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Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm 2 and the T score was −2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm 2 and the T score was −2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60-70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.A strong relation exists between bone mineral density (BMD) measured by dual energy x ray absorptiometry (DXA) and the risk of fracture.1 Fracture risk increases with decreasing BMD, so that there is no exact cut off point to characterise absolutely a person who will fracture from one who will not. The consensus definition 3 of osteoporosis captures the notion that low BMD is an important component of the risk of fracture. Furthermore, the operative definition 4 is based on BMD status; in 1994, an expert panel of the World Health Organisation (WHO) recommended thresholds of BMD in women to define osteopenia and osteoporosis.It is clear that the relation between fracture risk and bone density is best described as a gradient rather than a threshold. However, WHO thresholds are useful in clinical practice to give information on prognosis. Moreover, although risk factors independent of bone mass should also be considered, 2 BMD status is the main factor in the decision on intervention, and WHO thresholds are used as cut off points. 6Unfortunately, the generalised use of DXA is limited because it is expensive and time consuming, it is not portable, and it is available only in specialised clinics. It is therefore only feasible to use it to investigate patients at high risk of osteoporosis. Thus, a previous fragility fracture is a classic indication for bone densitometry, 7 which is supported by the more recent guide...

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