Do patients that fracture with normal DXA-measured BMD have normal bone?

Bandaru, Sindhura; Hare, Kristyn; Krueger, Diane; Binkley, Neil

doi:10.1007/s11657-020-00745-0

Cited by 15 publications

(4 citation statements)

References 26 publications

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“…The opportunistic use of computed tomography (CT) or assessment of the femoral cortical index may also be considered as adjunctive tools [31][32][33] . Considering these assessments is important because, in a small study of patients in an FLS, only 1.3% had normal bone when including other clinically available assessments 34 . Therefore, utilizing other bone assessments may help clinicians to conclude that the bone in patients who have sustained a fracture is abnormal, despite normal T-scores, thus prompting consideration of pharmacologic therapy.…”

Section: Historical Medication Usementioning

confidence: 99%

Fracture in Patients with Normal Bone Mineral Density

Kadri

Binkley

Daffner

et al. 2022

Journal of Bone and Joint Surgery

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Background: Fractures often occur in patients with normal dual x-ray absorptiometry (DXA)-measured bone mineral density (BMD). DXA does not consider clinical fracture risk factors or bone quality. We hypothesized that patients with normal BMD who sustain a fracture have other characteristics suggesting abnormal bone and an elevated fracture risk requiring additional bone health evaluation and potential anti-osteoporotic treatment.Methods: A total of 7,219 patients who were ‡50 years of age, had sustained a fracture from July 2016 to July 2021, and had DXA data in the American Orthopaedic Association's Own the Bone (AOA OTB) registry were included in this study. The index and prior fracture site data were obtained. BMD status was classified by the World Health Organization T-score criteria. The Fracture Risk Assessment Tool (FRAX) scores with and without BMD were calculated in patients with normal BMD. An elevated risk was defined as a major osteoporotic fracture risk of ‡20% or a hip fracture risk of ‡3%. Results:The mean patient age (and standard deviation) was 70.8 ± 9.71 years, 84% of patients were female, and 92% of patients were Caucasian. Normal BMD was present in 8.6% of patients. The index fracture was a major osteoporotic fracture in 68.6% of patients with normal BMD and 75.6% of patients with osteoporosis. The most common site for index and prior fractures other than major osteoporotic fractures was the foot and ankle; of patients with normal BMD, 13.9% had this as the most common index site and 17.4% had this as the most common prior site. The FRAX risk calculated without BMD was elevated in 72.9% of patients with normal BMD, and the FRAX risk calculated with BMD was elevated in 12.0% of patients.Conclusions: Most patients with a fracture and normal BMD met indications, including a prior fracture or elevated FRAX risk, for anti-osteoporotic therapies. Most patients were Caucasian and therefore potentially had a higher baseline fracture risk. The FRAX risk calculated without BMD was elevated more often than the FRAX risk with BMD, implying that clinical risk factors, which highlight multiple opportunities for non-pharmacologic secondary fracture prevention, should be considered along with DXA. Fractures other than major osteoporotic fractures were more common in patients with normal BMD, suggesting that minor fractures in adults who are ‡50 years of age should be considered sentinel events warranting further evaluation. Surgeons must recognize that other important risk factors apart from BMD may help to guide further bone health evaluation.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Fracture risk is influenced by both bone quality and bone structure, which contribute to the mechanical properties that determine the failure tolerance of bone. A sufficient force is needed to overcome the strength imparted by these characteristics to produce a fracture. However, fracture often occurs even though the severity of trauma, such as a gro...

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Section: Historical Medication Usementioning

confidence: 99%

Fracture in Patients with Normal Bone Mineral Density

Kadri

Binkley

Daffner

et al. 2022

Journal of Bone and Joint Surgery

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“…Currently, OP and ON are mainly diagnosed according to BMD value by dual-energy X-ray absorptiometry (DXA) [7,8], and these diseases are considered preventable and treatable. The mainstream therapies include estrogen treatment, alendronate sodium, calcium supplementation, and Chinese medicine [9].…”

Section: Introductionmentioning

confidence: 99%

Distinct Metabolites in Osteopenia and Osteoporosis: A Systematic Review and Meta-Analysis

