Клиническое значение высокой минеральной плотности кости (часть II). Артефакты, искусственно повышающие костную массу

В клинической практике при проведении двухэнергетической рентгеновской абсорбциометрии (ДРА, dual-energy X-ray absorptiometry) случаи обнаружения высоких показателей минеральной плотности кости (МПК) нередки. К заболеваниям, которые приводят к очевидным костным структурным изменениям, искажающим показатели МПК, относят дегенеративные заболевания позвоночника, анкилозирующий спондилит, диффузный идиопатический гиперостоз скелета, переломы тел позвонков. Другими причинами завышения показателей МПК могут быть внешние артефакты, такие как кальцификация брюшного отдела аорты, металлоконструкции в области тел позвонков или тазобедренного сустава, кифопластика и вертебропластика, эктопические кальцификаты в брюшной полости, попадающие в зону исследования, пассаж бария в кишечнике.

1. Gregson CL, Steel SA, O’Rourke KP, Allan K, Ayuk J, et al. ‘Sink or swim’: an evaluation of the clinical characteristics of individuals with high bone mass. Osteoporos Int. 2012; 23(2):643-54. doi: https://doi.org/10.1007/s00198-011-1603-4

2. Paccou J, Javier RM, Henry-Desailly I, Ternynck C, Nottez A, et al. The French multicentre elevated bone mass study: prevalence and causes. Osteoporos Int. 2021; 32(9):1763-1775. doi: https://doi.org/10.1007/s00198-021-05898-3

3. Orwoll ES, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab. 1990;70(4):1202-7. doi: https://doi.org/10.1210/jcem-70-4-1202

4. Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD. Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ. 1993;307(6897):172-3. doi: https://doi.org/10.1136/bmj.307.6897.172

5. von der Recke P, Hansen MA, Overgaard K, Christiansen C. The impact of degenerative conditions in the spine on bone mineral density and fracture risk prediction. Osteoporos Int. 1996; 6(1):43-9. doi: https://doi.org/10.1007/BF01626537

6. Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC. Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int. 1997;7(6):564-9. doi: https://doi.org/10.1007/BF02652563

7. Rand T, Schneider B, Grampp S, Wunderbaldinger P, Migsits H, Imhof H. Influence of osteophytic size on bone mineral density measured by dual X-ray absorptiometry. Acta Radiol. 1997;38(2):210-3. doi: https://doi.org/10.1080/02841859709172051

8. Tenne M, McGuigan F, Besjakov J, Gerdhem P, Åkesson K. Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women. Osteoporos Int. 2013; 24(4):1419-28. doi: https://doi.org/10.1007/s00198-012-2048-0

9. Paiva LC, Filardi S, Pinto-Neto AM, Samara A, Marques Neto JF. Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis. Sao Paulo Med J. 2002;120(1):9-12. doi: https://doi.org/10.1590/s1516-31802002000100003

10. Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925-48. doi: https://doi.org/10.1007/s00586-005-1053-9

11. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082-5. doi: https://doi.org/10.1097/01.brs.0000160842.43482.cd

12. Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky RL. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976). 2011;36(9):731-6. doi: https://doi.org/10.1097/BRS.0b013e3181e9f120

13. Xu L, Sun X, Huang S, Zhu Z, Qiao J, Zhu F, Mao S, Ding Y, Qiu Y. Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J. 2013;22(6):1326-31. doi: https://doi.org/10.1007/s00586-013-2678-8

14. Rubin J, Cleveland RJ, Padovano A, Hu D, Styner M, Sanders J. Lumbar Scoliosis in Postmenopausal Women Increases with Age but is not Associated with Osteoporosis. J Endocr Soc. 2021; 5(5):bvab018. doi: https://doi.org/10.1210/jendso/bvab018

15. Rumancik S, Routh RH, Pathak RD, Burshell AL, Nauman EA. Assessment of bone quantity and distribution in adult lumbar scoliosis: new dual-energy x-ray absorptiometry methodology and analysis. Spine (Phila Pa 1976). 2005;30(4):434-9. doi: https://doi.org/10.1097/01.brs.0000153344.06682.b2

16. Preidler KW, White LS, Tashkin J, McDaniel CO, Brossmann J, Andresen R, Sartoris D. Dual-energy X-ray absorptiometric densitometry in osteoarthritis of the hip. Influence of secondary bone remodeling of the femoral neck. Acta Radiol. 1997;38(4 Pt 1):539-42. doi: https://doi.org/10.1080/02841859709174383

17. Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995; 38(7):907-16. doi: https://doi.org/10.1002/art.1780380706

