What is her diagnosis?
This patient has severe or established osteoporosis based on her clinical history of fragility fractures and a hip T-score of -2.5, the cut-point for a diagnosis of osteoporosis by densitometry. (WHO Classification) Bone density measurements at L1 and L2—known sites of prior compression fractures—may be misinterpreted as increased BMD and, thus, these sites should not be considered when evaluating the patient's overall BMD. Certainly, having the BMD measured in g/cm2 and review of the BMD images would help substantiate this interpretation, but a diagnosis of osteoporosis can be made based on either the T-scores or the history of fragility fractures.