Calcified Tissue International

, Volume 64, Issue 3, pp 267–270

Comments on the Hypotheses Underlying Fracture Risk Assessment in Osteoporosis as Proposed by the World Health Organization

  • T.  Sandor
  • D.  Felsenberg
  • E.  Brown

DOI: 10.1007/s002239900616

Cite this article as:
Sandor, T., Felsenberg, D. & Brown, E. Calcif Tissue Int (1999) 64: 267. doi:10.1007/s002239900616


It was shown in a recent multivariate analysis of lumbar vertebral (L1–L3) CT scans of 171 women without fractures and 57 fractures somewhere in their skeletons, that regional assessment of the spinal mineral distribution can result in the discrimination of the above patient groups with an accuracy of about 90%. This level of discrimination was possible even in those cases with bone densities below the fracture threshold, where the overlap of patients with and without fractures is the greatest and clinically the most significant. In this region this new analytical technique could also identify a subgroup of patients who not yet had a fracture, but for whom all three lumbar vertebrae were classified as osteoporotic. From these results it follows that the osteoporosis model proposed by the World Health Organization (WHO), which assumes that fragility depends only on a single mean value of bone mineral density (BMD) for a patient, is overly simplistic and requires upgrading to include indices representing the distribution of bone mineral.

Key words: Bones — Bone densitometry — Quantitative computed tomography — Fracture risk — Osteoporosis.

Copyright information

© 1999 Springer-Verlag New York Inc.

Authors and Affiliations

  • T.  Sandor
    • 1
  • D.  Felsenberg
    • 2
  • E.  Brown
    • 3
  1. 1.Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Harvard Medical School, Boston, Massachusetts 02115, USAUS
  2. 2.Department of Radiology, Klinikum Benjamin Franklin, Freie Universitaet, Berlin, GermanyDE
  3. 3.Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USAUS