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Paget's disease of bone — SCE Rheumatology MCQ

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HardMetabolic Bone DiseasePaget's disease of boneSCE Rheumatology

An older patient has lumbar spondylosis, a lumbar-spine T-score of +0.1 and a total-hip T-score of −2.8. Vertebrae are visibly degenerative on DXA images. How should the discordance be interpreted?

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Correct answer: B — Degeneration falsely elevates lumbar BMD; assess risk using valid sites

Degenerative change can artifactually elevate lumbar-spine BMD. Fracture-risk assessment should use technically valid, interpretable sites—often the hip in this situation—together with clinical risk factors rather than averaging discordant T-scores.

Reference: NOGG clinical guideline for prevention and treatment of osteoporosis (Updated 2024): https://www.nogg.org.uk/full-guideline; NICE TA464: bisphosphonates for treating osteoporosis (Updated July 2019): https://www.nice.org.uk/guidance/ta464/chapter/1-Recommendations