Osteoporosis (DEXA)

Case contributed by Dr Henry Knipe


Multiple fractures post fall.

Patient Data

Age: 87 years
Gender: Male

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 (total), -2.7 (neck)
  • 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 

BMD: bone mineral density

Case Discussion

With a T-score of - 2.7 in the left femoral neck, this patient is considered osteoporotic 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 demonstrates osteopenic bone mineral density (BMD) values). Generally, the lowest value is taken as the measurement for determining normal vs osteopenia vs osteoporosis. 

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

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Case information

rID: 45996
Published: 16th Jun 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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