T-scores alone insufficient in assessing osteoporosis in patients with osteopenia

ByErich Martin

Fact checked byJason Laday

SAN DIEGO — Patients with low bone density may have osteoporosis despite registering a bone mineral density score higher than –2.5, according to a speaker at the Congress of Clinical Rheumatology West

Although osteoporosis is typically diagnosed when a patient demonstrates a T-score of less than or equal to –2.5, there are other factors that could indicate a patient qualifies for the diagnosis, said E. Michael Lewiecki, MD, of the University of New Mexico Health Sciences Center.

Hip fracture — “Patients with a T-score of greater than –2.5 may have osteoporosis and benefit from pharmacological therapy to reduce fracture risk,” **E. Michael** **Lewiecki, MD,** told attendees. *Source: Adobe Stock*

“Patients with a T-score of greater than –2.5 may have osteoporosis and benefit from pharmacological therapy to reduce fracture risk,” Lewiecki told attendees. “When T-score increases from –2.5 to greater than –2.5 with treatment, that patient still has osteoporosis.”

E. Michael Lewiecki

According to Lewiecki, factors that may suggest osteoporosis in patients with T-scores greater than –2.5 include previous fractures and Fracture Risk Assessment Tool (FRAX) scores.

“Circumstances that come to my mind right off the bat are if they have had a fracture that is persistent with osteoporosis,” he said, adding that FRAX scores predicting fracture probability through 10 years can be considered for osteoporosis if the patient scores high enough and demonstrates low T-scores.

Lewiecki recommended a discerning eye for dual-energy X-ray absorptiometry (DXA) when evaluating patients with osteopenia who may be considered for a diagnosis of osteoporosis. Additionally, physicians should pay particular attention to spine and hip positioning, and confirm that equivalent comparisons are being made.

“You can ask if the tech and interpreter are certified, if the facility is accredited, and ask what their least significant change is,” Lewiecki said. “If they don’t know what their least significant change is, or they don’t know what that means, you might want to consider sending your patient somewhere else.”

Other factors, including low-trauma fracture of the hip, vertebrae, proximal humorous or pelvis, should also be considered when assessing for osteoporosis, he added.

“As always, patient management decisions should be individualized,” Lewiecki said.

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Sources/Disclosures

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Source:

Lewiecki EM. When is osteopenia osteoporosis? Presented at The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).

Disclosures: Lewiecki reports professional relationships with Amgen, Alexion, Mereo, Radius and Ultragenyx.

Congress of Clinical Rheumatology Annual Meeting

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T-scores alone insufficient in assessing osteoporosis in patients with osteopenia

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