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. 2016 Apr;4(4):18.
doi: 10.1007/s40134-016-0144-1. Epub 2016 Feb 15.

Osteoporosis Imaging in the Geriatric Patient

Free PMC article

Osteoporosis Imaging in the Geriatric Patient

Ursula Heilmeier et al. Curr Radiol Rep. .
Free PMC article


Given the expected rapid growth of the geriatric world population (=individuals aged >65 years) to 1.3 billion by 2050, age-related diseases such as osteoporosis and its sequelae, osteoporotic fractures, are on the rise. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) is the current gold standard to diagnose osteoporosis, to assess osteoporotic fracture risk, and to monitor treatment-induced BMD changes. However, most fragility fractures occur in patients with normal or osteopenic aBMD, indicating that factors beyond BMD impact bone strength. Recent developments in DXA technology such as TBS, VFA, and hip geometry analysis are now available to assess some of these non-BMD parameters from the DXA image. This review will discuss the use of DXA and DXA-assisted technologies and their respective advantages and disadvantages. Special attention is given to if and how each method is indicated in the geriatric population, and the latest ISCD 2015 guidelines have been incorporated.

Keywords: Aging; FRAX; Geriatrics; ISCD.


Fig. 1
Fig. 1
Representative DXA studies of a the proximal femur and b the lumbar spine of a 68-year-old woman. The lowest T-score of total and femoral neck regions of interest is used to grade the bone as normal, osteopenic, or osteoporotic. a In this postmenopausal woman, the T-score of the proximal femur was −2.1 which is in the osteopenic range according to the WHO osteoporosis definition. b L1–4 DXA image of the lumbar spine in the same postmenopausal women (68 years). The total T-score of the lumbar spine involving L1 to L4 is −3.0 and therefore in the osteoporotic range. Please note the discordance between the two T-scores as they fall into different, but adjacent classes (osteopenic versus osteoporotic). Priority is given in this case to the osteoporotic T-score and the patient should be diagnosed as osteoporotic
Fig. 2
Fig. 2
Representative vertebral fracture assessment (VFA) image of the spine obtained with DXA showing multilevel osteoporotic fractures at the lumbar spine

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