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

Area of Science:

• Gerontology
• Orthopedics
• Radiology

Background:

• Dual-energy X-ray absorptiometry (DXA) is standard for diagnosing osteoporosis.
• Osteoporosis-related fractures can occur despite normal hip and spine bone mineral density (BMD).
• This highlights a potential gap in identifying at-risk individuals using conventional methods.

Purpose of the Study:

• To investigate if older adults with fractures but normal hip and spine BMD exhibit normal bone health via other assessments.
• To determine the utility of additional bone assessments in evaluating fracture patients with seemingly normal DXA results.

Main Methods:

• Retrospective study of 387 patients evaluated by a fracture liaison service.
• Assessed patients with normal spine/hip DXA (n=32) using additional bone data.
• Included ultradistal radius T-scores, trabecular bone score (TBS), L1 CT Hounsfield units (HU), and femoral cortical index (FCI).

Main Results:

• Additional assessments were available for 30/32 patients with normal hip/spine BMD.
• Most patients showed abnormalities in radius T-scores (85.7%), TBS (41.7%), L1 CT HU (80%), and FCI (66.7%).
• Only 1.3% of the total cohort (5/387) had normal bone health when all data were considered.

Conclusions:

• Patients sustaining fractures, even with normal hip/spine BMD, rarely have normal bone health.
• Comprehensive skeletal assessment using various available data is crucial for accurate osteoporosis evaluation.
• These findings underscore the need for broader diagnostic criteria beyond standard DXA.