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Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density

Xiaoguang Cheng 1Huishu Yuan 2Jingliang Cheng 3Xisheng Weng 4Hao Xu 5Jianbo Gao 6Mingqian Huang 7Yì Xiáng J Wáng 8Yan Wu 6Wenjian Xu 9Li Liu 10Hua Liu 10Chen Huang 11Zhengyu Jin 12Wei Tian 13Bone and Joint Group of Chinese Society of Radiology, Chinese Medical Association (CMA), Musculoskeletal Radiology Society of Chinese Medical Doctors Association, Osteoporosis Group of Chinese Orthopedic Association, Bone Density Group of Chinese Society of Imaging Technology, CMA*

Quant Imaging Med Surg doi: 10.21037/qims-2020-16.

Abstract

With an aging society, osteoporosis is one of the most common diseases threatening the health of China’s elderly population and is an issue that is raising increasing concern. Osteoporosis is characterized by bone loss and increased susceptibility to fragility fractures. Various imaging modalities such as X-ray, CT, MRI and nuclear medicine along with assessment of bone mineral density (BMD) play an important role in its diagnosis and management, and the treatment requires multidisciplinary teamwork. A lack of consensus in the approach to imaging and BMD measurement is hampering the quality of service and patient care in China. Therefore a panel of Chinese experts from the fields of radiology, orthopedics, endocrinology and nuclear medicine reviewed the international guidelines, consensus and literature with the most recent data from China and, taking account of current clinical practice in China, the panel reached this consensus to help guide the diagnosis of osteoporosis using imaging and BMD. This consensus report provides guidelines and standards for the imaging and BMD assessment of osteoporosis and criteria for the diagnosis of osteoporosis in China.

Key points of this expert consensus:

        i.            For post-menopausal women and elderly men, if there is an osteoporotic fracture identified by imaging, then osteoporosis should be diagnosed regardless of the BMD findings.

      ii.            When using DXA to measure lumbar spine and hip, use reference data from the normal Chinese population. If the T-score at the spine or hip is ≤−2.5 SD, then the diagnosis of osteoporosis can be made.

    iii.            When using QCT to measure the lumbar spine, if the volumetric BMD <80 mg/cm3, then the diagnosis of osteoporosis can be made. When QCT is used to measure hip using the CTXA application, the results are interpreted the same as a hip DXA scan.

    iv.            When BMD measurement meets the criteria for osteoporosis and there is also insufficiency fracture (s), then the diagnosis is severe osteoporosis.

      v.            Peripheral BMD measurements can be used for screening for osteoporosis but not for diagnosis.