Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management
Identifieur interne : 003190 ( Pmc/Curation ); précédent : 003189; suivant : 003191Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management
Auteurs : Celia L. Gregson [Royaume-Uni] ; Sarah A. Hardcastle ; Cyrus Cooper [Royaume-Uni] ; Jonathan H. TobiasSource :
- Rheumatology (Oxford, England) [ 1462-0324 ] ; 2013.
Abstract
A finding of high BMD on routine DXA scanning is not infrequent and most commonly reflects degenerative disease. However, BMD increases may also arise secondary to a range of underlying disorders affecting the skeleton. Although low BMD increases fracture risk, the converse may not hold for high BMD, since elevated BMD may occur in conditions where fracture risk is increased, unaffected or reduced. Here we outline a classification for the causes of raised BMD, based on identification of focal or generalized BMD changes, and discuss an approach to guide appropriate investigation by clinicians after careful interpretation of DXA scan findings within the context of the clinical history. We will also review the mild skeletal dysplasia associated with the currently unexplained high bone mass phenotype and discuss recent advances in osteoporosis therapies arising from improved understanding of rare inherited high BMD disorders.
Url:
DOI: 10.1093/rheumatology/ket007
PubMed: 23445662
PubMed Central: 3651616
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Celia L. Gregson<affiliation><nlm:aff wicri:cut=" and" id="ket007-AFF1">Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol</nlm:aff>
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<front><div type="abstract" xml:lang="en"><p>A finding of high BMD on routine DXA scanning is not infrequent and most commonly reflects degenerative disease. However, BMD increases may also arise secondary to a range of underlying disorders affecting the skeleton. Although low BMD increases fracture risk, the converse may not hold for high BMD, since elevated BMD may occur in conditions where fracture risk is increased, unaffected or reduced. Here we outline a classification for the causes of raised BMD, based on identification of focal or generalized BMD changes, and discuss an approach to guide appropriate investigation by clinicians after careful interpretation of DXA scan findings within the context of the clinical history. We will also review the mild skeletal dysplasia associated with the currently unexplained high bone mass phenotype and discuss recent advances in osteoporosis therapies arising from improved understanding of rare inherited high BMD disorders.</p>
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<journal-id journal-id-type="iso-abbrev">Rheumatology (Oxford)</journal-id>
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<title-group><article-title>Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management</article-title>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Gregson</surname>
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<aff id="ket007-AFF1"><sup>1</sup>
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol and<sup>2</sup>
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.</aff>
<author-notes><corresp>Correspondence to: Celia L. Gregson, Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, UK. E-mail: <email>celia.gregson@bristol.ac.uk</email>
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<pub-date pub-type="ppub"><month>6</month>
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<pmc-comment> PMC Release delay is 12 months and 0 days and was based on the
. </pmc-comment>
<volume>52</volume>
<issue>6</issue>
<fpage>968</fpage>
<lpage>985</lpage>
<history><date date-type="received"><day>8</day>
<month>10</month>
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<date date-type="rev-recd"><day>16</day>
<month>1</month>
<year>2013</year>
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<permissions><copyright-statement>© The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com</copyright-statement>
<copyright-year>2013</copyright-year>
</permissions>
<abstract><p>A finding of high BMD on routine DXA scanning is not infrequent and most commonly reflects degenerative disease. However, BMD increases may also arise secondary to a range of underlying disorders affecting the skeleton. Although low BMD increases fracture risk, the converse may not hold for high BMD, since elevated BMD may occur in conditions where fracture risk is increased, unaffected or reduced. Here we outline a classification for the causes of raised BMD, based on identification of focal or generalized BMD changes, and discuss an approach to guide appropriate investigation by clinicians after careful interpretation of DXA scan findings within the context of the clinical history. We will also review the mild skeletal dysplasia associated with the currently unexplained high bone mass phenotype and discuss recent advances in osteoporosis therapies arising from improved understanding of rare inherited high BMD disorders.</p>
</abstract>
<kwd-group><kwd>DXA</kwd>
<kwd>BMD</kwd>
<kwd>high bone mass</kwd>
<kwd>osteopetrosis</kwd>
<kwd>osteoarthritis</kwd>
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