The fallacy of BMD: a critical review of the diagnostic use of dual X-ray absorptiometry.

The diagnostic use of BMD should be cautious as BMD is not an ideal measure of true bone density; it is not an ideal measure of bone strength; it does not predict fractures well; and it has inherent problems of accuracy and linearity. The limitations of BMD, based on the physical deficiencies of DXA, are further obscured by the introduction of T-scores. It is suggested that BMD and BMC, when used diagnostically and for fracture risk classification, be used after correction for body size and/or bone size, age and sex, and that measured values be evaluated in the light of established mean fracture incidence data. BMD is not a parameter of sufficient validity to be the sole indicator of present and future fracture risk. A low BMD should be regarded one of several fracture risk factors. It seems that there is a need to redefine the T-score based definition of osteoporosis.