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By A. El-Maghraoui

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1999). 02 at the lumbar spine. 04, respectively. (Lodder, Lems et al. 05 at the lumbar spine. The SDD values of the children studied in this study tended to be lower than the values in the postmenopausal women (table I). Using the SDD, one can state that a (BMD) change larger than the figure found is a true (BMD) change in 95% of the cases. The characteristics of the Bland and Altman method thus allow direct insight into the variability of the measurement under study (figure 1). It has been shown that reproducibility expressed using the SDD is independent of the BMD value whereas reproducibility expressed using the CV or the derived LSC depend on the BMD value.

3. Clinical implications of bone mineral density reproducibility measurement In clinical practice, two absolute values (g/cm2) have to be compared, rather than two percentages (T-scores). When serial measurements are obtained in a patient, only changes greater than the LSC (in %) or the SDD (in g/cm2) can be ascribed to treatment effects. Smaller changes may be related to measurement error. We studied recently the in vivo short term variability of BMD measurement by DXA in three groups of subjects with a wide range of BMD values: healthy young volunteers, postmenopausal women and patients with chronic rheumatic diseases (most of them taking corticosteroids).

The reproducibility of DXA measurements is claimed to be good. Such variability is due to multiple causes, such as device errors, technician variability, patients’ movements, and variation due to other unpredictable sources (Nguyen, Sambrook et al. 1997; Lodder, Lems et al. 2004). The precision error is usually expressed as the coefficient of variation (CV), which is the ratio of the standard deviation (SD) to the mean of the measurements, although several other statistics to express reproducibility exist such as the smallest detectable difference (SDD) or the least significant change (LSC).

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