18. Chaganti RK, Parimi N, Lang T, Orwoll E, Stefanick ML, Nevitt M, Lane NE; Osteoporotic Fractures in Men (MrOS) Study Group. Bone mineral density and prevalent osteoarthritis of the hip in older men for the Osteoporotic Fractures in Men (MrOS) Study Group. Osteoporos Int. 2010;21(8):1307-16. doi: https://doi.org/10.1007/s00198-009-1105-9

19. Arokoski JP, Arokoski MH, Jurvelin JS, Helminen HJ, Niemitukia LH, Kröger H. Increased bone mineral content and bone size in the femoral neck of men with hip osteoarthritis. Ann Rheum Dis. 2002;61(2):145-50. doi: https://doi.org/10.1136/ard.61.2.145

20. Javaid MK, Lane NE, Mackey DC, Lui LY, Arden NK, Beck TJ, Hochberg MC, Nevitt MC. Changes in proximal femoral mineral geometry precede the onset of radiographic hip osteoarthritis: The study of osteoporotic fractures. Arthritis Rheum. 2009;60(7):2028-36. doi: https://doi.org/10.1002/art.24639

21. Antoniades L, MacGregor AJ, Matson M, Spector TD. A cotwin control study of the relationship between hip osteoarthritis and bone mineral density. Arthritis Rheum. 2000;43(7):1450-5. doi: https://doi.org/10.1002/1529-0131(200007)43:7<1450::AID-ANR6>3.0.CO;2-6

22. Hardcastle SA, Dieppe P, Gregson CL, Hunter D, Thomas GE, et al. Prevalence of radiographic hip osteoarthritis is increased in high bone mass. Osteoarthritis Cartilage. 2014; 22(8):1120-8. doi: 10.1016/j.joca.2014.06.007

23. Hardcastle SA, Gregson CL, Deere KC, Davey Smith G, Dieppe P, Tobias JH. High bone mass is associated with an increased prevalence of joint replacement: a case-control study. Rheumatology (Oxford). 2013; 52(6):1042-51. doi: https://doi.org/10.1093/rheumatology/kes411

24. Hardcastle SA, Dieppe P, Gregson CL, Arden NK, Spector TD, et al. Osteophytes, enthesophytes, and high bone mass: a bone-forming triad with potential relevance in osteoarthritis. Arthritis Rheumatol. 2014; 66(9):2429-39. doi: https://doi.org/10.1002/art.38729

25. Funck-Brentano T, Nethander M, Movérare-Skrtic S, Richette P, Ohlsson C. Causal Factors for Knee, Hip, and Hand Osteoarthritis: A Mendelian Randomization Study in the UK Biobank. Arthritis Rheumatol. 2019; 71(10):1634-1641. doi: https://doi.org/10.1002/art.40928

26. Westerveld LA, Verlaan JJ, Lam MG, Scholten WP, Bleys RL, Dhert WJ, Oner FC. The influence of diffuse idiopathic skeletal hyperostosis on bone mineral density measurements of the spine. Rheumatology (Oxford). 2009; 48(9):1133-6. doi: https://doi.org/10.1093/rheumatology/kep177

27. Nascimento FA, Gatto LA, Lages RO, Neto HM, Demartini Z, Koppe GL. Diffuse idiopathic skeletal hyperostosis: A review. Surg Neurol Int. 2014; 5(Suppl 3):S122-5. doi: https://doi.org/10.4103/2152-7806.130675

28. Sethi A, Ruby JG, Veras MA, Telis N, Melamud E. Genetics implicates overactive osteogenesis in the development of diffuse idiopathic skeletal hyperostosis. Nat Commun. 2023; 14(1):2644. doi: https://doi.org/10.1038/s41467-023-38279-x

29. Weinfeld RM, Olson PN, Maki DD, Griffiths HJ. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol. 1997;26(4):222-5. doi: https://doi.org/10.1007/s002560050225

30. Mader R, Novofestovski I, Adawi M, Lavi I. Metabolic syndrome and cardiovascular risk in patients with diffuse idiopathic skeletal hyperostosis. Semin Arthritis Rheum. 2009;38(5):361-5. doi: https://doi.org/10.1016/j.semarthrit.2008.01.010

31. Harlianto NI, Westerink J, Foppen W, Hol ME, Wittenberg R, et al., On Behalf Of The Ucc-Smart-Study Group. Visceral Adipose Tissue and Different Measures of Adiposity in Different Severities of Diffuse Idiopathic Skeletal Hyperostosis. J Pers Med. 2021;11(7):663. doi: https://doi.org/10.3390/jpm11070663

32. Pillai S, Littlejohn G. Metabolic factors in diffuse idiopathic skeletal hyperostosis - a review of clinical data. Open Rheumatol J. 2014;8:116-28. doi: https://doi.org/10.2174/1874312901408010116

