Dear Hilary,
Thank you very much for sharing this case,and it is a very common question for MSK radiologists around the world.
The diagnosis of osteoporosis with BMD, either with DXA or QCT, is much negnected by MSK radiologists in most part of the world, maybe this is the time for MSK radiologists to pay attention to this subject and help the clinicians to standardize the diagnosis of osteoporosis.
As a practice guideline, for elder subjects, for DXA exam, a spine+hip is required and diagnosis can be made on T score, most important use the reference database on your own country population. It says, when you have problem to measure the spine and hip, then forearm can be measured as an extra site.
So for your case, you should make the call based on spine and hip, which is normal for this case. Negnect the forearm result.
Hyperparathyroidism patients usually have low forearm BMD since it damage the cortical bone, so for hyperparathyroidism patient, it is useful to measure this site. But it is not true the vice versa.
QCT is better choose for BMD measurement.
Hope this helpful
Cheng
Sent: 2024-03-11 22:58
Subject: DEXA consult, 67F no known risk factors. I have a question. [Please note that the email is sent by ocad-msk+bncbdx5negl4agbbinyxsxqmgqe5tiaoya]
Based on this 67 yo woman’s questionnaire, she has no risk factors for osteoporosis.
Her BMD scores are normal in the hip and spine, but in the Osteoporosis range in the forearm.
I have often wondered what percentage of osteoporosis patients we miss by not including the forearm in the Std DEXA.
I found this reference which unsurprisingly concludes that inclusion the forearm (which primarily evaluates cortical rather than cancellous bone loss, which we see in Hyperparathyroidism) in patients with known HPTH identifies more patients with osteopenia / osteoporosis.
In This case, we have someone who does not carry a known diagnosis of HPTH.
Do any of you report that isolated osteopenia/osteoporosis in the forearm suggests the possibility of Hyperparathyroidism?
Is that even a valid assumption?
In other news, we just had our 4th "annual" OCAD Live meeting in PR.
I don’t think it’s an exaggeration to say it was TOO MUCH FUN….the cases were fabulous, the hot topic discussions were scintillating (too much? I don’t think so) and Yulia Melenevsky’s Eye Test was even more challenging than before.
Other attendees are welcome to chime in.
I hope that we can share some of the cases from the session in the coming weeks….
