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Manitoba Health

Manitoba Bone Density Program

Bone Density Testing Information for Researchers

Research – Past, Present and Future

The Manitoba Bone Density Program Committee is responsible for overseeing the delivery of clinical services to the population of Manitoba.  At the same time, the Program's mandate includes a commitment to clinical researchers

"... to ensure that the operation of bone density units contributes to research and other academic activities that benefit the residents of Manitoba".

Bone densitometry is an important outcomes measure in osteoporosis research, and researchers should have access to this technology.  Furthermore, Manitoba has the largest population-based database of clinical DXA results in the world.  This is a valuable research resource, and would like to encourage other researchers to take advantage of it.  After removing names and other personal identifiers (in accordance with the Personal Health Information Act), the anonymous database can be linked with administrative health files.  This creates unique research opportunities which are not available anywhere else.  The most recent version of the database covers the period January 1, 1990-March 31, 2006 and contains more than 57,000 scan results.

Approval Procedure

The Manitoba Bone Density Program Committee must review each application to use the provincially operated bone densitometers or data for clinical research.  Inquiries should be addressed to Dr. William D. Leslie (bleslie@sbgh.mb.ca), Chair of the Manitoba Bone Density Program Committee.

The researcher must provide written approval from the relevant Faculty of Medicine Research Ethics Board (REB) and institutional Research Review Committee (RRC).  If the project also involves linkage with provincial health services data from Manitoba Health then it also requires approval from the Health Information and Privacy Committee (HIPC) and review by the Manitoba Centre for Health Policy (MCHP).  The Manitoba Bone Density Program should be acknowledged in any publication or presentation that arises from using its resources.

Any costs related to hardware, software, quality assurance, data manipulation or non-clinical testing services will need to be covered by the researcher. 

The Principal Investigator will be asked to attend a meeting to present the protocol and address the following questions:

1) What is the clinical value of this project?

2) What is the status of any required approvals and/or funding requests?

3) Does the research require access to the Manitoba Bone Density Program's database?

4) Does the research require access to administrative health from Manitoba Health?

If yes:

- Include a copy of the HIPC application form.

5) Does the research require additional non-clinical DXA testing?

If yes:

- Is this project better suited to a provincial bone densitometer or a private bone densitometer?

- Are any additional hardware, software or quality assurance procedures required for the project?

- How will patients be scheduled to minimize impact on clinical services?

- How will the Manitoba Program be reimbursed for costs?

- What is the expected number of patients, number of tests, testing schedule and recruitment period?


Publications from the Manitoba Bone Density Program

Bone micro-architecture assessed by TBS predicts osteoporotic fractures independent of bone density: The Manitoba study.
Hans D, Goertzen AL, Krieg MA, Leslie WD.
J Bone Miner Res. 2011 Sep 1. doi: 10.1002/jbmr.499. [Epub ahead of print] [Pubmed link]

Clinical Risk Factors for Fracture in Diabetes: A Matched Cohort Analysis.
Fraser LA, Pritchard J, Ioannidis G, Giangegorio LM, Adachi JD, Papaioannou A, Leslie WD.
J Clin Densitom. 2011 Aug 30. [Epub ahead of print] [Pubmed link]

Longitudinal Evaluation of Bone Mineral Density and Body Composition in Patients With Positive Celiac Serology.
Duerksen DR, Leslie WD.
J Clin Densitom. 2011 Aug 16. [Epub ahead of print] [Pubmed link]

Fracture risk assessment without bone density measurement in routine clinical practice.
Leslie WD, Morin S, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA; for the Manitoba Bone Density Program.
Osteoporos Int. 2011 Aug 18. [Epub ahead of print] [Pubmed link]

Effects of FRAX(®) Model Calibration on Intervention Rates: A Simulation Study.
Leslie WD, Lix LM; Manitoba Bone Density Program.
J Clin Densitom. 2011 Jul-Sep;14(3):272-8. [Pubmed link]

Spine-Hip T-Score Difference Predicts Major Osteoporotic Fracture Risk Independent of FRAX(®): A Population-Based Report From CAMOS.
Leslie WD, Kovacs CS, Olszynski WP, Towheed T, Kaiser SM, Prior JC, Josse RG, Jamal SA, Kreiger N, Goltzman D; CaMos Research Group.
J Clin Densitom. 2011 Jul-Sep;14(3):286-93. [Pubmed link]

