Osteoporosis Imaging in the Geriatric Patient

Abstract

Given the expected rapid growth of the geriatric world population (=individuals aged >65 years) to 1.3 billion by 2050, age-related diseases such as osteoporosis and its sequelae, osteoporotic fractures, are on the rise. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) is the current gold standard to diagnose osteoporosis, to assess osteoporotic fracture risk, and to monitor treatment-induced BMD changes. However, most fragility fractures occur in patients with normal or osteopenic aBMD, indicating that factors beyond BMD impact bone strength. Recent developments in DXA technology such as TBS, VFA, and hip geometry analysis are now available to assess some of these non-BMD parameters from the DXA image. This review will discuss the use of DXA and DXA-assisted technologies and their respective advantages and disadvantages. Special attention is given to if and how each method is indicated in the geriatric population, and the latest ISCD 2015 guidelines have been incorporated.

Current Status of the Diagnosis and Management of Osteoporosis

“…the diagnosis of osteoporosis is mainly based on the evaluation of bone mass by bone densitometry (DEXA) [ 67 ]. Although osteoporosis is more than a bone densitometry value, this evaluation allows for the quantification of bone tissue, which is used as a diagnostic criterion and is considered a predictive value for the risk of fracture, which makes it the best method for determining the rate of bone loss and as a reference point for the evolutionary control of the disease [ 68 ].…”

The mechanical loading and muscle activation of four common exercises used in osteoporosis prevention for early postmenopausal women

“…Skin was shaved, abraded and cleansed with a 70% alcohol swab before electrode attachment. The accelerometer was vertically aligned and attached to the participant's sacrum (S1) due to the flatter attachment site, to estimate whole body acceleration in close proximity to the hip and lumbar spine which are at risk of osteoporotic fracture (Kelley et al, 2014;Heilmeier et al, 2016). Accelerometer and EMG wearable hardware were secured with surgical tape and elasticated bandages to reduce signal artefacts.…”

Additional tools for the estimation of fracture risk using DXA method

“…Given this reality, efforts have been made in recent years to more accurately screen patients who may be at increased risk of fragility fractures by developing better assessment tools based on DXA, which is readily available. These adjunct techniques include VFA (vertebral fracture assessment), (TBS) trabecular bone score, as well as, DXA-derived hip structural analysis [1][2][3][4][5][6] .…”