Our skeleton wears out with age, and if we are not careful, this can lead to falls and disabilities. In prevention, examination of the bones is essential.
Bone analysis can be as useful as a blood test: it is a key examination for identifying an insidious and dangerous pathology: osteoporosis. This skeletal disease results both in a decrease in bone mass and in a deterioration of the internal architecture of the bone. After a fracture known as “low trauma” – that is to say not caused by a violent shock, but simply by slipping on the ground or falling from its height -, the examination is required regardless of the age, and it is reimbursed by Social Security. If there are strong indications of disease, especially given the medical history, bone mineral density or BMD is a reference measurement.
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“ BMD not only helps diagnose osteoporosis, but also predicts fracture risk “says Dr. Karine Briot, rheumatologist at Cochin Hospital. The lower the BMD, the higher the risk. In addition, its result allows in part to assess the need for treatment against osteoporosis.
“ This is not the only determining factor. Consideration should also be given to age and history of fractures “, she adds. This has motivated the development of computer tools integrating all these parameters, such as the Frax software developed by the WHO.
Perform a bone densitometry
As for the BMD, it is an examination which does not last more than fifteen minutes and is called bone densitometry. Performed in a rheumatologist’s office or in equipped radiology centers, it relies on very weakly ionizing X-rays. Its principle is simple. When a beam of energy passes through a solid body, the latter absorbs it all the more as its density is high. By irradiating the bone with it, then measuring the amount of energy released, we can therefore assess its density. It is done at the level of the spine and at the hip, which makes it possible to assess the bone mass of the two types of bone: trabecular (or spongy) and cortical (or compact).
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But there is a downside. “ It has been found that 30-40% of patients with a typical osteoporosis fracture have sufficient amount of bone », Comments Professor Didier Hans, from the Lausanne University Hospital. Hence the development, in recent years, of a complementary tool to go further: software coupled to the densitometer which analyzes its images to determine the quality of the bone and its microarchitecture.
The urgency of screening
Developed by Inserm researchers in collaboration with the Center for Bone Diseases of the Chuv in Lausanne, this process called TBS (trabecular bone score) has been evaluated in Switzerland. In the United States, a 2019 study showed that it predicted fracture risk better than traditional exams. But for now, in France, bone densitometry remains underused. “ There is clearly a lack of prescription “, points out Karine Briot: less than 15% of people considered at risk of osteoporosis because having a history of fracture are directed to this examination.
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Remember that with the lengthening of life, this pathology affects a growing number of people: 39% of women after 65 years, 70% after 80 years. And if men are less often affected – it is estimated that there are two women for every man with an osteoporotic fracture – the disease is just as disabling for them. When it occurs at an advanced age, osteoporosis accompanies many other diseases (pulmonary, cardiovascular, etc.), and fractures can then seriously impact the quality of life. Even life itself. It is therefore urgent to encourage its screening.