Closing the Postfracture Care Gap Using Administrative Health Databases: Design and Implementation of a Randomized Controlled Trial.
Caetano PA, Labine L, Klassen P, Dreilich D, Leslie WD.
J Clin Densitom. 2011 Jun 30. [Epub ahead of print] [Pubmed link]

Fracture Burden in Relation to Low Bone Mineral Density and FRAX(®) Probability.
Leslie WD, Morin S.
J Clin Densitom. 2011 Jul-Sep;14(3):279-85. [Pubmed link]

Ankle fractures do not predict osteoporotic fractures in women with or without diabetes.
Pritchard JM, Giangregorio LM, Ioannidis G, Papaioannou A, Adachi JD, Leslie WD.
Osteoporos Int. 2011 May 12. [Epub ahead of print] [Pubmed link]

A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving.
Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM.
Osteoporos Int. 2011 Apr 8. [Epub ahead of print] [Pubmed link]

High fracture probability with FRAX(®) usually indicates densitometric osteoporosis: implications for clinical practice.
Leslie WD, Majumdar SR, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA; for the Manitoba Bone Density Program.
Osteoporos Int. 2011 Mar 2. [Epub ahead of print] [Pubmed link]

Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women.
Bolton JM, Targownik LE, Leung S, Sareen J, Leslie WD.
J Clin Psychopharmacol. 2011 Feb;31(1):56-60. [Pubmed link]

Construction of a FRAX(®) model for the assessment of fracture probability in Canada and implications for treatment.
Leslie WD, Lix LM, Langsetmo L, Berger C, Goltzman D, Hanley DA, Adachi JD, Johansson H, Oden A, McCloskey E, Kanis JA.
Osteoporos Int. 2011 Mar;22(3):817-27. [Pubmed link]

A before-and-after study of fracture risk reporting and osteoporosis treatment initiation.
Leslie WD, Morin S, Lix LM.
Ann Intern Med. 2010 Nov 2;153(9):580-6. [Pubmed link]

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts.
Leslie WD, Berger C, Langsetmo L, Lix LM, Adachi JD, Hanley DA, Ioannidis G, Josse RG, Kovacs CS, Towheed T, Kaiser S, Olszynski WP, Prior JC, Jamal S, Kreiger N, Goltzman D; Canadian Multicentre Osteoporosis Study (CaMos) Research Group.
Osteoporos Int. 2011 Jun;22(6):1873-83. [Pubmed link]

Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement.
Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA.
Osteoporos Int. 2011 Mar;22(3):839-47. [Pubmed link]

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: Derivation and validation of a hybrid system.
Leslie WD, Lix LM; for the Manitoba Bone Density Program.
J Bone Miner Res. 2011 Mar;26(3):460-7. [Pubmed link]

Bone mineral density and risk of postmenopausal breast cancer.
Grenier D, Cooke AL, Lix L, Metge C, Lu H, Leslie WD.
Breast Cancer Res Treat. 2011 Apr;126(3):679-86. [Pubmed link]

Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration.
Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA; Manitoba Bone Density Program.
J Bone Miner Res. 2010 Nov;25(11):2350-8. [Pubmed link]

Validation of a case definition for osteoporosis disease surveillance.
Leslie WD, Lix LM, Yogendran MS.
Osteoporos Int. 2011 Jan;22(1):37-46. [Pubmed link]

Simplified 10-year absolute fracture risk assessment: a comparison of men and women.
Leslie WD, Lix LM; Manitoba Bone Density Program.
J Clin Densitom. 2010 Apr-Jun;13(2):141-6. [Pubmed link]

Abdominal fat from spine dual-energy x-ray absorptiometry and risk for subsequent diabetes.
Leslie WD, Ludwig SM, Morin S.
J Clin Endocrinol Metab. 2010 Jul;95(7):3272-6. [Pubmed link]

Time since prior fracture is a risk modifier for 10-year osteoporotic fractures.
Giangregorio LM, Leslie WD; Manitoba Bone Density Program.
J Bone Miner Res. 2010 Jun;25(6):1400-5. [Pubmed link]

Positive celiac disease serology and reduced bone mineral density in adult women.
Duerksen DR, Leslie WD.
Can J Gastroenterol. 2010 Feb;24(2):103-7. [Pubmed link]

