Among the 25,270 study participants, 11,317 underwent a whole body DXA using a QDR 4500A fan beam X-ray bone densitometer (Hologic Inc., Marlborough, MA, USA). The total and regional body compositions as measured using the DXA scans were analyzed using the Hologic Discovery software version 12.1 (Hologic Inc.). The appendicular skeletal mass was defined as the sum of the total lean mass excluding bone mineral contents from the limbs, and the ASMI was defined as the appendicular skeletal mass divided by the square of the height (m). Sarcopenia was defined as an ASMI <7 kg/m2 in men and <5.5kg/m2 in women based on the revised European consensus on the definition and diagnosis of sarcopenia [18 (link)]. ABSI was calculated using the following equation: ABSI=WC/(BMI2/3×height1/2) [9 (link)].
Discovery software
Manufactured by Hologic
Sourced in United States
Hologic Discovery software is a data management and analysis platform designed for clinical laboratories. It provides tools for managing patient records, test results, and laboratory workflows. The software enables secure data storage, report generation, and integration with other laboratory systems.
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10 protocols using discovery software
1
Sarcopenia and Body Composition Assessment
2
Sarcopenia and Obesity Assessment by DEXA
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DEXA was performed to measure muscle mass, and the results of the DEXA were analyzed using industry standard techniques at the Korean Society of Osteoporosis with Hologic Discovery software (version 13.1) in its default configuration. Appendicular skeletal muscle mass (ASM) was measured as the sum of the lean soft tissue masses of the arms and legs by DEXA [11] (link). Skeletal muscle mass index (SMI) was calculated using ASM/weight (kg)×100, and sarcopenia was defined when SMI was less than 1 SD below the gender-specific mean for a young reference group between 20 and 39 years of age based on a previous Korean cohort study [12] (link)–[14] . The cut-off value for sarcopenia in the reference groups was 30.8%, 29.8%, and 30.4% for the group from 2009, 2010, and 2011, respectively. The lowest value observed (2010) was set as the reference value for sarcopenia. Obesity was defined when subjects had a BMI greater than 25 kg/m2 based on the World Health Organization recommendations for Asian population-based classification [15] (link). The definition of central obesity followed the criteria for Asian individuals (waist circumference ≥90 cm for males).
3
Comprehensive Anthropometric and Bone Measurements
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Anthropometric measurements were taken by well-trained examiners. Height and weight (in light clothes) were measured by standard methods. Height was measured to the nearest 0.1 cm, and weight was measured to the nearest 0.1 kg. BMI was calculated as the ratio of weight (kg) to height (m2). BMD (g/cm2) measurements were obtained using dual-energy X-ray absorptiometry (DXA, Discovery. QDR 45000; Hologic Inc., Waltham, MA, USA). The DXA scanner was calibrated daily, using a spine phantom and weekly using a step phantom. The DXA results were reviewed and analyzed at the Korean Society of Osteoporosis (Seoul, Korea), using industry-standard techniques. The analysis was performed using Hologic Discovery software (version 13.1 Hologic, Inc., Waitham, MA, USA). Diagnosis of osteopenia was made using the World Health Organization (WHO) T-score criteria (−2.5 < T-score < −1.0) for Asians. Serum 25(OH)D level was measured using a gamma counter (1470 Wizard; Perkin Elmer, Turku, Finland) with a radioimmunoassay (RIA) kit (DiaSorin Inc., Stillwater, MN, USA). The serum 25(OH)D inter-assay coefficients of variation were 19.6–6.1% for the samples [30 (link)]. The measurement of 25(OH)D was standardized according to the measurement procedures of the National Institute of Standards and Technology (NIST) and the Ghent University Vitamin D Standardization Program (VDSP).
