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==Overview==
==Overview==
[[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[osteoporosis]]. The main finding on [[x-ray]] suggestive of [[osteoporosis]] is [[bone]] mass loss, identified with decreased bony [[trabecula]] in primary stages and then decreased [[Cortical bone|cortical thickness]]. The most common [[bones]] monitored for [[osteoporosis]] evidences are [[femoral neck]], [[lumbar vertebrae]], and [[calcaneus]]. [[Radiography|Plain radiography]] needs at least 30-50% of [[bone]] loss to demonstrate decreased [[bone density]]; therefore, it is not a very sensitive [[modality]].
 
An [[X-rays|X-ray]] may be helpful in the [[diagnosis]] of osteoporosis. The main [[X-ray]] finding suggestive of osteoporosis is the [[Bone loss|bone mass loss]]. Primarily, the loss is mainly in bony [[trabecula]], than the [[cortex]]. The most common [[bones]] monitored for osteoporosis are the [[femoral neck]], [[lumbar vertebrae]], and [[calcaneus]]. For [[Radiography|plain radiography]] to be sensitive, 30-50% of bone loss needs to occur, thus making this modality less desirable in diagnosis of osteoporosis.


==X-ray==
==X-ray==
[[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[osteoporosis]]. The main finding on [[x-ray]] suggestive of [[osteoporosis]] is [[bone]] mass loss, identified with decreased bony [[trabecula]] in primary stages and then decreased [[Cortical bone|cortical thickness]]. The most common [[bones]] monitored for [[osteoporosis]] evidences are [[femoral neck]], [[lumbar vertebrae]], and [[calcaneus]]. [[Radiography|Plain radiography]] needs at least 30-50% of [[bone]] loss to demonstrate decreased [[bone density]]; therefore, it is not a very sensitive [[modality]].
An [[X-rays|X-ray]] may be helpful in the [[diagnosis]] of osteoporosis. The main [[X-ray]] finding suggestive of osteoporosis is the [[Bone loss|bone mass loss]]. Primarily, the loss is mainly in bony [[trabecula]], than the [[cortex]]. The most common [[bones]] monitored for osteoporosis are the [[femoral neck]], [[lumbar vertebrae]], and [[calcaneus]]. For [[Radiography|plain radiography]] to be sensitive, 30-50% of bone loss needs to occur, thus making this modality less desirable in diagnosis of osteoporosis.
{| align="right"
{| align="right"


| [[image:Vertebra-plana.jpg|thumb|300px|Vertebra-plana - Case courtesy of Radswiki, Radiopaedia.org, rID: 12072]]
| [[Image:Ezgif.com-resize (1).gif|900px|thumb|Vertebra-plana and Dowager's hump, Via:Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/12072">rID: 12072</ref>]]


