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Primary Osteoporosis
Donna G. Blankenbaker, MD, FACR; Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Primary osteoporosis encompasses postmenopausal (type I) & senile (type II) osteoporosis
                • Other terms: age-related or involutional osteoporosis
            • Definitions

              • Osteoporosis: ↓ amount of histologically normal bone
                • For clinical purposes, defined by bone mineral density (BMD) relative to standard population
              • Senile osteoporosis: osteoporosis occurring in individuals > 75 years old
              • Osteopenia: different meanings depending on context
                • Radiographic appearance of ↓ bone density
                  • Osteoporosis is 1 of many causes
                • Dual-energy x-ray absorptiometry (DXA) interpretation applies to BMD between normal & osteoporosis; T score between -1 & -2.5
              • Fragility fracture: results from minor trauma, such as fall from standing height
                • Typically occurs in vertebral body, femoral neck, or distal radius (Colles fracture)
              • Insufficiency fracture: stress fracture that results from normal stress on abnormal bone
              • Severe or established osteoporosis
                • T score ≤ -2.5 & fragility fracture

            IMAGING

            • General Features

              • Imaging Recommendations

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Dual-Energy X-Ray Absorptiometry

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          • Future Directions

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. International Society for Clinical Densitometry. Accessed December 27, 2021. www.ISCD.org
                                                2. Baim S et al: Approaches to fracture risk assessment and prevention. Curr Osteoporos Rep. 19(2):158-65, 2021
                                                3. Link TM et al: Update on imaging-based measurement of bone mineral density and quality. Curr Rheumatol Rep. 22(5):13, 2020
                                                4. Jang S et al: Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20 000 adults. Radiology. 291(2):360-7, 2019
                                                5. Ross AB et al: Diagnostic accuracy of an abbreviated MRI protocol for detecting radiographically occult hip and pelvis fractures in the elderly. Skeletal Radiol. 48(1):103-8, 2019
                                                6. Steiner B et al: Prescreening for osteoporosis with quantitative ultrasound in postmenopausal white women. J Ultrasound Med. 38(6):1553-9, 2019
                                                7. Link TM: Radiology of osteoporosis. Can Assoc Radiol J. 67(1):28-40, 2016
                                                8. Marques A et al: The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis. Ann Rheum Dis. 74(11):1958-67, 2015
                                                9. Krappinger D et al: Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol. 41(3):299-304, 2012
                                                10. Link TM: Osteoporosis imaging: state of the art and advanced imaging. Radiology. 263(1):3-17, 2012
                                                11. Adams JE: Quantitative computed tomography. Eur J Radiol. 71(3):415-24, 2009
                                                12. Bauer JS et al: Advances in osteoporosis imaging. Eur J Radiol. 71(3):440-9, 2009
                                                13. Krestan C et al: Imaging of insufficiency fractures. Eur J Radiol. 71(3):398-405, 2009
                                                14. Genant HK et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 8(9):1137-48, 1993
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Primary osteoporosis encompasses postmenopausal (type I) & senile (type II) osteoporosis
                                                              • Other terms: age-related or involutional osteoporosis
                                                          • Definitions

                                                            • Osteoporosis: ↓ amount of histologically normal bone
                                                              • For clinical purposes, defined by bone mineral density (BMD) relative to standard population
                                                            • Senile osteoporosis: osteoporosis occurring in individuals > 75 years old
                                                            • Osteopenia: different meanings depending on context
                                                              • Radiographic appearance of ↓ bone density
                                                                • Osteoporosis is 1 of many causes
                                                              • Dual-energy x-ray absorptiometry (DXA) interpretation applies to BMD between normal & osteoporosis; T score between -1 & -2.5
                                                            • Fragility fracture: results from minor trauma, such as fall from standing height
                                                              • Typically occurs in vertebral body, femoral neck, or distal radius (Colles fracture)
                                                            • Insufficiency fracture: stress fracture that results from normal stress on abnormal bone
                                                            • Severe or established osteoporosis
                                                              • T score ≤ -2.5 & fragility fracture

                                                          IMAGING

                                                          • General Features

                                                            • Imaging Recommendations

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Dual-Energy X-Ray Absorptiometry

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        • Future Directions

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. International Society for Clinical Densitometry. Accessed December 27, 2021. www.ISCD.org
                                                                                              2. Baim S et al: Approaches to fracture risk assessment and prevention. Curr Osteoporos Rep. 19(2):158-65, 2021
                                                                                              3. Link TM et al: Update on imaging-based measurement of bone mineral density and quality. Curr Rheumatol Rep. 22(5):13, 2020
                                                                                              4. Jang S et al: Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20 000 adults. Radiology. 291(2):360-7, 2019
                                                                                              5. Ross AB et al: Diagnostic accuracy of an abbreviated MRI protocol for detecting radiographically occult hip and pelvis fractures in the elderly. Skeletal Radiol. 48(1):103-8, 2019
                                                                                              6. Steiner B et al: Prescreening for osteoporosis with quantitative ultrasound in postmenopausal white women. J Ultrasound Med. 38(6):1553-9, 2019
                                                                                              7. Link TM: Radiology of osteoporosis. Can Assoc Radiol J. 67(1):28-40, 2016
                                                                                              8. Marques A et al: The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis. Ann Rheum Dis. 74(11):1958-67, 2015
                                                                                              9. Krappinger D et al: Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol. 41(3):299-304, 2012
                                                                                              10. Link TM: Osteoporosis imaging: state of the art and advanced imaging. Radiology. 263(1):3-17, 2012
                                                                                              11. Adams JE: Quantitative computed tomography. Eur J Radiol. 71(3):415-24, 2009
                                                                                              12. Bauer JS et al: Advances in osteoporosis imaging. Eur J Radiol. 71(3):440-9, 2009
                                                                                              13. Krestan C et al: Imaging of insufficiency fractures. Eur J Radiol. 71(3):398-405, 2009
                                                                                              14. Genant HK et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 8(9):1137-48, 1993