Major Discordance in the Diagnosis of Osteoporosis Among Participants With Degenerative Lumbar Spine Using Spine and Hip Dual-Energy X-ray Absorptiometry

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Alisara Wongsuttilert Kasem Chaiklongkit Sutasinee Kongpromsuk Wanlop Jaidee


Background: Major T-score discordance in the diagnosis of osteoporosis at spine and the hip may induce misinterpretation in people with degenerative lumbar spine.

Objective: To investigate major T-score discordance in the diagnosis of osteoporosis using bone mineral density (BMD) at the lumbar spine and the hip among people with degenerative lumbar spine.

Methods: Demographic data, anthropometric measurements, and dual-energy X-ray absorptiometry (DXA) scans at the lumbar spine and the hip were retrieved from a database of Burapha University Hospital. The interrater reliabilities of image interpretation were performed. The correlation between degenerative lumbar spine lesions with T-scores at the lumbar spine and the hip was analyzed. Major discordance was defined when one site is osteoporotic and the other site is osteopenia or normal.

Results: Major T-score discordance of the lumbar spine and the hip was 28.6% and the hip BMD detected in participants with osteoporosis was less than the lumbar spine BMD (15.7% vs 36.5%). T-score at lumbar spine showed a false negative rate of 25.0%. Degenerative lumbar spine lesions showed a poor correlation with T-score at the lumbar spine (R2 = 0.21, P < 0.01) and the hip (R2 at femoral neck = 0.24, P < 0.01; R2 at total hip = 0.32, P < 0.01).

Conclusions: Twenty-six percent of participants with degenerative lumbar spine were not evaluated L1-L4 BMD. While the hip seems to be the best measurement site, 28.6% of T-score discordance between lumbar spine and hip was still observed. T-score at lumbar spine showed a false negative rate of 25.0% and associated with older age. This study suggested that it would not be suitable to use the hip BMD alone to diagnose osteoporosis in older adults with degenerative spine disease.



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Wongsuttilert, A., Chaiklongkit, K., Kongpromsuk, S., & Jaidee, W. (2018). Major Discordance in the Diagnosis of Osteoporosis Among Participants With Degenerative Lumbar Spine Using Spine and Hip Dual-Energy X-ray Absorptiometry. Ramathibodi Medical Journal, 41(3), 13-20.
Original Articles


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