Bone mineral density evaluation in osteoporosis: why yes and why not?

Abstract

Osteoporosis is a diffuse skeletal disease in which a decrease in bone strength leads to an increased risk of fractures. A wide variety of types of bone densitometry measurements are available, including quantitative computed tomography measurements of the spine, quantitative ultrasound devices for measurements of the heel and other peripheral sites and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD) at the lumbar spine, proximal femur, forearm and total body scans. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. However, in recent years, the authors have raised some important questions about the objective limits of this method that have led to doubts about its effectiveness in terms of clinical outcome.

Impaired healing of fragility fractures in type 2 diabetes: clinical and radiographic assessments and serum cytokine levels

“…In fact, they have inefficient bone mass redistribution characterized by cortical bone loss and increased trabecular bone density. We can therefore affirm that diabetes is a BMD-independent fracture risk factor [11,12].…”

Femoral cortical index: an indicator of poor bone quality in patient with hip fracture

“…DXA, according to the World Health Organization, is still the gold standard method for measurement of BMD at the lumbar spine and proximal femur, but it cannot discriminate cortical and cancellous bone in terms of structure. In elderly subjects, structural changes such as vascular calcifications, scoliosis, and degenerative arthritis in the posterior elements of the spine may falsely increase BMD at the spine and therefore limit its utility [25]. Thus, in these subjects, osteoporosis may be underestimated if assessed by lumbar spine BMD.…”

Ultrasound analysis of mental artery flow in elderly patients: a case–control study

“…8 On the other hand, one limitation of the present study is that dual-energy X-ray absorptiometry values for BMD were taken from the forearm, whereas the lumbar spine is considered the gold standard method for obtaining T-score (BMD measurement compared with a young adult reference population) and Z-score (BMD measurement compared with an age-matched reference population), in accordance with the World Health Organization. 20 Furthermore, while the case-control design of the present study allows for the assessment of risk associations, future cohort studies with larger sample sizes are needed to determine the causality of a decreasing mental artery flow and mandibular ridge atrophy, as well as the biological and genetic factors associated with these alterations.…”