Osteopaenia on DEXA

Case contributed by Dr Henry Knipe

Presentation

Multiple fractures post fall.

Patient Data

Age: 87 years
Gender: Male
Modality: X-ray

PA spine

  • BMD for L2-L4 is 1.28 g/cm2
  • T-score: 0.3 Age Matched
  • Z-score: 1.3

Left proximal femur

  • BMD for the total hip site is 0.82 g/cm2
  • T-score: -2.1
  • Age Matched Z-score: -0.7

Left forearm

  • BMD for the distal 33% of radius region is 0.86 g/cm2
  • T-score: -1.3
  • Age Matched Z-score: 0.2 

Case Discussion

With a T-score of - 2.1 in the left femoral neck, this patient is considered osteopenic according to World Health Organization (WHO) criteria. Z-score of - 0.7 is within normal limits for age and gender. However, the patient is still considered osteopenic.

Note how the lumbar spine T-score is 0.3 (i.e. appears within normal limits) but is artificially elevated secondary to sclerotic degenerative endplate change. This is why the forearm measurements were also taken (which also demonstrates osteopaenic BMD values). Generally, the lowest value is taken as the measurement for determining normal vs osteopaenia vs osteoporosis. 

Fracture risk is moderate on BMD alone but high taking into account age and history of falls/fractures.

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Case Information

rID: 45996
Case created: 16th Jun 2016
Last edited: 16th Jun 2016
Inclusion in quiz mode: Included

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