Classification of osteoporosis and osteopenia in men is dependent on site-specific analysis

To examine the diagnosis of osteoporosis and osteopenia in men based on bone density measurements at single or multiple sites using central and peripheral measurements, we studied 206 ambulatory, community-dwelling men over age 50, Bone mineral density of the hip, PA spine, forearm, and finger were assessed by dual X-ray absorptiometry. The diagnosis of osteoporosis based on a single measurement ranged from 1% using the trochanter to 39% using Ward's triangle. Twenty-one percent of men had osteoporosis when the diagnosis was based on at least one osteoporotic value at three central sites (PA spine, total hip, femoral neck). Among these men, using T-scores provided by the manufacturers, 51% of osteoporotic patients would be misclassified as normal using the accuDEXA(R) (finger), and 37% of osteoporotic men would be misclassified as normal using the PA spine. We conclude that depending on the number and selection of sites, there is considerable variability in the classification and misclassification of osteoporosis and osteopenia in men.