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Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture

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A Correction to this article was published on 23 November 2023

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Abstract

The 1994 WHO criterion of a T-score ≤ -2.5 for densitometric osteoporosis was chosen because it results in a prevalence commensurate with the observed lifetime risk of fragility fractures in Caucasian women aged ≥ 50 years. Due to the much lower risk of fragility fracture among East Asians, the application of the conventional WHO criterion to East Asians leads to an over inflated prevalence of osteoporosis, particularly for spine osteoporosis. According to statistical modeling and when a local BMD reference is used, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.7 for Hong Kong Chinese women. Using radiographic osteoporotic vertebral fracture as a surrogate clinical endpoint, we empirically demonstrated that a femoral neck T-score of -2.77 for Chinese women was equivalent to -2.60 for Italian women, a spine T-score of -3.75 for Chinese women was equivalent to -2.44 for Italian women, and for Chinese men a femoral neck T-score of -2.77 corresponded to spine T-score of -3.37. For older Chinese men, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.2. With the BMD reference published by IKi et al. applied, T-score of femoral neck, total hip, and spine of -2.75, -3.0, and -3.9 for Japanese women will be more in line with the WHO osteoporosis definition. The revised definition of osteoporosis cutpoint T-scores for East Asians will allow a more meaningful international comparison of disease burden.

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Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China

    Yi Xiang J. Wáng, James F. Griffith & Ben-Heng Xiao

  2. School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK

    Glen M. Blake

  3. Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy

    Daniele Diacinti

  4. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Wei Yu

  5. Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China

    Yi Su

  6. VA Healthcare System, University of Michigan, Ann Arbor, MI, USA

    Yebin Jiang

  7. Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy

    Giuseppe Guglielmi

  8. Department of Radiology, Scientific Institute “Casa Sollievo Della Sofferenza” Hospital, San Giovanni Rotondo, Italy

    Giuseppe Guglielmi

  9. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Ali Guermazi

  10. Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Timothy C. Y. Kwok

  11. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Timothy C. Y. Kwok

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  1. Yi Xiang J. Wáng
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Wáng, Y.X.J., Griffith, J.F., Blake, G.M. et al. Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture. Skeletal Radiol 53, 609–625 (2024). https://doi.org/10.1007/s00256-023-04481-7

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