DXA parameters: beyond bone mineral density

Dual-energy X-ray absorptiometry (DXA) is the reference standard for measuring bone mineral density (BMD) to diagnose osteoporosis. However, BMD measurement alone does not reliably predict the fracture risk. DXA can be used to assess other parameters (e.g. presence of vertebral fractures, bone microarchitecture, bone geometry, and body composition) simultaneously with BMD measurements, to help identify individuals at high fracture risk. Among these parameters, some are suitable for use in clinical practice, whereas others are reserved for research. Vertebral fracture assessment (VFA) is a very low radiation-dose method for detecting thoracic and lumbar vertebral fractures. Compared to standard radiography, VFA can be used in a broader population to detect asymptomatic vertebral fractures. The very good negative predictive value of VFA leads, in one-third of cases, to changes in patient management (drug treatment and prescription of radiographs). The trabecular bone score (TBS) is a noninvasively measured texture parameter that correlates with 3D bone microarchitecture parameters independently from BMD and that can be determined from lumbar-spine DXA images. Several cross-sectional studies and a prospective study established that the TBS was effective in identifying individuals with fractures. Additional studies will have to be performed to determine whether TBS determination can be recommended for everyday practice when treatment decisions are difficult.