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Osteopenia and Osteoporosis
Fathima Fijula P. Manzil, MD; Umesh D. Oza, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Osteopenia
            • Bone density that is not normal but not as low as osteoporosis
              • According to WHO criteria, osteopenia is defined as BMD lying 1.0-2.5 standard deviations below average value for healthy young women (-2.5 < T-score < -1.0)
          • Osteoporosis
            • Osteoporosis-related bone loss occurs when bone resorption exceeds bone formation
              • Peak bone mass occurs in 20s
              • Bone loss increases with age and after menopause
              • Most common cause for fracture in elderly
            • Systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture
              • According to WHO criteria, osteoporosis is defined as BMD lying ≥ 2.5 standard deviations below average value for healthy young women (T-score ≤ -2.5 SD)
          • T-score
            • Calculated by taking difference between patient's measured BMD and mean BMD of healthy young adults, matched for sex and ethnic group, and expressing difference relative to young adult population SD
          • Z-score
            • Compared with mean BMD expected for healthy subject matched for age, sex, and ethnic origin

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  • Artifacts and Quality Control

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              • Risk Factors for Osteoporosis

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Dash AS et al: Abnormal microarchitecture and stiffness in postmenopausal women with isolated osteoporosis at the 1/3 radius. Bone. 132:115211, 2019
                                    2. Iconaru L et al: Does the prediction accuracy of osteoporotic fractures by BMD and clinical risk factors vary with fracture site? JBMR Plus. 3(12):e10238, 2019
                                    3. Qu XL et al: Bone turnover markers and bone mineral density to predict osteoporotic fractures in older women: A retrospective comparative study. Orthop Surg. ePub, 2019
                                    4. Pisani P et al: Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol. 5(11):398-410, 2013
                                    5. Whitaker M et al: Bisphosphonates for osteoporosis--where do we go from here? N Engl J Med. 366(22):2048-51, 2012
                                    6. Blake GM et al: The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. 83(982):509-17, 2007
                                    7. Kanis JA: Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 359(9321):1929-36, 2002
                                    8. Kanis JA et al: Risk factors in osteoporosis. Maturitas. 30(3):229-33, 1998
                                    Related Anatomy
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Definitions

                                            • Osteopenia
                                              • Bone density that is not normal but not as low as osteoporosis
                                                • According to WHO criteria, osteopenia is defined as BMD lying 1.0-2.5 standard deviations below average value for healthy young women (-2.5 < T-score < -1.0)
                                            • Osteoporosis
                                              • Osteoporosis-related bone loss occurs when bone resorption exceeds bone formation
                                                • Peak bone mass occurs in 20s
                                                • Bone loss increases with age and after menopause
                                                • Most common cause for fracture in elderly
                                              • Systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture
                                                • According to WHO criteria, osteoporosis is defined as BMD lying ≥ 2.5 standard deviations below average value for healthy young women (T-score ≤ -2.5 SD)
                                            • T-score
                                              • Calculated by taking difference between patient's measured BMD and mean BMD of healthy young adults, matched for sex and ethnic group, and expressing difference relative to young adult population SD
                                            • Z-score
                                              • Compared with mean BMD expected for healthy subject matched for age, sex, and ethnic origin

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    • Artifacts and Quality Control

                                                      PATHOLOGY

                                                      • Staging, Grading, & Classification

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                • Risk Factors for Osteoporosis

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Dash AS et al: Abnormal microarchitecture and stiffness in postmenopausal women with isolated osteoporosis at the 1/3 radius. Bone. 132:115211, 2019
                                                                      2. Iconaru L et al: Does the prediction accuracy of osteoporotic fractures by BMD and clinical risk factors vary with fracture site? JBMR Plus. 3(12):e10238, 2019
                                                                      3. Qu XL et al: Bone turnover markers and bone mineral density to predict osteoporotic fractures in older women: A retrospective comparative study. Orthop Surg. ePub, 2019
                                                                      4. Pisani P et al: Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol. 5(11):398-410, 2013
                                                                      5. Whitaker M et al: Bisphosphonates for osteoporosis--where do we go from here? N Engl J Med. 366(22):2048-51, 2012
                                                                      6. Blake GM et al: The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J. 83(982):509-17, 2007
                                                                      7. Kanis JA: Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 359(9321):1929-36, 2002
                                                                      8. Kanis JA et al: Risk factors in osteoporosis. Maturitas. 30(3):229-33, 1998