Guidelines for the diagnosis of osteoporosis: T-scores vs fractures

Abstract

The development of bone mineral densitimometry methodologies, especially central dual energy X-ray absorptiometry (DXA) methods have allowed this quantitative tool to be used to diagnose osteoporosis before the first fragility fracture has occurred. The World Health Organization osteoporosis working group set the stage for the BMD cut-off criteria development. The wide application of DXA has brought the treatment of osteoporosis to the primary care level, a very necessary step if this increasingly prevalent disease is to have a decline in its incidence. The most difficult osteoporosis cases, for which there are many and their associated difficult DXA results and interpretation will always require specialists' involvement. In particular, the embracement of the WHO absolute fracture risk validated project will take DXA to a much greater level of value in making management decisions. In particular, the WHO absolute risk data will allow physicians, health-economic policy makers, and payors of medical services to come closer together to decide which patients are at a level of unacceptable fracture risk that justifies treatment intervention. The implementation of this validated project will also remove the unacceptable subjective computer printouts on DXA reports that often lead to the over-treatment of low risk patients and at times the under-treatment of high risk patients. The evolution of the clinical interpretation of bone densitometry has been a work in progress. Challenges in the clinical measurement of bone strength remain and will also evolve. The field of osteoporosis has grown with the use of DXA and will continue to embrace this technology as other technologies to measure fracture risk become applied in clinical practice.

Low bone mineral density and fracture burden in postmenopausal women

“…As a result, older patients with fragility fractures who did not have osteoporosis, as defined by the World Health Organization criteria, may not have received treatment. 18 Our study supports the concept that bone mineral density captures only one aspect of fracture risk, namely the quantity of bone, and that other factors that may influence bone strength or the risk of falls are also contributors to fracture risk. For example, prospective studies have consistently demonstrated that clinical risk factors such as age, prior fracture, a family history of osteoporosis and corticosteroid use contribute to fracture risk, independent of bone density as determined by absorptiometry.…”

Evaluation of the WHO criteria for the classification of patients with mastocytosis

“…Presence of osteoporosis was defined following well-established criteria 20,21 and the presence of bone sclerosis-as assessed by skeletal X-ray survey and/or computed tomography-scanwas also recorded. Skin biopsy was performed in all cases with cutaneous lesions.…”

Bone mineral density in Japanese prostate cancer patients under androgen-deprivation therapy

“…units relative to young adult men (T-score) and relative to age-matched men (Z-score). According to World Health Organization criteria, a normal BMD is defined as a T-score greater than K1 S.D.s, osteopenia as a T-score between K1 and K2.5, and osteoporosis as a T-score of K2.5 or less (Miller 2006).…”

“…Comparison of the BMDs, T-scores, and Z-scores of the hormone-naive and ADT-treated patients According to new guidelines, osteoporosis can be diagnosed when DXA of the lumbar spine, total hip, or femoral neck yields a T-score of K2.5 or less (Miller 2006). Therefore, we measured the BMD at these three sites in this study.…”