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

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.