Skip to main content
Log in

The tale of the T-score: review and perspective

  • Editorial
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The T-score is well known to anyone working in the field of bone densitometry. It is the primary output from a bone densitometry system and is most often used for diagnosis of osteoporosis and for making treatment decisions. Despite widespread acceptance of the T-score, most clinicians are unfamiliar with the historical evolution of the T-score as a clinical measure. Furthermore, evidence is mounting that the T-score is not the optimal diagnostic parameter for clinical decision making. Many additional risk factors have been reported which can be combined with bone density results to assess absolute fracture risk. This editorial provides an historical review of the T-score, followed by summary of the status of the T-score, and concludes with suggestions for the future use of the T-score in bone densitometry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Watts NB (2002) T-scores and osteoporosis. Menopause Med 10:1–4

    Google Scholar 

  2. The WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organization, Geneva

  3. Kanis JA (1994) Assessment of fracture risk and is application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381

    CAS  PubMed  Google Scholar 

  4. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  5. National Osteoporosis Foundation (1998) Physician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC

  6. Lenchik L, Leib ES, Hamdy RC, Binkley NC, Miller PD, Watts NB (2002) International Society for Clinical Densitometry Position Development Panel and Scientific Advisory Committee. Executive summary. International Society for Clinical Densitometry position development conference. J Clin Densitom 5 (Suppl):S1–S3

    Article  PubMed  Google Scholar 

  7. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. Lancet 341:72–75

    Article  CAS  PubMed  Google Scholar 

  8. Gardsell P, Johnell O, Nilsson BE (1989) Predicting fractures in women by using forearm bone densitometry. Calcif Tiss Int 44:235–242

    CAS  Google Scholar 

  9. Wasnich RD, Ross PD, Davis JW, Vogel JM (1989) A comparison of single and multi-site BMC measurements for assessment of spine fracture probability. J Nucl Med 30:1166–1171

    CAS  PubMed  Google Scholar 

  10. Smith DM, Khairi MRA, Johnston CC (1975) The loss of bone mineral with aging and its relationship to risk for fracture. J Clin Invest 5:311–318

    Google Scholar 

  11. Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P, Vogt T (1990) Appendicular bone density and age predict hip fracture in women. J Am Med Assoc 263:665–668

    Article  CAS  Google Scholar 

  12. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    CAS  PubMed  Google Scholar 

  13. Hui SL, Slemenda CW, Johnston CC (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809

    CAS  PubMed  Google Scholar 

  14. Pocock NA, Sambrook PN, Nguyen T, Kelly P, Freund J, Eisman JA (1992) Assessment of spinal and femoral bone density by dual X-ray absorptiometry: comparison of Lunar and Hologic instruments. J Bone Miner Res 7:1081–1084

    CAS  PubMed  Google Scholar 

  15. Greenspan SL, Maitland-Ramsey L, Myers E (1996) Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tissue Int 58:409–414

    Article  CAS  PubMed  Google Scholar 

  16. Faulkner KG, Stetten E von, Miiller P (1999) Discordance in patient classification using T-scores. J Clin Densitom 2:343–350

    Article  CAS  PubMed  Google Scholar 

  17. Faulkner KG (1998) Bone densitometry: choosing the proper skeletal site to measure. J Clin Densitom 1:279–285

    Article  CAS  PubMed  Google Scholar 

  18. Faulkner KG, Roberts LA, McClung MR (1996) Discrepancies in normative data between Lunar and Hologic DXA systems. Osteoporos Int 6:432–436

    CAS  PubMed  Google Scholar 

  19. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768

    CAS  PubMed  Google Scholar 

  20. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  CAS  PubMed  Google Scholar 

  21. Steiger P (1995) Standardization of spine BMD measurements. J Bone Miner Res 10:1602–1603

    PubMed  Google Scholar 

  22. Hanson J (1997) Standardization of femur BMD. J Bone Miner Res 12:1316–1317

    CAS  PubMed  Google Scholar 

  23. Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, van Kuijk C (1994) Universal standardization of dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514

    CAS  PubMed  Google Scholar 

  24. Faulkner KG, Orwoll E (2002) Implications in the use of T-scores for the diagnosis of osteoporosis in men. J Clin Densitom 5:87–93

    Article  PubMed  Google Scholar 

  25. FDA Radiological Devices Panel Summary, 17 May 1999 http://www.fda.gov/cdrh/rdp.html, Accessed 20 March 2004

  26. Black DM (2001) A proposal to establish comparable diagnostic categories for bone densitometry based on hip fracture risk among Caucasian women over 65. J Bone Miner Res 16 (Suppl 1):S342

    Google Scholar 

  27. Black DM, Cooper C (2000) Epidemiology of fractures and assessment of fracture risk. Clin Lab Med 20:439–453

    CAS  PubMed  Google Scholar 

  28. Faulkner KG (1998) Bone matters: Are density increases necessary to reduce fracture risk? J Bone Miner Res 15:183–187

    Google Scholar 

  29. Kanis JA, Black D, Cooper C et al. (2002) A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 13:527–536

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth G. Faulkner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Faulkner, K.G. The tale of the T-score: review and perspective. Osteoporos Int 16, 347–352 (2005). https://doi.org/10.1007/s00198-004-1779-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1779-y

Keywords

Navigation