Title: June 2018 – To Delete (a Vertebral Body from analysis), or Not to Delete, That is the Question: (Part One of Two)

Submitted By: Lawrence Jankowski, CBDT
Affiliation: Illinois Bone and Joint Institute, LLC.

Morton Grove, Illinois.  USA

Patient History:

Morbidly obese (BMI 49.2, 134 kg) white female, age 53,  three years post-menopause, on oral prednisone 5mg q.d. for undifferentiated mixed connective tissue disease.  Chief complaints include chronic lower back pain, and severe bilateral osteoarthritis of the knees, with right knee more severe than left, and the development of an increasingly antalgic gait, is referred for a baseline DXA.  No other FRAX related risk factors were identified. Spine, and bilateral hip DXA scans were acquired. Fat panniculus was retracted from the hip scans as per department protocol. Images of spine and hip scans are shown below in images 1 and 2 respectively. The FRAX 10-yr risk values are displayed in Image 3.

Image1:DXA image and corresponding individual and total area, BMC, BMD, T-scores and Z-scores

Image2: Bilateral femur scans and results. Note: Fat panniculus was retracted during both hip scans.

Image3: Caption: FRAX 10-year major and hip fracture risks based on left femur neck BMD (lower of the two).

Questions:

  1. Are the scans properly acquired and analyzed?
  2. Should you be concerned with the discordance in BMD between left and right femur necks?
  3. FRAX Major osteoporosis fracture risk was 9.2%, and hip fracture risk was 0.9%, based on the lower femur neck BMD.  Is this appropriate?
  4. What, if any, additional testing would you consider in this patient?

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