CAN BES TEST HELP IN ASSESSING THE RISK OF FRAGILITY FRACTURES IN PATIENTS WITH NORMAL OR OSTEOPENIC DEXA T-SCORE? HOW TO COMPARE DEXA AND BES TEST IN OSTEOPENIC PATIENTS WITH OR WITHOUT RECENT FRAGILITY FRACTURES

Introduction: osteoporosis is characterized by reduced bone mass and deterioration of bone microarchitecture, leading to bone fragility. Dual-energy x-ray absorptiometry (DEXA), which measures bone mineral density (BMD), is considered the gold standard for the diagnosis of osteoporosis and osteopenia. However, BMD is only one among several fracture risk factors. Consequently, DEXA should be associated with fracture risk assessment tools (FRAX, DeFRA, or FRA-HS). Therefore, the development of additional tests capable of measuring trabecular structure properties (quality), rather than only bone density, is needed. Methods: the Bone Elastic Structure Test (BES TEST) is a CE-marked, registered software medical device that measures bone elastic response to loads. It is based on an internationally patented method using high-definition digital radiographs of the proximal epiphysis of 3 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 performance of the BES TEST in patients with fragility fractures and normal or osteopenic DEXA T-scores. Previous data suggest that the BES TEST could be a useful complementary tool for completing fracture risk assessment. Therefore, we conducted a randomized controlled trial in which 50 female patients, divided into 2 groups (25 nonfractured and 25 recently fractured), underwent baseline lumbar spine, femoral, and femoral neck DEXA, together with a baseline BES TEST. Both examinations were repeated after 18 to 24 months, with the addition of spine morphometry. Conclusions: preliminary data confirm the reliability and reproducibility of both DEXA T-score and BSI T-score. The expected result is confirmation that BSI, associated with DEXA and FRAX-score or DeFRA-score, can help assess the risk of fragility fractures.