This patient has a history of 10 years’ oral bisphosphonate therapy. What are the potential complications of long term bisphosphonate use?
There is a small risk of bisphosphonate-related atypical femoral fracture and osteonecrosis of the jaw.
What is the diagnosis based on the DXA results?
Osteoporosis (WHO crtieria. Lowest T-score <-2.5)
To which DXA regions of interest can the WHO diagnostic criteria be applied?
Femoral neck; total hip; lumbar spine. In some circumstances, the criteria can also be applied to the 1/3 radius ROI.
The lumbar spine images show vertebral fractures at T12 and L1. L1 has therefore been excluded from the analysis.
The hip measurement is of good technical quality.
The vertebral fracture assessment (VFA) image shows:
- Moderate wedge fractures at T6, T7 and T8.
- Moderate superior endplate fracture at T11 and T12.
- Severe wedge fracture at L1.
There is some mild loss of height at T10 (relative to T9), however there is no definite central endplate depression and this cannot be confirmed to be a fracture on this image.
These findings are consistent with the patient’s history of osteoporosis.
The lowest T-score is -3.0 at the lumbar spine, giving a diagnosis of osteoporosis according to WHO criteria (<-2.5).
The Z-score at the lumbar spine is -2.5, the patients BMD is below the expected range for their age.
Since the previous scan there has been a 6.7% increase in BMD at the spine, which surpasses the least significant change.
There is no statistically significant change in BMD at the hip.