33. Hirota R, Teramoto A, Yoshimoto M, Takashima H, Yasuda N, et al. Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis. J Clin Med. 2023;12(16):5412. doi: https://doi.org/10.3390/jcm12165412

34. Diederichs G, Engelken F, Marshall LM, Peters K, Black DM, Issever AS, Barrett-Connor E, Orwoll E, Hamm B, Link TM; Osteoporotic Fractures in Men Research Group. Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density. Osteoporos Int. 2011;22(6):1789-97. doi: https://doi.org/10.1007/s00198-010-1409-9

35. Harlianto NI, Ezzafzafi S, Foppen W, Kuperus JS, van der Horst-Bruinsma IE, de Jong PA, Verlaan JJ. The prevalence of vertebral fractures in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: A systematic review and meta-analysis. N Am Spine Soc J. 2024;17:100312. doi: https://doi.org/10.1016/j.xnsj.2024.100312

36. Guiot A, Estublier C, Gaude M, Szulc P, Chapurlat R. Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men. Rheumatology (Oxford). 2021;60 (5):2197-2205. doi: https://doi.org/10.1093/rheumatology/keaa517

37. Clunie G, Horwood N. Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features? Ther Adv Musculoskelet Dis. 2020; 12:1759720X20969260. doi: https://doi.org/10.1177/1759720X20969260

38. Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis. 1994;53(2):117-21. doi: https://doi.org/10.1136/ard.53.2.117

39. van der Weijden MA, Claushuis TA, Nazari T, Lems WF, Dijkmans BA, van der Horst-Bruinsma IE. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review. Clin Rheumatol. 2012;31(11):1529-35. doi: https://doi.org/10.1007/s10067-012-2018-0

40. Klingberg E, Lorentzon M, Mellström D, Geijer M, Göthlin J, et al. Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment. Arthritis Res Ther. 2012;14(3):R108. doi: https://doi.org/10.1186/ar3833

41. Deminger A, Klingberg E, Lorentzon M, Geijer M, Göthlin J, et al. Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study. Arthritis Res Ther. 2017;19(1):273. doi: https://doi.org/10.1186/s13075-017-1480-0

42. Takahashi T, Takada T, Narushima T, Tsukada A, Ishikawa E, Matsumura A. Correlation Between Bone Density and Lumbar Compression Fractures. Gerontol Geriatr Med. 2020; 6:2333721420914771. doi: https://doi.org/10.1177/2333721420914771

43. Krege JH, Miller PD, Lenchik L, Misurski DA, Chen P. New or worsening lumbar spine vertebral fractures increase lumbar spine bone mineral density and falsely suggest improved skeletal status. J Clin Densitom. 2006; 9 (2):144-9. doi: https://doi.org/10.1016/j.jocd.2006.02.001

44. Frye MA, Melton LJ 3rd, Bryant SC, Fitzpatrick LA, Wahner HW, Schwartz RS, Riggs BL. Osteoporosis and calcification of the aorta. Bone Miner. 1992; 19(2):185-94. doi: https://doi.org/10.1016/0169-6009(92)90925-4

45. Drinka PJ, DeSmet AA, Bauwens SF, Rogot A. The effect of overlying calcification on lumbar bone densitometry. Calcif Tissue Int. 1992;50(6):507-10. doi: https://doi.org/10.1007/BF00582163

46. Gupta P, Cherian KE, Kapoor N, Paul TV. Aortic Calcification Artifact Causing Spuriously High Bone Mineral Density in the Lumbar Spine. AACE Clin Case Rep. 2020;7(4):284-286. doi: https://doi.org/10.1016/j.aace.2020.12.007

47. Smith JA, Vento JA, Spencer RP, Tendler BE. Aortic calcification contributing to bone densitometry measurement. J Clin Densitom. 1999;2(2):181-3. doi: https://doi.org/10.1385/jcd:2:2:181

48. Cherney DD, Laymon MS, McNitt A, Yuly S. A study on the influence of calcified intervertebral disk and aorta in determining bone mineral density. J Clin Densitom. 2002; 5(2):193-8. doi: https://doi.org/10.1385/jcd:5:2:193

49. Gebre AK, Lewis JR, Leow K, Szulc P, Scott D, et al. Abdominal Aortic Calcification, Bone Mineral Density, and Fractures: A Systematic Review and Meta-analysis of Observational Studies. J Gerontol A Biol Sci Med Sci. 2023; 78(7):1147-1154. doi: https://doi.org/10.1093/gerona/glac171

