may have to be redefined if the ICMR reference database is used. Initiation of treatment in these subjects must be based on multiple fracture risk factor assessment in addition to looking at BMD. Further studies with a larger sample size of subjects with fracture are needed to validate our findings.