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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2020

01-12-2020 | Osteoporosis | Original Article

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

Authors: Sindhura Bandaru, Kristyn Hare, Diane Krueger, Neil Binkley

Published in: Archives of Osteoporosis | Issue 1/2020

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Abstract

Mini abstract

Patients that sustain “osteoporosis-related” fractures may have normal BMD at the hips and spine, but rarely have normal bone when other clinically available studies are considered. Such data often exist and can inform clinical decisions regarding osteoporosis therapy.

Purpose

Dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) at the hip and spine is widely used to diagnose osteoporosis. However, patients that sustain “osteoporosis-related” fractures often have normal BMD at these sites. The aim of this study was to explore whether older adults with fracture, but normal reported hip and spine BMD, also have normal bone using additional clinically available assessments.

Methods

This retrospective electronic medical record study included 387 patients evaluated by a university-based fracture liaison service with spine and hip DXA; 32 (8.3%) had normal spine/hip BMD reported. In this cohort, clinically available bone data including 0.3 and ultradistal radius T-scores, trochanteric T-scores, lumbar spine trabecular bone score (TBS), L1 opportunistic CT Hounsfield units (HU), and femoral cortical index (FCI) were assessed.

Results

One or more of the above noted studies were available in 30/32 patients. UD and 0.3 radius results were available in 21 patients, and 18 (85.7%) had T-scores < − 1.0. Trochanteric values were available in 16; T-scores were < − 1.0 in 18.8%. TBS data were available in 24; partially degraded or degraded values were present in 41.7%. L1 opportunistic CT was available in 25 patients, 80% were below normal, and < 150 HU. Finally, femoral cortical index (FCI) was measurable in 9 subjects; 66.7% were below < 0.4. When including all additional available data in the skeletal assessment, only 5/387 (1.3%) were identified with normal bone.

Conclusion

Patients with normal spine/hip BMD who sustain fracture rarely have normal bone when all available data are considered.
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Metadata
Title
Do patients that fracture with normal DXA-measured BMD have normal bone?
Authors
Sindhura Bandaru
Kristyn Hare
Diane Krueger
Neil Binkley
Publication date
01-12-2020
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00745-0

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