[Use of imaging procedures in the diagnostics of osteoporosis interpretation of x-rays and bone density measurements].

According to the recently published BoneEVA study, 7.8 million Germans (6.5 million women) are affected by osteoporosis. Of them, 4.3% experienced at least one clinical fracture. Only 21.7% were treated with an anti-osteoporotic drug, whereby only 10% received a bisphosphonate and 17% given calcium and vitamin D. On the other hand, as osteoporosis may be associated with severe pain in 90% of patients, analgesics are prescribed. The total direct costs attributable to osteoporosis amounted to Euro 5.4 billion in 2003. One out of three postmenopausal women and one out of five men over the age of 50 years will experience osteoporotic fractures unless preventive measures are undertaken. According to the German guidelines for diagnosis and treatment of osteoporosis, bone densitometry using dual energy x-ray absorptiometry (DXA) together with other clinical risk factors (previous low trauma fracture, use of nicotine, low body weight [BMI<20 kg/m2], immobilisation, and more than two falls during the last six months) are recommended for diagnosis. Using typical cases out of clinical practice, this article delineates frequent mistakes in the interpretation of DXA measurements. Furthermore, the present paper clarifies the role of classical x-rays, which still represent the predominant procedure for the identification of fractures and especially vertebral fractures. In comparison to x-rays, CT or MRI are more important in differential diagnosis of malignant disease and bone metastases. Essentially a reduction of vertebral height without evidence of central endplate fracture in postmenopausal women may be unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision-making. Therefore, we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out deformities related to degenerative disease and norm variants of which we will present several examples to train the view of the reader.