|}
|}
=== Indications for imaging ===
Consider [[vertebral]] imaging tests for the following individuals:
* All women age 70 and older and all men age 80 and older if [[Bone mineral density|BMD]] T-score at the [[spine]], total [[hip]], or [[femoral neck]] is ≤−1.0
* Women age 65 to 69 and men age 70 to 79 if [[Bone mineral density|BMD]] T-score at the [[spine]], total [[hip]], or [[femoral neck]] is ≤−1.5
* [[Postmenopausal]] women and men age 50 and older with specific risk factors such as:
** Low-trauma [[fracture|fractures]] during adulthood (age 50 and older)
** Historical height loss of 1.5in or more (4 cm)
** Prospective height loss of 0.8in or more (2 cm)
** Recent or ongoing long-term [[glucocorticoid]] treatment<ref name="pmid25182228">{{cite journal| author=Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al.| title=Clinician's Guide to Prevention and Treatment of Osteoporosis. | journal=Osteoporos Int | year= 2014 | volume= 25 | issue= 10 | pages= 2359-81 | pmid=25182228 | doi=10.1007/s00198-014-2794-2 | pmc=4176573 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182228  }}</ref>
* [[X-rays]] of children with [[idiopathic]] juvenile [[osteoporosis]] (IJO) often show low [[bone density]], [[fractures]] of weight-bearing [[bones]], and collapsed or misshapen [[vertebrae]]. However, conventional [[X-rays]] may not be able to detect [[osteoporosis]] until significant [[bone mass]] already has been lost.
* Newer methods such as [[Dual energy X-ray absorptiometry|dual energy x-ray absorptiometry (DXA)]], and quantitative computed tomography (QCT) allow for earlier and more accurate diagnosis of low [[bone mass]].<ref name="urlJuvenile Osteoporosis">{{cite web |url=https://www.niams.nih.gov/health_info/bone/Bone_Health/Juvenile/juvenile_osteoporosis.asp |title=Juvenile Osteoporosis |format= |work= |accessdate=}}</ref>
==== Lumbar vertebrae ====
==== Lumbar vertebrae ====
* The major findings correlated to [[osteoporosis]] in [[lumbar vertebrae]] are include:
* The major findings correlated to [[osteoporosis]] in [[lumbar vertebrae]] include:
*# [[Wedges|Wedge shape]] of [[vertebrae]] (decreasing anterior aspect of the body)
** [[Wedges|Wedge shape]] of [[vertebrae]] (decreasing anterior aspect of the body)
*# Picture frame vertebrae (decreased [[cortical bone]] in periphery)
** Picture frame [[vertebrae]] (decreased [[cortical bone]] in periphery)
*# Ghost vertebrae (decreased [[trabecular bone]] in the body)
** Ghost [[vertebrae]] (decreased [[trabecular bone]] in the body)
*# Vertebra plana (severe [[compression fracture]])<ref name="urlOsteoporosis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/osteoporosis-3 |title=Osteoporosis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
** [[Vertebra]] plana (severe [[compression fracture]])<ref name="urlOsteoporosis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/osteoporosis-3 |title=Osteoporosis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>


==== Femoral neck ====
==== Femoral neck ====
* Singh's index: categorization of [[femoral neck]] [[bone mineral density]] upon visual scale of the [[trabecular bone]] existence on [[x-ray]].  
* Singh's index: Categorization of [[femoral neck]] [[bone mineral density]] upon the visual scale of the [[trabecular bone]] existence on [[x-ray]].  
* The Singh's categories include:
* The Singh's categories include:
** Grade 1: thin principle compression [[trabeculae]]  
** Grade 1: Thin principle compression [[trabeculae]]  
** Grade 2: principle compression [[trabeculae]]
** Grade 2: Principle compression [[trabeculae]]
** Grade 3: thin principle tensile [[trabeculae]], with discontinuity
** Grade 3: Thin principle tensile [[trabeculae]], with discontinuity
** Grade 4: thin principle tensile [[trabeculae]], with continuity
** Grade 4: Thin principle tensile [[trabeculae]], with continuity
** Grade 5: thin principle tensile and compression [[trabeculae]]  
** Grade 5: Thin principle tensile and compression [[trabeculae]]  
** Grade 6: normal appearance
** Grade 6: Normal appearance
* Reduced density of [[trabecular bone]] in the area, which is described by means of Singh's index (grades 3, 2, and 1), could reflect the diagnosis of [[osteoporosis]]<ref name="urlSingh index | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/singh-index |title=Singh index &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
* Reduced density of [[trabecular bone]] in the area, which is described by means of Singh's index (grades 3, 2, and 1), could reflect the diagnosis of [[osteoporosis]]<ref name="urlSingh index | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/singh-index |title=Singh index &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>


==== Tubular bones ====
==== Tubular bones ====
* [[Osteoporosis]] in these bones, especially [[metacarpals]] and [[metatarsals]], appeared as loss of [[Cortical bone|cortical thickness]]. However, [[Cortical bone|cortical thickness]] of less than 25% of entire [[bone]] demonstrate [[osteoporosis]].<ref name="urlOsteoporosis | Radiology Reference Article | Radiopaedia.org" />
* [[Osteoporosis]] in these bones, especially [[metacarpals]] and [[metatarsals]], appeared as loss of [[Cortical bone|cortical thickness]]. However, [[Cortical bone|cortical thickness]] of less than 25% of entire [[bone]] demonstrates [[osteoporosis]].<ref name="urlOsteoporosis | Radiology Reference Article | Radiopaedia.org" />


