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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.

Original publication

DOI

10.1093/rheumatology/ket007

Type

Journal article

Journal

Rheumatology (Oxford, England)

Publication Date

06/2013

Volume

52

Pages

968 - 985

Addresses

Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. celia.gregson@bristol.ac.uk

Keywords

Bone and Bones, Humans, Osteopetrosis, Osteoporosis, Osteoarthritis, Absorptiometry, Photon, Bone Density, Fractures, Bone