Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors

Diagnostic discordance for osteoporosis is the presence of different categories of T-scores in 2 skeletal sites of an individual patient, falling into 2 different diagnostic categories identified by the World Health Organization classification system.

To evaluate the prevalence and risk factors for T-score discordance between spine and total hip measurement sites.

Demographic data, anthropometric measurements, and risk factors for osteoporosis were derived from a database of 3479 patients referred to a community-based outpatient osteoporosis testing center. Dual-energy x-ray absorptiometry (DXA) was performed on L1-L4 lumbar spine and total hips for all cases. Minor discordance was defined as present when the difference between 2 sites was no more than 1 World Health Organization diagnostic class. Major discordance was present when 1 site is osteoporotic and the other is normal. Subjects with incomplete data were excluded.

In 3479 participants (2871 women; mean age, 55.7 +/- 11.9 years), concordance of T-scores, minor discordance, and major discordance were seen in 54, 42, and 4%, respectively. In multivariate logistic regression analysis, age, menopause, and obesity were identified as risk factors against T-score discordance.

Densitometrists and clinicians should expect that at least 4 of every 10 patients tested by DXA to demonstrate T-score discordance between spine and total hip measurement sites. T-score discordance can occur for a variety of reasons related to physiologic and pathologic patient factors as well as the performance or analysis of DXA itself.