Differential Diagnosis: Low Bone Mass

  • Michael Kleerekoper
  • Dorothy A. Nelson


Low bone mass is necessary but not sufficient for osteoporosis and fracture. It is the major contributor to the risk of fracture in an individual patient, but other factors also come into play. These include age, previous fracture, family history of fracture, and frequency of falls. Thus, when a patient has a bone mass measurement that results in a value that is lower than expected for age, and/or compared with young normals, it should be assumed that the risk of fracture is increased in this patient and intervention should be considered. Interventions can include pharmacologic therapy to stabilize or increase bone mass, lifestyle changes to protect the fragile skeleton, and physical activities that increase muscle strength and improve balance.


Bone Loss Bone Mass Fracture Risk Skeletal Site Increase Fracture Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Suggested Reading

  1. Cummings SR, Black DM, Nevitt MC et al. (1993) Bone density at various sites for prediction of hip fractures. Lancet 341: 72–75.PubMedCrossRefGoogle Scholar
  2. Gardsell P, Johnell O, Nilsson BE, Gullbert B. (1993) Predicting various fragility fractures in women by forearm bone densitometry: A follow-up study. CalcifTiss Int 52: 348–353.CrossRefGoogle Scholar
  3. Greenspan SL, Maitland-Ramsey L, Myers E. (1996) Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tiss Int 58: 409–414.CrossRefGoogle Scholar
  4. Hui SL, Slemenda CW, Johnston CC Jr. (1988) Age and bone mass as predictors offracture in a prospective study. J Clin Invest 81: 1804–1809.PubMedCrossRefGoogle Scholar
  5. Kanis JA, Melton LJ III, Christiansen C et al. (1994) The diagnosis of osteoporosis. JBone Miner Res 9: 1137–1141.CrossRefGoogle Scholar
  6. Kleerekoper M, Nelson D. (1988) Osteoporosis as a community health problem: Lessons learned from studying hypertension. Henry Ford Hosp Med J 36: 113–116.PubMedGoogle Scholar
  7. Lafferty FW, Rowland DY. (1996) Correlations of dual-energy X-ray absorptiometry, quantitative computed tomography, and single photon absorptiometry with spinal and non-spinal fractures. Osteoporosis Int 6: 407–415.CrossRefGoogle Scholar
  8. Lai D, Rencken M, Drinkwater B et al. (1993) Site of bone density measurement may affect therapy decision. CalcifTiss Int 53: 225–228.CrossRefGoogle Scholar
  9. Melton LJ III, Atkinson EJ, O’Fallon WM, Wahner HW. (1991) Long-term fracture risk prediction with bone mineral measurements made at various skeletal sites. J Bone Miner Res 6(S1): S136.CrossRefGoogle Scholar
  10. Miller PD, Bonnick SL, Rosen CJ. (1996) (for the Society for Clinical Densitometry). Clinical utility of bone mass measurements in adults: consensus of an international panel. Sem Arth Rheum 25: 361–372.CrossRefGoogle Scholar
  11. Nevitt MC, Cummings SR (1993) The Study of Osteoporotic Fractures Research Group. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J AmGeriatr Soc 41:1126–1234.Google Scholar
  12. Ott SM. (1991) Methods of determining bone mass. J Bone Miner Res 6(2): S71–76.CrossRefGoogle Scholar
  13. Riggs BL, Melton LJ III (1983) Evidence for two distinct syndromes of involutional osteoporosis. Am J Med 75: 899.PubMedCrossRefGoogle Scholar
  14. Riis BJ, Christiansen C. (1988) Measurement of spinal or peripheral bone mass toestimate early postmenopausal bone loss? Am JMed 84: 646–653.Google Scholar
  15. Ross PD, Davis JW, Epstein RS, Wasnich RD. (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114: 919–923.PubMedGoogle Scholar
  16. WHO Study Group. (1994) Assessment of fracture risk and its application to screening forpostmenopausal osteoporosis. WHO Technical Report Series 843. Geneva, Switzerland.Google Scholar

Copyright information

© Springer-Verlag London Limited 1998

Authors and Affiliations

  • Michael Kleerekoper
  • Dorothy A. Nelson

There are no affiliations available

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