Positive celiac disease serology and reduced bone mineral density in adult women.
Duerksen DR, Leslie WD.
Can J Gastroenterol. 2010 Feb;24(2):103-7. [Pubmed link]

Proton pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss.
Targownik LE, Lix LM, Leung S, Leslie WD.
Gastroenterology. 2010 Mar;138(3):896-904. [Pubmed link]

Prediction of body composition from spine and hip bone densitometry.
Leslie WD.
J Clin Densitom. 2009 Oct-Dec;12(4):428-33. [Pubmed link]

Imputation of ten year osteoporotic fracture rates from hip fractures: A clinical validation study.
Leslie WD, Lix LM; for the Manitoba Bone Density Program.
J Bone Miner Res. 2010 Feb;25(2):388-92. [Pubmed link]

Simplified system for absolute fracture risk assessment: clinical validation in Canadian women.
Leslie WD, Tsang JF, Lix LM; Manitoba Bone Density Program.
J Bone Miner Res. 2009 Feb;24(2):353-60. [Pubmed link]

Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort.
Leslie WD, Pahlavan PS, Tsang JF, Lix LM; Manitoba Bone Density Program.
Osteoporos Int. 2009 Oct;20(10):1767-74. [Pubmed link]

Factors predicting osteoporosis treatment initiation in a regionally based cohort.
Cranney A, Tsang JF, Leslie WD.
Osteoporos Int. 2009 Sep;20(9):1621-5. [Pubmed link]

High bone mineral density is associated with high body mass index.
Morin S, Leslie WD; Manitoba Bone Density Program.
Osteoporos Int. 2009 Jul;20(7):1267-71. [Pubmed link]

Hodsman AB, Leslie WD, Tsang JF, Gamble GD.
10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program.
Arch Intern Med. 2008 Nov 10;168(20):2261-7. [Pubmed link]

Sadatsafavi M, Moayyeri A, Wang L, Leslie WD; Manitoba Bone Density Program.
Heteroscedastic regression analysis of factors affecting BMD monitoring.
J Bone Miner Res. 2008 Nov;23(11):1842-9. [Pubmed link]

Metge CJ, Leslie WD, Manness LJ, Yogendran M, Yuen CK, Kvern B; Maximizing Osteoporosis Management in Manitoba Steering Committee.
Postfracture care for older women: gaps between optimal care and actual care.
Can Fam Physician. 2008 Sep;54(9):1270-6. [Pubmed link]

Morin S, Tsang JF, Leslie WD.
Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years.
Osteoporos Int. 2008 Jul 17. 2009 Mar;20(3):363-70. [Pubmed link]

Lix LM, Yogendran MS, Leslie WD, Shaw SY, Baumgartner R, Bowman C, Metge C, Gumel A, Hux J, James RC.
Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases.
J Clin Epidemiol. 2008 Dec;61(12):1250-60. [Pubmed link]

Leslie WD, Tsang JF, Lix LM.
Validation of ten-year fracture risk prediction: a clinical cohort study from the Manitoba Bone Density Program.
Bone. 2008 Oct;43(4):667-71. [Pubmed link]

Leslie WD, Tsang JF, Lix LM.
Effect of total hip bone area on osteoporosis diagnosis and fractures.
J Bone Miner Res. 2008 Sep;23(9):1468-76. [Pubmed link]

Sadatsafavi M, Moayyeri A, Wang L, Leslie WD.
Optimal decision criterion for detecting change in bone mineral density during serial monitoring: a Bayesian approach.
Osteoporos Int. 2008 Nov;19(11):1589-96. [Pubmed link]

Leslie WD; Manitoba Bone Density Program Committee.
Absolute fracture risk reporting in clinical practice: a physician-centered survey.
Osteoporos Int. 2008 Apr;19(4):459-63. [Pubmed link]

Leslie WD.
Factors affecting short-term bone density precision assessment and the effect on patient monitoring.
J Bone Miner Res. 2008 Feb;23(2):199-204. [Pubmed link]

Moayyeri A, Sadatsafavi M, Leslie WD; for the Manitoba Bone Density Program.
Sample size requirements for bone density precision assessments and effect on patient categorization: A Monte Carlo simulation study.
Bone. 2007 Oct;41(4):679-84. [PubMed link]