50. Canepa M, Ameri P, AlGhatrif M, Pestelli G, Milaneschi Y, et al. Role of bone mineral density in the inverse relationship between body size and aortic calcification: results from the Baltimore Longitudinal Study of Aging. Atherosclerosis. 2014; 235(1):169-75. doi: https://doi.org/10.1016/j.atherosclerosis.2014.04.018

51. Meyers C, Lisiecki J, Miller S, Levin A, Fayad L, Ding C, Sono T, McCarthy E, Levi B, James AW. Heterotopic Ossification: A Comprehensive Review. JBMR Plus. 2019; 3(4):e10172. doi: https://doi.org/10.1002/jbm4.10172

52. van Kuijk AA, Geurts AC, van Kuppevelt HJ. Neurogenic heterotopic ossification in spinal cord injury. Spinal Cord. 2002; 40 (7):313-26. doi: https://doi.org/10.1038/sj.sc.3101309

53. Jaovisidha S, Sartoris DJ, Martin EM, Foldes K, Szollar SM, Deftos LJ. Influence of heterotopic ossification of the hip on bone densitometry: a study in spinal cord injured patients. Spinal Cord. 1998; 36(9):647-53. doi: https://doi.org/10.1038/sj.sc.3100701

54. Davuluri S, Chung L, Lood C. Calcinosis in dermatomyositis. Curr Opin Rheumatol. 2024;36(6):453-458. doi: https://doi.org/10.1097/BOR.0000000000001036

55. Sanyal S, Atwal SS, Mondal D, Garga UC. Radiographic patterns of soft tissue calcinosis in juvenile dermatomyositis and its clinical implications. J Clin Diagn Res. 2014; 8(12):RD08-11. doi: https://doi.org/10.7860/JCDR/2014/10787.5321

56. Morgan SL, Lopez-Ben R, Nunnally N, Burroughs L, Fineberg N, Tubbs RS, Yester MV. The effect of common artifacts lateral to the spine on bone mineral density in the lumbar spine. J Clin Densitom. 2008;11(2):243-9. doi: https://doi.org/10.1016/j.jocd.2007.11.004

57. Martineau P, Morgan SL, Leslie WD. Bone Mineral Densitometry Reporting: Pearls and Pitfalls. Can Assoc Radiol J. 2021; 72(3):490-504. doi: https://doi.org/10.1177/0846537120919627

58. Kendler DL, Kiebzak GM, Ambrose CG, Dinu C, Robertson S, Schmeer P, Van Pelt JL. Effect of calcium tablets on interpretation of lumbar spine DXA scans. J Clin Densitom. 2006; 9 (1):97-104. doi: https://doi.org/10.1016/j.jocd.2005.12.002

59. Yildiz M, Canatan D. Soft tissue density variations in thalassemia major: a possible pitfall in lumbar bone mineral density measurements by dual-energy X-ray absorptiometry. Pediatr Hematol Oncol. 2005;22(8):723-6. doi: https://doi.org/10.1080/08880010500278707

60. Allard HM, Calvelli L, Weyhmiller MG, Gildengorin G, Fung EB. Vertebral Bone Density Measurements by DXA are Influenced by Hepatic Iron Overload in Patients with Hemoglobinopathies. J Clin Densitom. 2019;22(3):329-337. doi: https://doi.org/10.1016/j.jocd.2018.07.001

61. Baris HN, Cohen IJ, Mistry PK. Gaucher disease: the metabolic defect, pathophysiology, phenotypes and natural history. Pediatr Endocrinol Rev. 2014;12 Suppl 1(0 1):72-81

62. Hughes D, Mikosch P, Belmatoug N, Carubbi F, Cox T, Goker-Alpan O, Kindmark A, Mistry P, Poll L, Weinreb N, Deegan P. Gaucher Disease in Bone: From Pathophysiology to Practice. J Bone Miner Res. 2019; 34(6):996-1013. doi: https://doi.org/10.1002/jbmr.3734

63. Slart RHJA, Punda M, Ali DS, et al. International Working Group on DXA Best Practices. Updated practice guideline for dual-energy X-ray absorptiometry (DXA). Eur J Nucl Med Mol Imaging. 2025; 52(2):539-563. doi: https://doi.org/10.1007/s00259-024-06912-6

64. Hauache OM, Vieira JG, Alonso G, Martins LR, Brandão C. Increased hip bone mineral density in a woman with gluteal silicon implant. J Clin Densitom. 2000; 3(4):391-3. doi: https://doi.org/10.1385/jcd:3:4:391

65. McCloskey EV, Odén A, Harvey NC, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX®. J Bone Miner Res. 2016;31(5):940-948. doi: https://doi.org/10.1002/jbmr.2734