Fracture prevalence and bone mineral mass in osteoporosis measured with computed tomography and dual energy photon absorptiometry.

In 174 adults presenting with backache, bone densitometry was performed on the lumbar spine, both femoral necks, and one femoral shaft employing dual energy photon absorptiometry (DPA); in 112 of these, densitometry was undertaken on L4 using single energy quantitative computer assisted tomography (CT). Radiographs of the spine were obtained in all patients and those with known or suspected malignant disease were excluded. The subjects were divided into two groups according to the presence (n = 128) or absence (n = 44) of signs of vertebral collapse or compression. The predictive value of the densitometric results for the presence of vertebral fractures was calculated and used as an estimate of fracture risk. While CT showed somewhat higher predictive values than DPA of the spine or combinations of DPA results from spine and femoral necks, the difference was not significant. It is concluded that with both CT and DPA the probability of the presence or absence of fracture can be raised to 75-80% when the probability prior to the investigation is 50% and when the threshold values of the measurements are chosen so that their sensitivity and specificity are about equal.