Can the BES TEST help in assessing the risk of fragility fractures in patients with normal or osteopenic DEXA T-score?

Introduction: osteoporosis is characterized by bone mass reduction and bone micro-architecture damage leading to bone fragili¬ty. Dual-X-ray absorptiometry (DEXA), which measures the bone mineral density (BMD), is considered the gold standard for the diagnosis of osteoporosis/ osteopenia. However, BMD is only one among several risk factors for fracture. Consequently, DEXA should be associated with a map of fracture risk (FRAX, DeFRA or FRA-HS). Therefore, the development of other tests capable of measuring the trabecular structure properties (quality), instead of just density of bone are needed. Methods: the Bone Elastic Structure Test (BES TEST) is a measure of bone elastic response to loads, a CE marked, registered, software. medical device, based on an internationally patented method that uses high definition digital radiographs in the proximal epiphysis of three fingers to investigate the biomechanical functionality of the trabecular structure, in terms of its contribution to bone strength. Results: the main objective of the study is to assess the reliability and the performance of BES TEST in patients affected by fragility fracture with normal or osteopenic DEXA T-score. Previous data suggest that BES TEST could be a helpful complementary test for completing the fracture risk assessment. Therefore, we conducted a RCT in which 50 female patients, divided in two groups (25 non fractured and 25 recently fractured), underwent a basal lumbar, femoral and femoral-neck DEXA and a basal BES TEST, both of which were repeated after 18-24 months with the addition of spine morphometry. Conclusion: preliminary data confirm the reliability and reproducibility of both DEXA T-score and BSI T-score. The expected result is the confirmation that BSI, associated to DEXA and FRAX-score or DeFra-score can help in assessing the risk of fragility fractures.