Bone Density Measurement in Patients with Severe Lumbar Arthritis

Mechanisms of BMD Measurement Interference

In spine (facet) osteoarthritis, the development of osteophytes, hypertrophy, and sclerosis of the facet joints causes a spurious increase in BMD values 3, 1
Approximately 40% of women aged 55 and 85% of those age >75 years have spine osteoarthritis, making this a common clinical issue 1
The lumbar spine is the site most frequently affected by artifacts that may bias BMD estimates, with most artifacts causing a spurious increase rather than decrease in BMD values 1

DXA scans typically overestimate bone mineral density in patients with severe lumbar arthritis due to the presence of osteophytes, facet joint hypertrophy, and sclerosis that artificially elevate BMD measurements 1, 2

QCT is recommended for patients with advanced degenerative changes of the spine with or without scoliosis (rated 8/9 for appropriateness) 4, 5
For patients with established osteoarthritis, assessment of BMD by volumetric QCT may be more appropriate, according to the American College of Radiology 4

For patients with severe lumbar arthritis, QCT of the lumbar spine and hip is the preferred modality for accurate BMD assessment, as recommended by the American College of Radiology 4
Consider using alternative measurement sites such as the distal forearm when severe spinal degenerative changes are present, with an appropriateness rating of 7/9 by the American College of Radiology 4
Be vigilant for T-score differences >1.0 between adjacent vertebrae, which may indicate the presence of degenerative changes affecting BMD measurements, according to the European Journal of Nuclear Medicine and Molecular Imaging 1