Wang,

Han,

Shi

et al. 2023

Nutrients

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Multiple studies have indicated that distinct metabolites are involved in the occurrence and development of osteopenia (ON) and osteoporosis (OP); however, these metabolites in OP and ON have not yet been classified and standardized. This systematic review and meta-analysis included 21 articles aiming to investigate the distinct metabolites in patients with ON and OP. The quality of the included articles was generally high; seventeen studies had >7 stars, and the remaining four received 6 stars. This systematic review showed that three metabolites (phosphatidylcholine (PC) (lipid metabolites), galactose (carbohydrate metabolites), and succinic acid (other metabolites)) increased, four (glycylglycine (gly-gly), cystine (amino acids), sphingomyelin (SM) (lipid metabolites) and glucose (carbohydrate metabolites)) decreased, and five (glutamine, hydroxyproline, taurine (amino acids), lysophosphatidylcholine (LPC) (lipid metabolites), and lactate (other metabolites)) had conflicting directions in OP/ON. The results of the meta-analysis show that gly-gly (MD = −0.77, 95%CI −1.43 to −0.11, p = 0.02) and cystine (MD = −5.52, 95%CI −7.35 to −3.68, p < 0.00001) decreased in the OP group compared with the healthy control group. Moreover, LPC (MD = 1.48, 95%CI 0.11 to 2.86, p = 0.03) increased in the OP group compared with the healthy control group. These results indicate that distinct metabolites were associated with ON and OP, which could be considered a predictor for OP.

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“…These HU measurements correlate significantly with T-scores as calculated with DXA measurements, and therefore provide an alternative method for assessing BMD with no additional radiation exposure or costs [ 8 , 9 ]. Moreover, CT imaging is increasingly considered a more accurate tool for BMD assessment in comparison to DXA, as was shown, for example, in trauma and oncologic patients [ 10 , 11 ]. Furthermore, BMD assessment using DXA has been shown to suffer from misguided elevation caused by vertebral compression fractures, degenerative joint disease, and vascular calcifications, which could be avoided using CT [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography-Based L1 Bone Mineral Density in 624 Dutch Trauma Patients—Are North American Reference Values Valid in Europe?

Kobes

Sweet

Verstegen

et al. 2022

JPM

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Opportunistic screening for bone mineral density (BMD) of the first lumbar vertebra (L1) using computed tomography (CT) is increasingly used to identify patients at risk for osteoporosis. An extensive study in the United States has reported sex-specific normative values of CT-based BMD across all ages. The current study aims to validate North American reference values of CT-based bone mineral density in a Dutch population of level-1 trauma patients. All trauma patients aged 16 or older, admitted to our level-1 trauma center during 2017, who underwent a CT scan of the chest or abdomen at 120 kVp within 7 days of hospital admission, were retrospectively included. BMD measurements in Hounsfield Units (HU) were performed manually in L1 or an adjacent vertebra. Student’s t-tests were performed to compare the Dutch mean BMD value per age group to the North American reference values. Linear regression analysis and Pearson’s correlation coefficient (ρ) calculations were performed to assess the correlation between BMD and age. In total, 624 patients were included (68.4% men, aged 16–95). Mean BMD decreased linearly with 2.4 HU per year of age (ρ = −0.77). Sex-specific analysis showed that BMD of premenopausal women was higher than BMD of men at these ages. Dutch mean BMD values in the age groups over 35 years were significantly lower than the North American reference values. Our findings indicate that using North American BMD thresholds in Dutch clinical practice would result in overdiagnosis of osteoporosis and osteopenia. Dutch guidelines may benefit from population-specific thresholds.

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Do patients that fracture with normal DXA-measured BMD have normal bone?

Cited by 15 publications

References 26 publications

Fracture in Patients with Normal Bone Mineral Density

Fracture in Patients with Normal Bone Mineral Density

Distinct Metabolites in Osteopenia and Osteoporosis: A Systematic Review and Meta-Analysis

Computed Tomography-Based L1 Bone Mineral Density in 624 Dutch Trauma Patients—Are North American Reference Values Valid in Europe?

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