Jul 2026· Journal of clinical densitometry· Vol 29 4, pp.
101734
· 0 citations· 34 references
Medicine
TL;DR
Spine-hip BMD discordance is common among Jordanian adults undergoing DXA, particularly in those assessed using T-scores, underscoring the importance of multisite DXA assessment to improve diagnostic accuracy and fracture risk evaluation.
Abstract
BACKGROUND/
Objectives
Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and increased fracture risk. Dual-energy X-ray absorptiometry (DXA) is the reference standard for diagnosis, typically assessing the lumbar spine and femoral neck. Site-specific differences may result in spine-hip BMD discordance, potentially influencing clinical decision making. This study aimed to determine the prevalence, patterns, and predictors of spine-hip BMD discordance among Jordanian adults.
Methods
This retrospective observational study included adults aged ≥18 years who underwent DXA for osteoporosis evaluation at two tertiary hospitals in Jordan between March 2024 and June 2025. Lumbar spine and femoral neck BMD were measured using standardized DXA protocols. Discordance was classified using T-scores or Z-scores as appropriate.
Results
A total of 826 participants were included, comprising 576 evaluated using T-scores and 250 using Z-scores. In the T-score group, lumbar spine-femoral neck BMD discordance was observed in 66.0% of participants, including 50.5% with minor discordance and 15.5% with major discordance, while 34.0% were concordant. In contrast, discordance was present in only 18.4% of the Z-score group. After adjusting for principal demographic and high-prevalence clinical parameters, Multivariable analysis identified family history of osteoporosis and sex as independent predictors of discordance severity in the T-score group, whereas no significant predictors were identified in the Z-score group.
Conclusions
Spine-hip BMD discordance is common among Jordanian adults undergoing DXA, particularly in those assessed using T-scores, underscoring the importance of multisite DXA assessment to improve diagnostic accuracy and fracture risk evaluation.
Lumbar VBQ-DXA discordance is associated with a physiological signature characterized by triglyceride-rich lipoproteins, glycation burden, and conjugated bilirubin, which may complement VBQ by identifying metabolically vulnerable, marrow-related bone quality changes that are not fully captured by DXA-derived T-scores.
Jie Hao, Fayao Yan, Yu Yao et al.· Bone· 0 citations
Osteoporosis is the most prevalent metabolic bone disease and is associated with an increased risk of fragility fractures. Current guidelines recommend bone mineral density (BMD) assessment by DXA primarily in women aged ≥65 years or in younger women with clinical risk factors. However, DXA is frequently performed in women under 65 years without guideline-based indications. Objective: To describe the prevalence of densitometric osteoporosis in women under 65 years undergoing DXA in the absence of clinical risk factors. Methods: A descriptive cross-sectional study was conducted at a referral center. Women aged 40–65 years consecutively referred for DXA between February and September 2024 were included. Participants with FRAX® clinical risk factors, major osteoporotic fractures, secondary metabolic bone diseases, or dietary restrictions were excluded. BMD was assessed at the lumbar spine, total hip, and femoral neck. Osteoporosis was defined as a T-score ≤ -2.5. Results: A total of 119 women were included (mean age 53 years; range 43-62). Mean T-scores were -0.9±1.3 at the lumbar spine, -0.9±1.1 at the total hip, and -1.0±1.0 at the femoral neck. BMD values within the osteoporotic range was observed in 13% (n=15) at the lumbar spine and in 7% (n=8) at both the total hip and femoral neck. Overall, 17% (n=20) had BMD values within the osteoporotic range at at least one skeletal site. Conclusion: Densitometric osteoporosis was identified in a relevant proportion of women younger than 65 years without traditional risk factors, supporting an individualized approach to bone health assessment.
Josefina Rosmino, M. Pavlove, M. L. Brance et al.· EndoAr· 0 citations
Study Design
Retrospective sex- and age-matched case-control study.
Purpose
To assess bone mineral density (BMD)-trabecular bone score (TBS) discordance and high-burden abdominal aortic calcification (AAC) in patients with radiographically confirmed osteoporotic vertebral compression fracture (OVCF).
Overview of Literature
Conventional BMD thresholds may fail to identify all patients with vertebral skeletal fragility, as vertebral fractures can occur despite nonosteoporotic BMD. TBS complements BMD by evaluating trabecular microarchitecture, while AAC may serve as a marker of systemic bone-vascular health associated with skeletal fragility.
Methods
This retrospective sex- and age-matched case-control study enrolled patients aged ≥50 years who underwent dual-energy X-ray absorptiometry (DXA) with TBS assessment and vertebral imaging. OVCF was defined as a Genant grade 2 or 3 vertebral fracture. The primary cohort included 47 OVCF patients and 188 matched controls. BMD T-scores at the lumbar spine, femoral neck, total hip, TBS, and AAC-24 were evaluated. Matched conditional logistic regression was used to determine associations with OVCF.
