Vertebral anomalies in retired rugby players and the impact on bone density calculation of the lumbar spine

Abstract Introduction Dual energy X-ray absorptiometry (DXA) lumbar spine bone mineral density (BMD) measurements are subject to artificial elevation in the presence of structural abnormalities that are more common with age and injury, including osteoarthritis, fracture and osteophytes. The aims of this study were to investigate the presence of vertebral abnormalities on DXA scans in retired rugby players and a non-rugby control group, and to explore the effect of vertebral exclusion on BMD diagnostic outcome. Methods 87 male retired rugby players and 51 non-rugby controls from the UK Rugby Health Project participated in the study. Lumbar spine, total hip and femoral neck BMD were measured by DXA and scans were analysed pre and post exclusion of anomalous vertebrae. Data were analysed by age group to enable application of T-scores (≥50 y) and Z-scores ( Results From 138 lumbar spine scans, 66 required adjustment. 122 vertebral exclusions were made, and 12 lumbar spine scans (10 in retired rugby athletes) were un-reportable ( Conclusion Vertebral abnormalities detected on lumbar spine scans, were highly prevalent and impacted final T/Z-score in this cohort of retired rugby players. Current guidelines recommend exclusion of abnormalities from lumbar spine scans in adults aged ≥50 years. Our findings suggest that vertebral exclusions should also be applied to lumbar spine scans performed in those aged