A 51-year-old baby-sitter sustained a fracture in her right wrist after an apparently minor fall. Her dorsal spine is kyphotic. Her blood biochemical profile is normal. You are thinking of osteoporosis and planning to perform DEXA scan. Indications for bone mineral density measurement include all of the following, except?

a- Previous low trauma fracture.
b- Family history of osteoporotic fracture.
c- Systemic diseases associated with high risk of osteoporosis like rheumatoid arthritis.
d- A patient on long term prednisolone treatment.
e- Body mass index of more than 23.

The correct answer is e.

• a - with a fall from standing height or less.
• b - also, radiological evidence of osteoporosis, and premature gonadal failure.
• c - remember, not only the disease may pose a risk but also its treatment like corticosteroids.
• d - also, clinical features of osteoporosis, like loss of height and kyphosis.
• e -false, BMI less than 19; hence obese persons are usually protected.

Polycystic ovarian syndrome patients although may be infertile with irregular or absent menstrual cycles, but the high BMI and the good amount of estrogens and androgens protect them from osteoporosis. Measurement of BMD is valuable not only for diagnosis but also for management of osteoporosis, since the anti-fracture efficacy of many treatments is restricted to individuals who have low spine or hip BMD values. BMD measurements are also used to assess treatment response. Since changes in BMD with most osteoporosis treatments are small and occur slowly, repeat measurements

should not be performed until 12-24 months after starting therapy. Measurement of spine BMD is better than hip BMD for assessing treatment response because precision is better and changes in BMD at the spine occur more quickly because of the higher content of trabecular bone.