An update on the diagnosis and assessment of osteoporosis with densitometry

In 1994 the WHO proposed guidelines for the diagnosis of osteoporosis based on measurement of bone mineral density. They have been widely used for epi demiological studies, clinical research and for treatment strategies. Despi te the widespread acceptance of the diagnostic criteria, several problems r emain with their use. Uncertainties concern the optimal site for assessment , thresholds for men and diagnostic inaccuracies at different sites. In add ition, the development of many new technologies to assess the amount or qua lity of bone poses problems in placing these new tools within a diagnostic and assessment setting. This review considers the recent literature that ha s highlighted the strengths and weaknesses of diagnostic thresholds and the ir use in the assessment of fracture risk, and makes recommendations for ac tions to resolve these difficulties.