Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management
Open Access
- 27 February 2013
- journal article
- review article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 52 (6), 968-985
- https://doi.org/10.1093/rheumatology/ket007
Abstract
A finding of high BMD on routine DXA scanning is not infrequent and most commonly reflects degenerative disease. However, BMD increases may also arise secondary to a range of underlying disorders affecting the skeleton. Although low BMD increases fracture risk, the converse may not hold for high BMD, since elevated BMD may occur in conditions where fracture risk is increased, unaffected or reduced. Here we outline a classification for the causes of raised BMD, based on identification of focal or generalized BMD changes, and discuss an approach to guide appropriate investigation by clinicians after careful interpretation of DXA scan findings within the context of the clinical history. We will also review the mild skeletal dysplasia associated with the currently unexplained high bone mass phenotype and discuss recent advances in osteoporosis therapies arising from improved understanding of rare inherited high BMD disorders.Keywords
This publication has 149 references indexed in Scilit:
- Bone Overgrowth-associated Mutations in the LRP4 Gene Impair Sclerostin Facilitator FunctionJournal of Biological Chemistry, 2011
- ‘Sink or swim’: an evaluation of the clinical characteristics of individuals with high bone massOsteoporosis International, 2011
- Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone densityOsteoporosis International, 2010
- A point mutation in KINDLIN3 ablates activation of three integrin subfamilies in humansNature Medicine, 2009
- Drug-induced morphea: Report of a case induced by balicatib and review of the literatureJournal of the American Academy of Dermatology, 2008
- SAPHO syndrome associated spondylitisEuropean Spine Journal, 2008
- Buschke-Ollendorff syndrome: A manifestation of a heterozygous nonsense mutation in the LEMD3 geneJournal of the American Academy of Dermatology, 2008
- A LAD-III syndrome is associated with defective expression of the Rap-1 activator CalDAG-GEFI in lymphocytes, neutrophils, and plateletsThe Journal of Experimental Medicine, 2007
- Hormones and growth factors in the pathogenesis of spinal ligament ossificationEuropean Spine Journal, 2007
- The spine in Paget’s diseaseSkeletal Radiology, 2007