Osteoporotic Fractures: Diagnosis, Evaluation, and Significance

Dr. Aliya Khan, is a Clinical Professor of Medicine at McMaster University in Hamilton, Ontario, Canada and is the Co-Chair of the International Working Group on DXA Best Practices. She shares insights from her article appearing in the July 2024 issue of Mayo Clinic Proceedings where she describes fragility fractures as being indicative of compromised bone strength; individuals with fragility fractures can benefit from pharmacologic intervention designed to treat the underlying metabolic bone disease; fracture history is critical in the evaluation of fracture risk; the majority of fragility fractures occur in individuals with BMD T-scores higher than -2.5 and it is necessary to be aware of the limitations of DXA technology in evaluating fracture risk.
VFA -Vertebral Fracture Assessment - is valuable in identifying the presence of previously undiagnosed vertebral fractures and assessing the risk of future fractures and can be obtained at the same time as the BMD study at minimal cost and radiation exposure. Also Trabecular Bone Score (TBS) is a valuable tool which can assess bone quality and is determined from the DXA spine image. TBS can independently predict fracture risk and is particular value in conditions where bone quality is impaired. These include poorly controlled diabetes, chronic kidney disease, parathyroid disease as well as long term steroid use. In these conditions adjusting the FRAX score for the TBS can further improve fracture risk assessment. Available at: mayocl.in/3yvBbFZ