Clinical Rheumatology

, Volume 19, Issue 3, pp 174–183

The Fallacy of BMD: A Critical Review of the Diagnostic Use of Dual X-ray Absorptiometry


  • S. Pors Nielsen
    • Department of Clinical Physiology and Nuclear Medicine, Hillerød Hospital, Hillerød, Denmark
Review Article

DOI: 10.1007/s100670050151

Cite this article as:
Pors Nielsen, S. Clin Rheumatol (2000) 19: 174. doi:10.1007/s100670050151


The diagnostic use of BMD should be cautious as BMD is not an ideal measure of true bone density; it is not an ideal measure of bone strength; it does not predict fractures well; and it has inherent problems of accuracy and linearity. The limitations of BMD, based on the physical deficiencies of DXA, are further obscured by the introduction of T-scores.

 It is suggested that BMD and BMC, when used diagnostically and for fracture risk classification, be used after correction for body size and/or bone size, age and sex, and that measured values be evaluated in the light of established mean fracture incidence data. BMD is not a parameter of sufficient validity to be the sole indicator of present and future fracture risk. A low BMD should be regarded one of several fracture risk factors.

 It seems that there is a need to redefine the T-score based definition of osteoporosis.

Key words:Bone mineral density – Dual X-ray absorptiometry – Fracture risk – Osteoporosis

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© Clinical Rheumatology 2000