1. This patient had a compression fracture at L1. This is very similar to the mistake made in the first case. The fracture can be detected on the image, and there is a marked increase in L1 but a decrease in the other vertebrae. The radiologist did not notice this.

2. Although it is not technically a mistake to report the calculated loss per year, it may be misleading.

3. The relationship between BMD and fracture is probably different in men than in women. The WHO guidelines were meant for women. A study in Rotterdam found similar rates of fractures depending on the absolute bone density (g/cm2) regardless of gender. But another study in the USA found that there were gender differences even using the same absolute bone density.

In case you are now asking yourself "Why does he have a compression fracture if he has only osteopenia?" I will tell you that he had been taking glucocorticoids, which can cause fractures at higher bone density values.

Updated 8/8/05