Results
More than half of OVCF patients did not demonstrate osteoporotic BMD at any measured DXA site (53.2%). Among those with nonosteoporotic BMD, low TBS was more common in cases than in controls (48.0% vs. 22.7%). Low TBS remained independently associated with OVCF after adjusting for the lowest BMD T-score and high-burden AAC (odds ratio, 2.66; 95% confidence interval, 1.25-5.63; p =0.011). High-burden AAC was more frequent among cases, although its association was attenuated after adjustment.
Conclusions
Low TBS may aid in identifying vertebral skeletal fragility in OVCF patients with nonosteoporotic BMD on conventional DXA. High-burden AAC may provide vascular information, although its incremental association beyond BMD and TBS was attenuated.
VBQ can serve as an opportunistic exploratory screening marker of low BMD and FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.
Margrit Elis Müller, João Paulo Colhado Ferreira, Laura Mulazzani Minuzzi Macedo et al.· Skeletal Radiology· 0 citations
Background: Whether routinely available laboratory measures are associated with longitudinal bone mineral density (BMD) change in clinical practice remains uncertain, particularly when treatment exposure and other major skeletal determinants are incompletely recorded. This study examined BMD trajectories and incident osteoporosis in a Saudi dual-energy X-ray absorptiometry (DXA) cohort. Anti-osteoporosis therapy, glucocorticoid exposure and menopausal status were unavailable, limiting causal interpretation. Methods: This retrospective longitudinal cohort included DXA examinations performed at King Saud University Medical City (KSUMC), Riyadh, from 2016 to 2021. The trajectory analysis comprised 2147 patients with at least two scans and a minimum one-year interval. Diagnostic category was based on the lowest T-score across the lumbar spine, bilateral femoral necks and distal radius. Twenty linear mixed-effects (LME) models evaluated time-by-biomarker interactions with Benjamini–Hochberg correction. Cox proportional hazards (PH) regression was the primary analysis of incident osteoporosis among 789 patients without osteoporosis at baseline. Results: During 2045 person-years of observation, 107 patients developed osteoporosis (5.2 events per 100 person-years). No event occurred among 124 patients with normal baseline BMD, compared with 107 events among 665 patients with baseline osteopenia (log-rank p < 0.001). In the complete-case Cox model (n = 384; 53 events; C-index = 0.679), baseline osteopenia had a hazard ratio (HR) of 3.12 (95% Confidence interval (CI) 0.89–10.97; p = 0.076); no modelled covariate reached statistical significance. None of the 20 time-by-biomarker interactions remained significant after multiplicity correction (smallest q = 0.214). Four nominal terms with raw p < 0.10 were below the measurement-based clinical threshold and were compatible with chance variation. Conclusions: No routinely measured biomarker demonstrated clinical utility for identifying BMD trajectory in this cohort. Baseline DXA category separated the observed progression pattern, although this partly reflects the distance from the diagnostic threshold and should not be interpreted as a validated prediction model. The principal contribution is a carefully characterised null result. Prospective studies with explicit treatment tracking and repeated bone-turnover measurements are required for confirmation.
L. Jambi, S. Kabrah· Journal of Clinical Medicine· 0 citations
Objective To develop and validate a clinical prediction model integrating lumbar spine bone mineral density (LS-BMD) and fall risk assessment for identifying secondary osteoporosis in community-dwelling elderly men. Methods This retrospective cross-sectional study enrolled men aged 65 years or older from community health centers and geriatric outpatient clinics (June 2023-December 2025). Secondary osteoporosis was defined as T-score ≤ −2.5 at any site (lumbar spine, femoral neck, or total hip) with at least one confirmed major secondary etiology (hypogonadism, glucocorticoid use, vitamin D deficiency, etc). Controls were men with normal BMD or osteopenia without secondary etiology. Participants were randomly assigned to training (70%) and validation (30%) sets. LASSO regression and multivariate logistic regression were used for variable selection and model construction. Bootstrap resampling provided optimism-corrected performance estimates. Results Among 843 eligible participants (mean age 73.12±5.27 years), 187 (22.18%) were diagnosed with secondary osteoporosis. Six independent predictors were identified: age, LS-BMD T-score, history of fall, testosterone, glucocorticoid use, and vitamin D level. The apparent AUC was 0.846 (95% CI: 0.815–0.878) in the training set and 0.798 (95% CI: 0.741–0.854) in the validation set; the optimism-corrected AUC was 0.731, indicating moderate discrimination. Calibration was satisfactory. Decision curve analysis confirmed clinical net benefit. Of note, three predictors (testosterone, vitamin D, glucocorticoid use) overlap with the diagnostic criteria for secondary osteoporosis, and the AUC values should be interpreted with this caveat in mind. Conclusion This study developed a preliminary clinical prediction model for identifying secondary osteoporosis in elderly men using internal validation. The model integrates LS-BMD T-score, fall risk, Vitamin D, testosterone, and glucocorticoid use, but external validation is required before clinical application. The overlap between several predictors and the diagnostic criteria represents an important limitation.
Yi-You Fang, Liang Zhang, Gang Dong et al.· Orthopedic Research and Revi...· 0 citations
