BOF: 2.40
You see a 66-year-old female in the gastroenterology
clinic. She is known to have Crohn’s disease and has had several courses of
steroids but is now maintained in remission with the use of azathioprine.
Your registrar suggests that you arrange a dual-energy
x-ray absorptiometry (DXA) study on this patient to assess whether she has
osteoporosis.
Which of the following sites is the preferred site for
diagnosis of osteoporosis and is also the site at which fracture causes the
greatest personal and financial cost.
a)
Lumbar spine
b)
Thoracic spine
c)
Wrist
d)
Shaft of femur
e)
Hip
Answer:
e)
The hip is the preferred site for diagnosis as in this
area there is low precision error and there is adequate reference data. Spinal
assessment in the elderly gives falsely elevated results because of
degenerative disease. Femoral assessment gives the highest predictive value
for fracture risk.
The spine is the preferred site for monitoring treatment.
Hip fractures are also thought to cause the greatest
financial and personal cost.
Osteoporosis
