Endocrine Abstracts

Introduction: An 80-year old female with known osteoporosis was reassessed for BMD measurement. Her baseline BMD and T-score of lumbar spine (L1–L4) measured in 2004 were 0.699 g/cm², −3.5 S.D., T-score of total left hip was 0.618 g/cm², −2.7 S.D.. She was treated with alendronate 70 mg, cholecalciferol 7000 IE per week and calcium supplements.

Case report: At follow-up in 2013, DXA scan, BMD of lumbar spine L1–L4 was 0.910 g/cm², T-score was −1.2 S.D. BMD and T-scores for lumbar vertebrae: L1 1.384 g/cm²,+4.2 S.D.; L2 0.667 g/cm², −3.3 S.D.; L3 0.654 g/cm², −3.9 S.D.; L4 0.785 g/cm², −3.0 S.D. BMD and T-score of neck and total hip were 0.463 g/cm², −3.5 S.D., and 0.590 g/cm², −2.9 S.D., respectively. On image examination, we identified a calcified mass in the projection of the L1 vertebra. Upon the reanalysis of the DXA scan, we excluded the calcified formation and L1. BMD of lumbar spine (L2-L4) was 0.701 g/cm², T-score was −3.4 S.D.. BMD and T-scores were: L2 0.614 g/cm², −3.8 S.D.; L3 0.642 g/cm², −4.0 S.D.; L4 0.785 g/cm², −3.0 S.D. In 2016, BMD of lumbar spine (L3–L4) was 0.722 g/cm², T-score was −3.4 S.D. BMD and T-scores were: L3 0.667 g/cm², −3.8 S.D.; L4 0.778 g/cm², −3.1 S.D., and superposition of calcified formation was on L1+L2. We checked previous examinations: 3 years before she underwent an abdominal CT, which revealed a 3 cm large calcified Echinococcal cyst (EC). In 2013, a DXA scan EC was projected on L1, in 2016 on L1+L2 due to the collapsed L1, developed kyphosis and height reduction.

Conclusion: Artifacts can interfere with BMD measurements. The study showed that bra-wires and calcium carbonate pills positioned lateral to the spine can modify BMD. Several medical conditions, such as osteophyte formation, osteoarthritis, ankylosing spondylitis, vertebral fractions, and aortic calcifications can also increase BMD. However, after review of the PubMed literature, to our knowledge there were no cases of falsely increased BMD of lumbar spine due to calcified EC.