Leslie WD, Moayyeri A, Sadatsafavi M, Wang L.
A new approach for quantifying change and test precision in bone densitometry.
J Clin Densitom. 2007 Oct-Dec;10(4):365-9. [Pubmed link]

Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD.
Low bone mineral density and fracture burden in postmenopausal women.
CMAJ. 2007 Sep 11;177(6):575-80. [PubMed link]

Leslie WD, Lix LM, Tsang JF, Caetano PA; Manitoba Bone Density Program.
Single-site vs multisite bone density measurement for fracture prediction.
Arch Intern Med. 2007 Aug 13-27;167(15):1641-7. [PubMed link]

Leslie WD, Siminoski K, Brown JP.
Comparative effects of densitometric and absolute fracture risk classification systems on projected intervention rates in postmenopausal women.
J Clin Densitom. 2007 Apr-Jun;10(2):124-31. [PubMed link]

Tsang JF, Leslie WD.
Exclusion of focal vertebral artifacts from spine bone densitometry and fracture prediction: a comparison of expert physicians, three computer algorithms, and the minimum vertebra.
J Bone Miner Res. 2007 Jun;22(6):789-98. [PubMed link]

Leslie WD, Anderson WA, Metge CJ, Manness LJ; Maximizing Osteoporosis Management in Manitoba Steering Committee.
Clinical risk factors for fracture in postmenopausal Canadian women: a population-based prevalence study.
Bone. 2007 Apr;40(4):991-6. [PubMed link]

Leslie WD, Tsang JF, Caetano PA, Lix LM; for the Manitoba Bone Density Program.
Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program.
J Bone Miner Res. 2007 Mar;22(3):476-83. [PubMed link]

Leslie WD, Tsang JF, Caetano PA, Lix LM; Manitoba Bone Density Program.
Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice.
J Clin Endocrinol Metab. 2007 Jan;92(1):77-81. [PubMed link]

Demeter S, Leslie WD, Lix L, MacWilliam L, Finlayson GS, Reed M.
The effect of socioeconomic status on bone density testing in a public health-care system.
Osteoporos Int. 2007 Feb;18(2):153-8. [PubMed link]

Leslie WD; Manitoba Bone Density Program.
The impact of bone area on short-term bone density precision.
J Clin Densitom. 2006 Apr-Jun;9(2):150-3. [PubMed link]

Leslie WD, Moayyeri A; For the Manitoba Bone Density Program.
Minimum sample size requirements for bone density precision assessment produce inconsistency in clinical monitoring.
Osteoporos Int. 2006 Nov;17(11):1673-80. [PubMed link]

Leslie WD; Manitoba Bone Density Program.
The importance of spectrum bias on bone density monitoring in clinical practice.
Bone. 2006 Aug;39(2):361-8. [PubMed link]

Leslie WD, Caetano PA, Roe EB.
The impact of hip subregion reference data on osteoporosis diagnosis.
Osteoporos Int. 2005 Dec;16(12):1669-74. [PubMed link]

Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS.
Construction and validation of a population-based bone densitometry database.
J Clin Densitom. 2005 Spring;8(1):25-30. [PubMed link]

Leslie WD, MacWilliam L, Lix L, Caetano P, Finlayson GS.
A population-based study of osteoporosis testing and treatment following introduction of a new bone densitometry service.
Osteoporos Int. 2005 Jul;16(7):773-82. [PubMed link]

Leslie WD, Ward LM.
Bone density monitoring with the total hip site: time for a re-evaluation?
J Clin Densitom. 2004 Fall;7(3):269-74. [PubMed link]

Leslie WD, Metge C.
Establishing a regional bone density program: lessons from the Manitoba experience.
J Clin Densitom. 2003 Fall;6(3):275-82. [PubMed link]

Leslie WD, Metge C, Ward L.
Contribution of clinical risk factors to bone density-based absolute fracture risk assessment in postmenopausal women.
Osteoporos Int. 2003 Jun;14(4):334-8. [PubMed link]

Leslie WD, Metge C, Salamon EA, Yuen CK.
Bone mineral density testing in healthy postmenopausal women. The role of clinical risk factor assessment in determining fracture risk.
J Clin Densitom. 2002 Summer;5(2):117-30. [PubMed link]