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Comparative Study
. 2025 May 7;26(1):448.
doi: 10.1186/s12891-025-08599-8.

Estimation of T scores with Hologic using NatIve vs. Caucasian data in IndiAns (ETHNICA): a single center retrospective study

Narayanan Kandasamy  1 , Sri Lasya Karjala  2 , Divyalakshmi Jayakumar  3 , Phani Krishna Machiraju  3 , Hari Krishna Kalathur  3 , Logesh Balakrishnan  4
Affiliations
Comparative Study

Estimation of T scores with Hologic using NatIve vs. Caucasian data in IndiAns (ETHNICA): a single center retrospective study

Narayanan Kandasamy et al. BMC Musculoskelet Disord. .

Abstract

Background: 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 (Tstd) based on Caucasian BMD reference data with calculated T-scores based on ICMR reference data (TICMR).

Methods: 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 TICMR. This was compared with Hologic-generated Tstd, and the differences were analysed.

Results: 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%).

Conclusion: 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.

Keywords: Bone mineral density; DXA study; ETHNICA; NHANES-III; Osteoporosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Institutional Ethical Committee Bio Medical Research, Apollo Hospitals, Chennai, approved the protocol (AMH-C-S-088/10–23). As all data was anonymously used and this study does not contain protected health information in accordance with the Declaration of Helsinki, the ethics committee approved a waiver of the requirement for informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparison between mean Tstd and TICMR scores across normal, osteopenic, and osteoporotic populations at individual sites (left hip, right hip, lumbar spine) and their overall levels (lowest of all three sites)
Fig. 2
Fig. 2
Bar chart depicting the difference between the number of individuals classified as normal, osteopenic and osteoporotic as per Tstd and TICMR
Fig. 3
Fig. 3
The Bland-Altman plot displaying the level of agreement between Tstd and TICMR
See this image and copyright information in PMC

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