Bone mineral density (BMD)

Introduction:
 Bone mineral density (BMD) is a measure of bone mass per unit
of bone area that increases with age until peak bone density is
achieved. It is correlated highly with bone strength and is therefore
used to quantitatively screen and diagnose patients.
 Bone densitometry is the only method for diagnosing or
confirming osteoporosis in the absence of a fracture
BONE MINERAL DENSITOMETRY
Introduction:
 BMD is widely used in identifying patients with osteoporosis and an
increased risk of osteoporotic fracture
 It is expressed in grams per unit area (or unit volume in the case of
quantitative computed tomography) and is recorded in comparison to
the sex and age specific distribution of these values in the general
population.
Principle:
 Measurement is based on the principle that a beam of energy is
attenuated as it passes through bone, and the degree of attenuation is
related to the mass and mineral content of the bone.
 The measurements are specific for each location (lumbar spine,
femoral neck, distal radius, etc).

Various techniques:
a. Radiographic absorptiometry (RA)- conventional radiographic equipment and measures
bone density in the phalanges.
b. Quantitative computed tomography (QCT) - Measures trabecular bone density in
vertebral bodies, but is not widely
available and involves a higher dose of ionizing
radiation than DXA
c. Quantitative ultrasonometry (QUS) - assesses bone mineral density in the peripheral
skeleton (e.g. the wrist and
calcaneus) by measuring both the attenuation of ultrasound
and the variation of speed of sound through the bone
d. Single-energy x-ray absorptiometry - measuring the BMD at the wrist (for example) does
not accurately reflect bone density
in the spine or femoral neck
e. dual energy x-ray absorptiometry (DXA)- most popular and widely used
technique.
1) It uses columnated low-dose x-ray beams of two different
energy levels
2) Thus it distinguish the density of bone from that of soft
tissue.
3) Advantage: extremely low dose of ionizing radiation
4) It uses huge international database that allows expression
of bone mineral density values in comparison to both an age and
sex matched population (Z score) and also to the peak adult bone
mass (T score).
5) The T score in particular allows calculation of relative
fracture risk.
WHO bone density criteria for osteoporosis

from that of a young healthy

BMD measurement (expressed

T-score is a measure of SD the

Zscore is a measure of SD the

patient’s BMD value differs

BMD deviates from age-

hydroxyapatite/cm2)

matched controls
as grams of

control,
Indication of BMD measurement
A. For Screening
Recommendations for BMD testing are
1. Any woman aged 65 years or older, regarding of their risk
factors for osteoporosis
2. Postmenopausal women younger than 65 years who have at
least 1 risk factor for osteoporosis other than menopause. e.g
i. Family history of osteoporosis
ii. Personal history of low trauma fracture at age >
45 years
iii. Current smoking
iv. Low body wt (<127 lb)
3. All postmenopausal women who have experienced a fragility
fracture
Other factors for screening
i. Young women following oophorectomy
ii. Perimenopausal women with fractures of
wrist, ribs, vertebral bodies or hip
iii. Women or men with x-ray features of
osteopaenia
iv. Men with testosterone deficiency
B. For Diagnosis
 Patients with hyperparathyroidism,
hyperthyroidism, renal insufficiency or rheumatoid arthritis
C. For Monitoring
 Response to the therapy
 Patients on long-term glucocorticoids,
thyroid hormone, thiazide diuretics

Protocol to treat a patient with the help of bone densitometry:

 Indication of
reassessment:
a.Within 2 years
- to see additional
bone loss
- to asses response
to treatment

b. More frequent
testing
- If Pt. is receiving
steroid for > 3
years

Conclusion: BMD is an easy reliable non invasive procedure that takes only
20 to 40 min with minimal radiation and fulfills the aim to assess risk of
fracture.
 Bone mineral density (BMD) values
plotted in g/cm2 (left axis) and as the T-
score values (right axis). The solid line
represents the population average
plotted against age, and the interrupted
lines are ± 2 standard deviations from
the average. The patient shown, aged
80, has an osteoporotic T-score of −3.0,
but has a Z-score of −1.0, which is
within the ‘normal range’ for that age,
reflecting the fact that bone is lost with
age.

FRAX – fracture risk assement tool