Dual-energy x-ray absorptiometry (DXA) has long been considered the gold standard for assessing bone mass and fracture risk. However, new technologies are emerging that provide additional insights into bone health and highlight knowledge gaps that DXA alone cannot fill. These advancements in technology will be the focus of a presentation at the Menopause Society’s 2023 Annual Meeting in Philadelphia from September 27-30.
For postmenopausal women, maintaining good bone health is crucial as they become more vulnerable to conditions like osteoporosis and osteopenia due to declining estrogen levels during the menopause transition. DXA is currently the most common method used to measure bone mineral density and identify individuals at risk of fragility fractures. This is because a significant portion, between 60% and 75%, of bone strength comes from bone mass.
However, bone mass alone does not provide a complete picture of bone strength or fracture risk. Dr. Marcella Walker from Columbia University’s Division of Endocrinology will lead a discussion at the Menopause Society’s Annual Meeting on newer noninvasive or minimally invasive technologies that offer additional information beyond bone mineral density to assess Totally bone health.
One such advancement is trabecular bone score (TBS), which uses DXA imaging to indirectly measure spinal trabecular microarchitecture and predict fracture risk independently of, but in conjunction with, BMD. Another technique called vertebral fracture assessment (VFA) can detect vertebral fractures that often go unnoticed. In recent years, impact microindentation (IMI) has also gained FDA approval as a minimally invasive method to measure the strength of tibial bones by assessing their resistance to crack development using a handheld device.
According to Dr. Walker, there are numerous fascinating technologies available that can provide valuable insights into bone strength. While he believes using multiple measures of bone quality is beneficial for some patients, he highlights the fact that many women do not receive the minimal screening for osteoporosis with DXA bone mineral density measurement.
It is crucial for both doctors and patients to understand that osteoporosis does not exhibit symptoms until a fracture occurs. This underscores the importance of measuring bone mineral density using DXA in at-risk individuals. Dr. Walker emphasizes that adjunctive technologies like TBS and VFA are particularly useful in further assessing fracture risk in women who are near the threshold for therapeutic intervention, as this additional information could potentially alter treatment decisions.
“This presentation should provide valuable information on the various technologies available to healthcare professionals in order to obtain a more accurate picture of their patients’ fracture risk,” says Dr. Stephanie Faubion, medical director of The Menopause Society. “Bone health and avoiding fractures are very important issues for middle-aged women.”
Both Drs. Walker and Faubion will be available for interviews before and after the Annual Meeting presentation.
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