High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis

摘要

The current gold-standard for the diagnosis of osteoporosis, dual x-ray absorptiometry (DXA), measures areal projected bone mineral density (aBMD). Besides including projection artifacts, DXA does not allow assessment of the spatial distribution of BMD within the bone or aspects of bone quality, such as trabecular microstructure. Although the WHO definition of osteoporosis based on DXA correlates well with fracture risk in women with postmenopausal osteoporosis , the majority of fractures occur in women who are not classified as osteoporotic by this criterion . Absolute fracture risk models that capture a number of independent risk factors, such as prevalent fractures or age, show that DXA has limitations in assessing bone strength and the corresponding fracture risk.