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Çetin, Alp MD; Özçakar, Levent MD
From the Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.
All correspondence and requests for reprints should be addressed to Levent Özçakar, Yeni Ankara sokak 27/1, Cebeci, Ankara, Turkey.
A 67-yr-old woman with a working diagnosis of osteoporosis was seen for low-back pain. Her medical history revealed a recent kyphoplasty procedure for an L2-compression fracture. Limited low-back motions with bilateral paravertebral muscle guarding were noted on physical examination. Radiologic evaluations of lumbar vertebrae and bone mineral density measurements using dual-energy x-ray absorptiometry were performed (Figs. 1 and 2). The initial L1–L4 t score was thought to be consistent with osteopenia (−1.92); however, further analysis revealed that the L2 score (+2.48) had, in effect, skewed the results (Table 1). When the value pertaining to the L2 vertebra was neglected, the mean value of t scores were recalculated using L1, L3, and L4 values as −3.12 (osteoporotic).
The authors report this case for two reasons. First, considering the mounting frequency of kyphoplasty operations, we imply that dual-energy x-ray absorptiometry measurements may yield incorrect results in such patients.1 Accordingly, clinicians should diligently evaluate such patients’ bone mineral density measurements in light of their medical history. Secondly, a better estimation of L1–L4 t score can easily be done with a simple correction by omitting the value of the involved vertebra.
© 2007 Lippincott Williams & Wilkins, Inc.
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