Title: May 2017 – Discordance of Spine and Hip BMD

Submitted By: Tom Chen, DO, MBA, CCD & Stephen Handrich, MD, CCD
Affiliation: Medical College of Wisconsin Affiliated Hospitals – St. Joseph, Milwaukee, Wisconsin. USA

Patient History:
63-year-old Black male presents for a screening DXA. His weight was 194 lbs and height was 75 inches. There is no history of prior fractures. No previous DXA for comparison.

Figure 1: Bone density of the left hip with T-scores and Z-scores of the femur neck and total regions of interest.


Figure 2: Bone density scan of the lumbar spine with individual and L1-L4 BMD values and T-Scores

Questions:

  1. Which vertebra(e) appear pathologically abnormal?
  2. What would be in your differential diagnoses for the abnormal finding(s)?
  3. What additional imaging would you recommend, if any?

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