<gallery align="left">
Image:Vertebral-insufficiency-fractures-in-severe-osteoporosis25.jpg| Pathological fracture in T12 and L1 (saggital view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/17333">rID: 17333</ref>
Image:Vertebral-insufficiency-fractures-in-severe-osteoporosis(3).jpg| Pathological fracture in T12 and L1 (axial view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/17333">rID: 17333</ref>
Image:Efdfc0355363446eac868f3bf93ea0 jumbo.jpeg| Dowager's hump - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/18147">rID: 18147</ref>
Image:Transient-hip-osteoporosis25.jpg|Idiopathic transient osteoporosis of the hip- Case courtesy of Dr Ahmed Abd Rabou, Via: Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/22910">rID: 22910</ref>
Image:Osteogenesis-imperfecta-5.jpg|Juvenile osteoporosis in osteogenesis imperfecta, Via: Radiopaedia.org<ref>Radiopaedia.org. From the case <"https://radiopaedia.org/cases/11710">rID: 11710</ref>
</gallery>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}
{{WH}}


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Latest revision as of 23:29, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

An X-ray may be helpful in the diagnosis of osteoporosis. The main X-ray finding suggestive of osteoporosis is the bone mass loss. Primarily, the loss is mainly in bony trabecula, than the cortex. The most common bones monitored for osteoporosis are the femoral neck, lumbar vertebrae, and calcaneus. For plain radiography to be sensitive, 30-50% of bone loss needs to occur, thus making this modality less desirable in diagnosis of osteoporosis.

X-ray

An X-ray may be helpful in the diagnosis of osteoporosis. The main X-ray finding suggestive of osteoporosis is the bone mass loss. Primarily, the loss is mainly in bony trabecula, than the cortex. The most common bones monitored for osteoporosis are the femoral neck, lumbar vertebrae, and calcaneus. For plain radiography to be sensitive, 30-50% of bone loss needs to occur, thus making this modality less desirable in diagnosis of osteoporosis.

Vertebra-plana and Dowager's hump, Via:Radiopaedia.org[1]

Indications for imaging

Consider vertebral imaging tests for the following individuals:

Lumbar vertebrae

Femoral neck

Tubular bones

  • Pathological fracture in T12 and L1 (saggital view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[6]

    Pathological fracture in T12 and L1 (saggital view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[6]

  • Pathological fracture in T12 and L1 (axial view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[7]

    Pathological fracture in T12 and L1 (axial view) - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[7]

  • Dowager's hump - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[8]

    Dowager's hump - Case courtesy of Dr Roberto Schubert, Via: Radiopaedia.org[8]

  • Idiopathic transient osteoporosis of the hip- Case courtesy of Dr Ahmed Abd Rabou, Via: Radiopaedia.org[9]

    Idiopathic transient osteoporosis of the hip- Case courtesy of Dr Ahmed Abd Rabou, Via: Radiopaedia.org[9]

  • Juvenile osteoporosis in osteogenesis imperfecta, Via: Radiopaedia.org[10]

    Juvenile osteoporosis in osteogenesis imperfecta, Via: Radiopaedia.org[10]

References

  1. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/12072">rID: 12072
  2. ↑ Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S; et al. (2014). "Clinician's Guide to Prevention and Treatment of Osteoporosis". Osteoporos Int. 25 (10): 2359–81. doi:10.1007/s00198-014-2794-2. PMC 4176573. PMID 25182228.
  3. ↑ "Juvenile Osteoporosis".
  4. ↑ 4.0 4.1 "Osteoporosis | Radiology Reference Article | Radiopaedia.org".
  5. ↑ "Singh index | Radiology Reference Article | Radiopaedia.org".
  6. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/17333">rID: 17333
  7. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/17333">rID: 17333
  8. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/18147">rID: 18147
  9. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/22910">rID: 22910
  10. ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/11710">rID: 11710

​​

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