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Osteoporos Int. 2017 Feb 4. doi: 10.1007/s00198-017-3921-7. [Epub ahead of print]

Low-trauma fractures without osteoporosis.

Author information

  • 1Laboratoire I3MTO, Université d'Orléans, 4708, 45067, Orléans, EA, France.
  • 2Regional Hospital of Orleans, 14 avenue de l'hopital, 45067, Orleans, Cedex 2, France.
  • 3EA 4490 PMOI-Physiopathologie des Maladies Osseuses Inflammatoires, Université de Lille, 59000, Lille, France.
  • 4Service de Rhumatologie, CHU Lille, 59000, Lille, France.
  • 5Service de Rhumatologie, CHU d'Angers, 49933, Angers, France.
  • 6Service de Rhumatologie, CHU Rennes, 35203, Rennes, France.
  • 7, INSERM UMR 991, 35000, Rennes, France.
  • 8Faculté de Médecine, Université Rennes 1, 35043, Rennes, France.
  • 9INSERM U 1153, hôpital Cochin, Université Paris Descartes, Paris, France.


In clinical practice, areal bone mineral density (aBMD) is usually measured using dual-energy X-ray absorptiometry (DXA) to assess bone status in patients with or without osteoporotic fracture. As BMD has a Gaussian distribution, it is difficult to define a cutoff for osteoporosis diagnosis. Based on epidemiological considerations, WHO defined a DXA-based osteoporosis diagnosis with a T-score <-2.5. However, the majority of individuals who have low-trauma fractures do not have osteoporosis with DXA (i.e., T-score <-2.5), and some of them have no decreased BMD at all. Some medical conditions (spondyloarthropathies, chronic kidney disease and mineral bone disorder, diabetes, obesity) or drugs (glucocorticoids, aromatase inhibitors) are more prone to cause fractures with subnormal BMD. In the situation of fragility fractures with subnormal or normal BMD, clinicians face a difficulty as almost all the pharmacologic treatments have proved their efficacy in patients with low BMD. However, some data are available in post hoc analyses in patients with T score >-2. Overall, in patients with a previous fragility fracture (especially vertebra or hip), treatments appear to be effective. Thus, the authors recommend treating some patients with a major fragility fracture even if areal BMD T score is above -2.5.


BMD; Diagnosis of osteoporosis; Low-trauma fracture; Normal BMD; Treatment of osteoporosis

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