# Bone mineral density assessment by DXA in disease-associated osteoporosis: the limitations

## TL;DR

DXA scans for bone density have limitations in predicting fractures, especially in disease-related osteoporosis, and newer technologies like HR-pQCT may offer better risk assessment.

## Contribution

The paper highlights the limitations of DXA in secondary osteoporosis and suggests the need for advanced imaging techniques like HR-pQCT for improved fracture risk evaluation.

## Key findings

- DXA scans may underestimate fracture risk due to poor assessment of bone strength.
- HR-pQCT can better assess bone microarchitecture and improve fragility fracture risk evaluation.
- Secondary osteoporosis may not show classical risk factors, requiring more advanced diagnostic approaches.

## Abstract

Measuring bone density by DXA is a routine means of predicting fracture risk. These 2–dimensional images have limitations and may underestimate the risk of fracture due to inadequate evaluation of bone strength. The inclusion of clinical risk factors, calculating FRAX and adding TBS values all improve our ability in bone screening by DXA. However, secondary osteoporosis is not always associated with classical risk factors for bone loss. In addition, unrecognized underlying conditions may contribute to further bone loss and increased risk of low trauma fracture. Therefore, new technologies that assess bone microarchitecture, such as HR-pQCT, can improve our risk assessment for fragility fracture.