THE RELIABILITY OF DIAGNOSING OSTEOPOROSIS FROM SPINAL RADIOGRAPHS

In order to assess the value of spine radiographs in the diagnosis of osteoporosis, we have measured lumbar-spine bone mineral density (BMD) in 33 women aged 33-74 years whose radiographs were reported as showi ng 'osteopenia' only and 41 women aged 39-78 with radiological evidenc e of vertebral deformation. These results were compared with the norma l range for young women and with control groups of 41 normal elderly w omen aged 65-70 and 15 normal younger women aged 50-60. Women with rad iological osteopenia had a significantly lower BMD than the younger (p < 0.001) but not the older control group. The BMD in women with verte bral deformation was significantly lower than in both control groups ( p < 0.001) and women with radiological osteopenia (p < 0.01). Only 67% of women with radiological osteopenia had a bone density below the no rmal range for young women, compared with 81% of those with vertebral deformation, though the latter may be an underestimate because of the artefactual elevation of bone mass caused by vertebral fractures in th e lumbar spine. Our study suggests that a radiological report of reduc ed bone density may be misleading. Bone density measurements should be performed to confirm that patients so identified require treatment fo r osteoporosis. For patients with vertebral deformation after minimal or no trauma, bone density measurements are probably