Abstract
Requirements for clinical densitometric evaluation of fracture risk of an individual patient are obvious: the method must be noninvasive and safe, it should provide adequate assessment of bone fragility, be sensitive and specific enough to detect small differences or changes in structural bone traits that are vital to bone strength, and appreciably add to the predictive ability of prior assessment of fracture risk based on established clinical risk factors of the given patient. At present, clinical evaluation of bone fragility largely rests on dual-energy x-ray absorptiometry (DXA) and the obtained areal bone mineral density (BMD) and the T- and Z-scores derived from it. Whereas BMD correlates strongly with bone strength and low BMD indicates increased relative risk of fragility fractures, the overall proportion of fractures attributable to osteoporosis, as diagnosed by low DXA-measured BMD, remains quite modest. This paradox apparently arises from the limited ability of areal BMD to elicit individual pat...
Published Version
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