Open Access Highly Accessed Research article

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry

Alireza Moayyeri12*, Akbar Soltani12, Nasibeh Khaleghnejad Tabari1, Mohsen Sadatsafavi2, Arash Hossein-neghad1 and Bagher Larijani1

Author Affiliations

1 Endocrinology & Metabolism Research Centre, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Research Development Center, Evidence Based Medicine Working Team, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran

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BMC Endocrine Disorders 2005, 5:3  doi:10.1186/1472-6823-5-3

Published: 11 March 2005



Diagnostic discordance for osteoporosis is the observation that the T-score of an individual patient varies from one key measurement site to another, falling into two different diagnostic categories identified by the World Health Organization (WHO) classification system. This study was conducted to evaluate the presence and risk factors for this phenomenon in a large sample of Iranian population.


Demographic data, anthropometric measurements, and risk factors for osteoporosis were derived from a database on 4229 patients referred to a community-based outpatient osteoporosis testing center from 2000 to 2003. Dual-energy X-ray absorptiometry (DXA) was performed on L1–L4 lumbar spine and total hip for all cases. Minor discordance was defined as present when the difference between two sites was no more than one WHO diagnostic class. Major discordance was present when one site is osteoporotic and the other is normal. Subjects with incomplete data were excluded.


In 4188 participants (3848 female, mean age 53.4 ± 11.8 years), major discordance, minor discordance, and concordance of T-scores were seen in 2.7%, 38.9% and 58.3%, respectively. In multivariate logistic regression analysis, older age, menopause, obesity, and belated menopause were recognized as risk factors and hormone replacement therapy as a protective factor against T-score discordance.


The high prevalence of T-score discordance may lead to problems in interpretation of the densitometry results for some patients. This phenomenon should be regarded as a real and prevalent finding and physicians should develop a particular strategy approaching to these patients.