Sevil Ceyhan Doğan

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

BACKGROUND Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. METHODS All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. RESULTS A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. CONCLUSION In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Obstrüktif uyku apne sendromu ve fibromiyalji sendromu birlikteliği

Ozet Amac: B u calismada her iki hastalikta da dinlendirmeyen uyku, gunduz asiri uyuma ihtiyaci, sabahlari olan bas agrisi gibi ortak semptomlarin varligindan yola cikarak OUAS hastalarinda FMS birlikteligini incelemeyi amacladik. Yontem: OUAS suphesi olan 100 ardisik hasta alindi. Bu hastalara polisomnografi (PSG) uygulandi ve FMS acisindan fizik tedavi uzmani tarafindan degerlendirildi. OUAS tanisi icin Uluslararasi Uyku Bozukluklari Siniflamasi (ICSD-2) kriterleri, FMS tanisi icin Amerika Romatoloji Dernegi (ACR)’nin 1990 yilinda yayimladigi ve gunumuzde kullanilan kriterler temel alindi. Bulgular: Yuz hastanin 74’unde OUAS saptandi. OUAS saptanan 74 hastanin 20‘sinde (%27) FMS saptanirken OUAS olmayan 26 hastanin 4’unde (%15,4) FMS saptandi ve her iki grup arasinda FMS sikligi acisindan istatiksel anlamli fark yoktu. OUAS olan gruptaki hastalari FMS varligi ve yokluguna gore gruplara ayirdigimizda ve bu gruplar arasinda horlama, tanikli apne, gunduz asiri uyku hali (GAUH) ve uc major semptom birlikteligini kiyasladigimizda tanikli apne ve GAUH sadece OUAS olan FMS olmayan grupta istatiksel olarak anlamli oranda daha yuksekti (p 0,05). Sonuc: Sonuc olarak calismamizda OUAS’li hastalarda FMS birlikteligi acisindan anlamli iliski saptamasak da GAUH, dinlendirmeyen uyku, sabahlari olan bas agri gibi ortak semptomlarin varligi daha genis orneklemli ve daha cok sayida calismalara ihtiyac oldugunu gostermektedir. Anahtar sozcukler : Uyku apne, fibromyalji Abstract Aim. W e aimed to study coexistence of FMS in OSAS patients since there are common symptoms such as non-relaxing sleep, over need for sleep during the day, morning headaches in both diseases. Methods. 100 consecutive OSAS patients contributed to the study. These patients are evaluated by physical rehabilitation specialist with application of polysomnography (PSG). International Classification of Sleep Disorders (ICSD-2) criteria used for OSAS diagnosis and American College of Rheumatology (ACR) criteria published in 1990 and some criteria which are used today used for diagnosis for FMS. Results. OSAS determined in 74 patients of 100. While in 20 of 74 patients (27%) with OSAS FMS determined, in 4 of 26 patients with no OSAS (15.4%) FMS determined and there was no statistical difference in regards to FMS incidence between groups. In OSAS group, when groups separated according to FMS existence and absence and when coexistence of symptoms such as witnessed apnea, excessive day time sleepiness (GAUH), and 3 major symptoms only witnessed apnea and GAUH was statistically high, in only OSAS non-FMS group (p 0.05). Conclusion. In conclusion, although we did not determined significant coexistence of FMS in OSAS patients, common symptoms such as GAUH, non-relaxing sleep, morning headaches shows that further study need to be done in large scales. Key words : Sleep apnea, fibromyalgia