4
Assessing Bone Health Through DXA Scans
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T-scores of bone mineral density of the total femur (TF), femur neck (FN) and lumbar spine (LB) were used as a continuous variable or as a binary variables (T-score ≥−1 or <−1, respectively), to determine bone health status and characteristics of the participants by bone status. According to the WHO's standard, T-scores of ≥−1 are considered normal; −2.5< T-score <−1, osteopenia; and T-score ≤−2.5, osteoporosis; however, in this study, we categorised them into two groups: the normal (T-score ≥−1) and low-BMD groups (T-score <−1, osteopenia or osteoporosis). In order to measure BMD at these three sites, whole body dual-energy X-ray absorptiometry (DXA) was performed with a QDR Discovery (formerly known as the QDR 4500A) fan beam densitometer (Hologic, Inc, Bedford, Massachusetts, USA) following procedures recommended by the manufacturer. The results of DXA were analysed using the standard techniques of the Korean Society of Osteoporosis and Hologic Discovery software (V.13.1).
5
Bone Densitometry and Body Composition
6
Bone Densitometry and Body Composition
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Hologic QDR 4500A fan beam x-ray bone densitometer was used (Hologic, Inc., Bedford, Massachusetts) for DXA scans (22 ). Hologic Discovery software (version 12.1, Hologic, Inc.) was used to analyze original scan results and to derive fat mass and lean mass. Body regions, including head, arm, trunk, and leg, were delineated manually using tools provided by the software (see Supplemental Material , Definition of body regions ). Missing readings for DXA data were imputed five times using sequential regression multivariate imputation in the SAS-callable software package IVEware (23 ). All five datasets were provided, allowing analysts to incorporate the extra variability due to imputation into analyses (23 ). In the current study, 263 participants had 1 or more missing DXA measurements imputed (with <5% of all data points imputed). Body fat mass percentage (FM%) for the whole body and each region (trunk and legs) was calculated as fat mass divided by total mass times 100.
7
Whole Body Dual-Energy X-Ray Absorptiometry Protocol
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Whole body dual-energy X-ray absorptiometry (DEXA) was performed with a QDR Discovery fan beam densitometer (Hologic, Bedford, MA, USA), as per the procedures recommended by the manufacturer. The areal BMDs (aBMDs) of the total hip, femoral neck, and lumbar spine were measured with DEXA. The aBMD was calculated as the amount of bone mineral contents divided by the bone scanned area [37 (link)]. The DEXA results were analyzed using the standard techniques of the Korean Society of Osteoporosis and Hologic Discovery software (version 13.1; Hologic Inc., Bedford, MA, USA).
8
DXA Scan Protocol for Small Animals
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The DXA scans were performed as previously described with modification [19] . In brief, the animals were anesthetized using chloral hydrate (10%, 3 ml/kg body weight, i.p.). DXA scans were performed with a fan beam QDR 4500 A densitometer (Hologic, Inc., Bedford, MA, USA) calibrated daily in accordance with the manufacturer's recommendations. The animals were positioned centrally at the bottom of a square. All DXA measurements and analyses were performed by the same investigator, and the data were analyzed using the small-animal mode of Hologic Discovery Software (Hologic, Inc., Bedford, USA).
9
Assessing Body Composition in Cystic Fibrosis
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Spine and whole body DXA scans were acquired using a fan beam array (Hologic Delphi, Bedford, MA, USA), and analyzed using the Discovery software (version 12.3). Whole body scans were analyzed to generate estimates of LBM (kilogram) and FM (kilogram).
Lean body mass index (LBMI = LBM/height2) and fat mass index (FMI = FM/height2) were calculated for the CF and controls. Age-based reference curves were generated for males and females from 462 healthy subjects using the lambda-mu-sigma (LMS) method (20 ). LBMI and FMI were then converted to sex- and age-adjusted Z-scores for the CF and controls using these contemporary reference data.
Lean body mass index (LBMI = LBM/height2) and fat mass index (FMI = FM/height2) were calculated for the CF and controls. Age-based reference curves were generated for males and females from 462 healthy subjects using the lambda-mu-sigma (LMS) method (20 ). LBMI and FMI were then converted to sex- and age-adjusted Z-scores for the CF and controls using these contemporary reference data.
10
Whole Body DXA Scan Analysis
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Whole body DXA scans were acquired (Hologic Discovery, Bedford, MA) employing standard positioning techniques and analyzed using Discovery software (version 13.5). Lean body mass (LBM), fat mass (FM), and visceral fat area (FA) estimates were generated. The instrument was calibrated daily with a hydroxyapatite phantom. In vitro CV was <0.6%; In vivo CV was <1%. FM index (FMI = FM/height2) was calculated.
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