Ankylosing spondylitis (DEXA)

Case contributed by Dr Chris Newman

Presentation

Routine DEXA. ? Increased risk of fracture.

Patient Data

Age: 70 years
Gender: Male
X-ray
  • T-scores in the lumbar spine, femur and forearm are: 0.5 (lumbar); -2 (femoral neck); -2.6 (forearm) 
  • the femoral neck score of -2 and the forearm score of -2.6 are considered osteopenic and osteoporotic respectively as per the WHO guidelines
  • The lumbar score is within the normal range, however note the diffuse syndesmophytic ankylosis with "bamboo spine" appearance

Case Discussion

Ankylosing spondylitis on DEXA scan. The 'normal' lumbar values are likely inaccurate in the lumbar spine given the extent of flowing calcification / ankylosing syndesmophyes associated with ankylosing spondylitis.

This case illustrates the importance of reviewing the bone morphology in addition to the computer-generated numbers when determining fracture risk.

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