Bone Mineral Density: Clinical Relevance and Quantitative Assessment

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the benefits and limitations of evaluating bone mineral density by dual-energy x-ray absorptiometry and FRAX to assess fracture risk; (2) the uses of various pharmacologic therapies available for the treatment of osteoporosis; and (3) the process of monitoring and ensuring patient response to osteoporosis therapy.Financial Disclosure: Dr. Farooki has received consulting fees from Amgen and has been an Amgen advisory board member. Dr. Bilezikian has received consulting fees from Radius and Amgen. This work was supported in part by NIH/NCI Memorial Sloan Kettering Cancer Center support grant P30 CA008748. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through April 2024.Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility-fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the fracture risk assessment tool (FRAX) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the U.S. National Osteoporosis Foundation guidelines, postmenopausal women and men at least 50 y old with osteopenic BMD warrant pharmacologic treatment if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. Although reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiplefracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy with an improvement in BMD, or who have an incident fragility fracture on therapy, secondary causes of osteoporosis or non-compliance with medical therapy should be consider...

Bone mineral density and risk of breast cancer: A cohort study and Mendelian randomization analysis

“…At baseline assessment, the heel BMD of participants was evaluated by quantitative ultrasound and then converted into a T score. Although dual‐energy x‐ray absorptiometry technology is recognized by the World Health Organization as the gold standard for the diagnosis of osteoporosis, quantitative ultrasound was also widely used in screening because of its low cost, convenience, and high consistency with dual‐energy x‐ray absorptiometry diagnosis in the UK Biobank 17‐19 . The following descriptive categories were proposed according to diagnostic criteria of osteoporosis 20 : T score ≥−2.5, and T score <−2.5, whereas women with T score <−2.5 were further divided into those with or without fractures.…”

“…Although dual-energy x-ray absorptiometry technology is recognized by the World Health Organization as the gold standard for the diagnosis of osteoporosis, quantitative ultrasound was also widely used in screening because of its low cost, convenience, and high consistency with dual-energy x-ray absorptiometry diagnosis in the UK Biobank. [17][18][19] The following descriptive categories were proposed according to diagnostic criteria of osteoporosis 20 : T score ≥−2.5, and T score <−2.5, whereas women with T score <−2.5 were further divided into those with or without fractures. The diagnosis of fracture was obtained through linkage to the inpatient hospitalization data in the UK Biobank using International Classification of Diseases-10 (ICD-10) codes (S02, S12, S22, S32, S42, S52, S62, S72, S82, S92, T02, T12).…”

The Impact of an Adapted Physical Activity Program on Bone Turnover, Physical Performance and Fear of Falling in Osteoporotic Women with Vertebral Fractures: A Quasi-Experimental Pilot Study

“…The body of evidence available evokes the need to evaluate the benefits of exercise administered to postmenopausal women with OP. To date, the dual-energy X-ray absorptiometry (DXA) for the assessment of bone mineral density (BMD) is the most widely used tool to diagnose and monitor the OP [ 22 , 23 ]. Some blood and urinary biomarkers have been proposed to assess the dynamics of bone metabolism and to evaluate the efficacy of therapeutic interventions for OP [ 24 ].…”

Accuracy and applicability of dual-energy computed tomography in quantifying vertebral bone marrow adipose tissue compared with magnetic resonance imaging

“…Osteoporosis (OP) is a complex multifactorial disease, mainly manifested as a decrease in bone density and bone strength, and its diagnosis and quantitative assessment mainly rely on bone density assay [ 1 ]. Recent studies have shown that bone marrow adipose tissue (BMAT) plays an important influence in the mechanism of OP, and its endocrine effect and impact on bone structural strength is worth noting [ 2 , 3 ].…”