Low-trauma fractures without osteoporosis.
In clinical practice, areal bone mineral density (aBMD) is usually measured using dual-energy X-ray absorptiometry (DXA) to assess bone status in patients with or without osteoporotic fracture. As BMD has a Gaussian distribution, it is difficult to define a cutoff for osteoporosis diagnosis. Based on epidemiological considerations, WHO defined a DXA-based osteoporosis diagnosis with a T-score <-2.5. However, the majority of individuals who have low-trauma fractures do not have osteoporosis with DXA (i.e., T-score <-2.5), and some of them have no decreased BMD at all. Some medical conditions (spondyloarthropathies, chronic kidney disease and mineral bone disorder, diabetes, obesity) or drugs (glucocorticoids, aromatase inhibitors) are more prone to cause fractures with subnormal BMD. In the situation of fragility fractures with subnormal or normal BMD, clinicians face a difficulty as almost all the pharmacologic treatments have proved their efficacy in patients with low BMD. However, some data are available in post hoc analyses in patients with T score >-2. Overall, in patients with a previous fragility fracture (especially vertebra or hip), treatments appear to be effective. Thus, the authors recommend treating some patients with a major fragility fracture even if areal BMD T score is above -2.5.
Laboratoire I3MTO, Université d'Orléans, 4708, 45067, Orléans, EA, France. eric.lespessailles@chr-orleans.fr.|Regional Hospital of Orleans, 14 avenue de l'hopital, 45067, Orleans, Cedex 2, France. eric.lespessailles@chr-orleans.fr.
E
E
Lespessailles
EA 4490 PMOI-Physiopathologie des Maladies Osseuses Inflammatoires, Université de Lille, 59000, Lille, France.|Service de Rhumatologie, CHU Lille, 59000, Lille, France.
B
B
Cortet
Service de Rhumatologie, CHU d'Angers, 49933, Angers, France.
E
E
Legrand
Service de Rhumatologie, CHU Rennes, 35203, Rennes, France.|, INSERM UMR 991, 35000, Rennes, France.|Faculté de Médecine, Université Rennes 1, 35043, Rennes, France.
P
P
Guggenbuhl
INSERM U 1153, hôpital Cochin, Université Paris Descartes, Paris, France.
C
C
Roux
D015519:Bone Density / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005598:Fractures, Spontaneous / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D012016:Reference Values
D050071:Bone Density Conservation Agents; D005938:Glucocorticoids
BMD; Diagnosis of osteoporosis; Low-trauma fracture; Normal BMD; Treatment of osteoporosis