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To the Editor: Dr Siris and colleagues¹ found that many asymptomatic postmenopausal women have previously undetected low bone mineral density (BMD). They also confirmed that peripheral bone densitometry, categorized according to T scores, is predictive of subsequent fracture risk in this population.

In this study, and often in clinical practice, the diagnostic threshold of a T score of -2.5 (BMD of 2.5 SDs below the peak adult value) is used. However, Siris et al found that the proportion of women with BMDs below this value varies dramatically by device, from 3.4% with heel ultrasound to 13.5% with finger dual-energy x-ray absorptiometry (DXA). When adjusted for age, weight, and other confounding factors, there was more than a 6-fold difference in the proportion below the threshold. Other studies have shown similar variations in the apparent prevalence of osteoporosis, as well as risk of fractures, when different devices are used with T-score thresholds.^2-3

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