A DEXA scan at 20 years of age in select subjects may show a z-score "shift to the left" giving time after ethnic corrections to regain optimal peak BMD at 30 years

Kiran Kumar Venkata Satya Nandivada; Aditya Sridhar Acharya; Kabilesh  Jothilingam; Shabbeer Ahamed Imtiaz; Ajin Mathews John; Vaishnavi Nandivada; Aysha Naushad Khan; Adnan Mirza; Usama Ahmed Riswi; Maliha Karim; Chandanasri Kalapala; Sagarika Jayakumar; Praharsha Pothina; Ishan Mohzin

doi:10.18203/issn.2455-4510.IntJResOrthop20263940

Authors

Kiran Kumar Venkata Satya Nandivada International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Aditya Sridhar Acharya International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Kabilesh Jothilingam International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Shabbeer Ahamed Imtiaz International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Ajin Mathews John International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Vaishnavi Nandivada International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Aysha Naushad Khan International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Adnan Mirza International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Usama Ahmed Riswi International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Maliha Karim International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Chandanasri Kalapala International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Sagarika Jayakumar International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Praharsha Pothina International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India
Ishan Mohzin International Research Trainee Academy, Seethammadhaa, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263940

Keywords:

Osteopenia, Osteoporosis, DEXA scan, T score, Z score

Abstract

Background: Osteoporosis is a silent pandemic, and it's vital to detect osteopenia early. This study shows the importance of a DEXA baseline scan at 20 years of age as a part of a PREVENTIVE MEASURE to gain time to reach the optimum Peak BMD at around 30 years.

Methods: Among 5,000 patients tested in a mixed or ambispective study determining BMD between 2000-2026, by the IRT programme by NGO KRUSHI OWS.

The exclusion criteria were patients with known causes of bone weakness due to congenital diabetes, Thyroid deficiencies, renal dysfunction, familial history of bone weakness.

Results: Osteopenia was prevalent in 60% (n=3,000), Osteoporosis was found in 15% (n=750), and Normal Bone Density was found in 25% (n=1,250). The analysis showed that 75% of study patients had low bone density, highlighting the consequences of low bone mass for individuals, families, and insurance companies.

Conclusions: If the osteopenia stage, a precursor to osteoporosis, is missed or neglected, the opportunity to reach optimal peak BMD is lost forever, making this study an important call for attention from osteoporosis foundations worldwide.

References

Xue S, Kemal O, Lu M, Lix LM, Leslie WD, Yang S. Age at attainment of peak bone mineral density and its associated factors: the National Health and Nutrition Examination Survey 2005–2014. Bone. 2020;131:115163.

Chevalley T, Rizzoli R. Acquisition of peak bone mass. Best Pract Res Clin Endocrinol Metab. 2022;36(2):101616.

Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, et al. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27(4):1281–386.

Wang Q, Wang X, Iuliano-Burns S, Ghasem-Zadeh A, Zebaze R, Seeman E. Rapid growth produces transient cortical weakness: a risk factor for metaphyseal fractures during puberty. J Bone Miner Res. 2010;25(7):1521–6.

Sheikdon AA, Ahmed AM, Ahmed OH. Transient osteoporosis of the hip in a 17-year-old nonpregnant female: a case report. J Med Case Rep. 2025;19(1):323.

Doknic M, Stojanovic M, Markovic A. Transition period and young adulthood in patients with childhood onset growth hormone deficiency (COGHD): impact of growth hormone replacement on bone mass and body composition. Int J Mol Sci. 2024;25(19):10313.

Pham HT, Kram V, Dar QA, Komori T, Ji Y, Mohassel P, et al. Collagen VIα2 chain deficiency causes trabecular bone loss by potentially promoting osteoclast differentiation through enhanced TNFα signaling. Sci Rep. 2020;10(1):13749.

Sun C, Yang A, Teng F, Xia Y. Efficacy of collagen peptide supplementation on bone and muscle health: a meta-analysis. Front Nutr. 2025;12:1646090.

Miller M, Hangartner T. Temporary brittle bone disease: association with decreased fetal movement and osteopenia. Calcif Tissue Int. 1999;64:137–143.

So KW, Ng PC. Treatment and prevention of neonatal osteopenia. Curr Paediatr. 2005;15(2):106–13.

Perrone S, Caporilli C, Grassi F, Ferrocino M, Biagi E, Dell'Orto V, et al. Prenatal and neonatal bone health: updated review on early identification of newborns at high risk for osteopenia. Nutrients. 2023;15(16):3515.

Tabatabaei RS, Mirjalili SR, Ashrafi A, Shamsi F. The relationship between maternal vitamin D levels and osteopenia development in preterm infants: a cross-sectional study. Int J Reprod Biomed. 2024;22(11):845–56.

Babhulkar S, Seth SS. Prevalence of osteoporosis in India: an observation of 31238 adults. Int J Res Orthop. 2021;7:362–8.

Zmuda JM, Yerges LM, Kammerer CM, Cauley JA, Wang X, Nestlerode CS, et al. Association analysis of WNT10B with bone mass and structure among individuals of African ancestry. J Bone Miner Res. 2009;24(3):437–47.

Sosa-Henríquez M, Torregrosa-Suau Ó, Gómez de Tejada-Romero MJ, Cancelo-Hidalgo MJ, Tarazona-Santabalbina FJ, Etxebarria-Foronda I, et al. Rethinking vitamin D deficiency: controversies and practical guidance for clinical management. Nutrients. 2025;17(22):3573.

