Kandasamy Narayanan, Karjala Sri Lasya, Jayakumar Divyalakshmi, Machiraju Phani Krishna, Kalathur Hari Krishna, Balakrishnan Logesh
Department of Endocrinology, Apollo Hospitals, Greams road, Chennai, 600006, Tamil Nadu, India.
Department of Internal Medicine, Apollo Hospitals, Greams road, Chennai, 600006, Tamil Nadu, India.
BMC Musculoskelet Disord. 2025 May 7;26(1):448. doi: 10.1186/s12891-025-08599-8.
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) based on Caucasian BMD reference data with calculated T-scores based on ICMR reference data (T).
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 T. This was compared with Hologic-generated T, and the differences were analysed.
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%).
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.
双能X线吸收法（DXA）扫描被认为是目前评估骨密度（BMD）的金标准。用于生成T值的正常BMD数据基于来自美国国家健康与营养检查调查（NHANES）-III研究的年轻白人女性数据。然而，有报道称正常BMD值存在显著的种族差异，这可能导致骨质疏松症的诊断不足或过度诊断。印度医学研究理事会（ICMR）给出了印度人的正常BMD数据。我们的研究比较了基于白人BMD参考数据的机器生成T值（T）与基于ICMR参考数据计算的T值（T）。
ETHNICA是一项回顾性研究，涉及1144名在我们中心接受DXA研究（Hologic）的个体。纳入了835名年龄在18至95岁之间的女性和309名男性。总共分析了双侧髋部和脊柱L1-L4水平的3420个BMD值。年龄分布与NHANES-III和ICMR参考数据集不同，后者主要包括年轻个体（20-29岁），这样做是为了标准化T值。使用每个部位特定性别的ICMR BMD和标准差（SD）来计算T值。将其与Hologic生成的T值进行比较，并分析差异。
与NHANES-III数据相比，使用ICMR数据时骨质疏松症的患病率显著降低，男性的降低幅度更大（从16.8%降至7.1%），女性的降低幅度为（从26.6%降至18%）。同样，与女性（从41.2%增至59.6%）相比，男性中被归类为BMD正常的个体增加幅度更大（从59.5%增至76.1%）。
我们得出结论，如果使用NHANES-III BMD参考数据，在印度存在对骨质疏松症和骨质减少的显著过度诊断。我们建议采用具有代表性的区域参考标准进行诊断。
