Advantages of lateral BMD DEXA measurement and concomitant lateral spinal imaging at the point of service over conventional PA measurement in the estimation of BMD

Paul Sneider

doi:10.4102/sajr.v7i2.1400

Abstract

This study examined 144 sequentially selected female patients with a mean age of 53.4 years. The purpose was to assess whether instant vertebral assessment (IVA) and lateral DEXA bone mineral density (BMD) measurement in the lumbar spine would render a significant difference in the assessment of bone loss compared with the older conventional PA measurement only. Thirty-five per cent of our patients' bone loss had to be upgraded because of the lower BMDs found on lateral DEXA scanning of the lumbar spine than was shown on PADEXA studies. Using the Genant classification, asymptomatic vertebral fractures were found in 10% of osteopaenic patients and in 26% who had osteoporosis with lateral IVA assessment. It was therefore concluded that both of these modalities were useful and made a greater contribution in the assessment of bone density loss, therefore enabling a more appropriate treatment protocol to be instituted and also improving patient compliance. The latter occurred because patients would rather accept a visual image of their illness such as a spine fracture or BMD value visually displayed on a graph than a verbal explanation for their asymptomatic but serious disease.

Highlights

Galen (AD 130 - 200) described the skeleton 'as poles to tents and walls to houses, so are bones to living creatures, for other features naturally take form from them and change them
In their study they were able to show that even with a high bone mineral density (BMD) the presence of one vertebral fracture would increase the future vertebral fracture risk by 10.2 times, and this would increase to 75 times when there were multiple spine fractures with a low BMD
Osteoporosis patients (9%) were shown to be osteoporotic with lateral lumbar spine BMD measurement which was evaluated in the PA position as normal

Summary

Introduction

Galen (AD 130 - 200) described the skeleton 'as poles to tents and walls to houses, so are bones to living creatures, for other features naturally take form from them and change them. It is generally accepted that osteoporosis affects up to 30% of the female population As it is symptomless and the first time a patient may become aware of it is when a fracture occurs, it behoves all physicians to diagnose this condition, but to educate their patients so that adequate treatment can be given effectively.In 1991 Ross et aU clearly enunciated the importance of vertebral fractures in patients with bone loss. In 1993 Genant et aP, realising the importance of spinal fractures, classifiedthem according to severity by grading them and morphologically as wedge deformities, biconcave deformities and crush deformities and published a most elegant chart (Fig. 1) depicting these deformities. It has been estimated that about 25% of American women over the age of 50 years have vertebral fractures and this percentage increases dramatically with advancing age, so that by the age of 75, more

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