Akhiiarova K, Khusainova R, Minniakhmetov I, Mokrysheva N, Tyurin A. Peak bone mass formation: modern view of the problem. Biomedicines. 2023;11(11):2982.

Gilsanz V, Wren TAL, Ponrartana S, Mora S, Rosen CJ. Sexual dimorphism and the origins of human spinal health. Endocr Rev. 2018;39:221–39.

Hereford T, Kellish A, Samora JB, Reid Nichols L. Understanding the importance of peak bone mass. J Pediatr Orthop Soc North Am. 2024;7:100031.

Cherian KE, Kapoor N, Asha HS, Thomas N, Paul TV. Influence of different reference databases on categorization of bone mineral density: a study on rural postmenopausal women from southern India. Indian J Endocrinol Metab. 2018;22(5):579–83.

Bhudhikanok GS, Wang MC, Eckert K, Matkin C, Marcus R, Bachrach LK. Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size. J Bone Miner Res. 1996;11(10):1545–56.

Kandasamy N, Karjala SL, Jayakumar D, Machiraju PK, Kalathur HK, Balakrishnan L. Estimation of T scores with Hologic using Native vs. Caucasian data in Indians (ETHNICA): a single center retrospective study. BMC Musculoskelet Disord. 2025;26(1):448.

Shetty S, Kapoor N, Naik D, Asha HS, Thomas N, Paul TV, et al. The impact of the Hologic vs. the ICMR database in diagnosis of osteoporosis among South Indian subjects. Clin Endocrinol (Oxf). 2014;81:519–22.

Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42(3):467–75.

World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: World Health Organization; 1994. Available from: https://fraxplus.org/sites/frax/files/pdf/WHO_Technical_Report.pdf. Accessed on 11 September 2026.

Hadadi I. Comparative analysis of bone density measurement techniques: a systematic review of quantitative ultrasound and dual-energy X-ray absorptiometry. Front Endocrinol (Lausanne). 2026;17:1768327.

Kushwaha NS, Singh A, Kumar S, Kumar D, Bharat A. Validation of quantitative ultrasonography for osteoporosis diagnosis in postmenopausal women compared to dual-energy X-ray absorptiometry (DEXA). Cureus. 2023;15(5).

Métrailler A, Hans D, Lamy O, Gonzalez Rodriguez E, Shevroja E. Heel quantitative ultrasound (QUS) predicts incident fractures independently of trabecular bone score (TBS), bone mineral density (BMD), and FRAX: the OsteoLaus Study. Osteoporos Int. 2023;34(8):1401–9.

Hernandez CJ, Beaupre GS, Carter DR. A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int. 2003;14:843–7.

Miller M. Foetal bone loading is a critical determinant of foetal and young infant bone strength. Clin Biomech (Bristol, Avon). 2025;125:106513.

Jiang Z, Byers S, Casal ML, Smith LJ. Failures of endochondral ossification in the mucopolysaccharidoses. Curr Osteoporos Rep. 2020;18(6):759–73.

Subramanian S, Anastasopoulou C, Viswanathan VK. Osteogenesis imperfecta. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536957/. Accessed on 11 August 2026.

Mahon P, Harvey N, Crozier S, Inskip H, Robinson S, Arden N, et al.; SWS Study Group. Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res. 2010;25(1):14–9.

Ackah SA, Imel EA. Approach to hypophosphatemic rickets. J Clin Endocrinol Metab. 2023;108(1):209-20.

Ciancia S, Högler W, Sakkers RJB, et al. Osteoporosis in children and adolescents: how to treat and monitor? Eur J Pediatr. 2023;182:501–11.

Lee WT, Cheung CS, Tse YK, Guo X, Qin L, Lam TP, et al. Association of osteopenia with curve severity in adolescent idiopathic scoliosis: a study of 919 girls. Osteoporos Int. 2005;16(12):1924–32.

Bartynski WS, Heller MT, Grahovac SZ, Rothfus WE, Kurs-Lasky M. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol. 2005;26(8):2077–85.

Yoon BH, Kim DY. Discordance between hip and spine bone mineral density: a point of care. J Bone Metab. 2021;28(4):249–51.

Varacallo MA, Seaman TJ, Jandu JS, et al. Osteopenia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499878/. Accessed on 11 August 2026.

Deb P, Gupta SK, Godbole MM. Effects of short-term testosterone replacement on areal bone mineral density and bone turnover in young hypogonadal males. Indian J Endocrinol Metab. 2012;16(6):947–51.

Li S. Testosterone deficiency in aging males: a dual threat to vascular and bone health through coronary artery calcification and osteoporosis—a narrative review. Aging Male. 2026;29(1):2662042.

Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Zhu YQ, et al. Prevalent osteoporotic vertebral fractures more likely involve the upper endplate than the lower endplate and even more so in males. Ann Transl Med. 2018;6(22):442.

Bilek LD, Flores LE, Waltman N, Smith K, Hillstrom D, Yecies L, et al. MON-802 wearable vibration therapy for low bone density: high adherence and usability scores in a 12-month clinical trial. J Endocr Soc. 2025;9(Suppl 1).544.

Caffarelli C, Tomai Pitinca MD, Al Refaie A, De Vita M, Catapano S, Gonnelli S. Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine? BMC Musculoskelet Disord. 2022;23:1–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9118880/ Accessed on 11 August 2026.

Mobasseri M, Tarverdizadeh N, Mirghafourvand M, Salehi-Pourmehr H, Ostadrahimi A, Farshbaf-Khalili A. The role of bone turnover markers in screening low bone mineral density and their relationship with fracture risk in the postmenopausal period. J Res Med Sci. 2023;28:54.