| Objective When using areal bone mineral density (aBMD) to diagnose osteoporosis, the three-dimensional bone was standardized to two dimension, and in theory it would cause missed diagnosis in big bone and misdiagnosis in small bone. Thus, in this article, we investigated whether using aBMD in the diagnosis of osteoporosis could cause missed diagnosis or misdiagnosis and whether these could be avoided by using vBMD through epidemiological investigation. Methods Bone mineral density of lumbar spine and femoral neck was measured using the GE-Lunar DPX dual-energy X-ray absorptiometry bone densitometer. Bone volume and vBMD (vBMD=BMC/bone volume) were obtained using the cube digital mode (lumbar spine) and the cylinder number (femoral neck) of the instrument’s projection area (area, cm2). The standard deviation of aBMD and vBMD of people aged 20 to 39 years as recommended by the WHO was used to generate the T-score reference for normal, low bone density and osteoporosis (OP), and the WHO established T-score diagnosis method was used for the diagnosis of OP. Results Compared with using aBMD, the diagnosis of OP at lumbar spine and femoral neck using vBMD avoided small bone misdiagnosis by 16% and 11.6%, and big bone missed diagnosis by 7% and 18%, respectively. For lumbar bone volume every 10 cm3 less than the average, the rate of misdiagnosis using aBMD increased by 1%; for 10 cm3 more than the average, the rate of missed diagnosis increased by 0.44%. For femoral neck bone volume every 1 cm3 less than the average, the rate of misdiagnosis using aBMD increased by 2.6%; for every 1 cm3 more than average, the rate of missed diagnosis increased by 4%. Conclusion Using vBMD to diagnose osteoporosis could avoid missed diagnosis in big bone and misdiagnosis in small bone caused by using aBMD. |