How do you interpret DXA results in cases where there is discordance between normal hip and spine BMD with abnormal one-third radius BMD?

This is an interesting question. To my knowledge, there are no fracture prediction models based only on forearm bone density values so my response is my opinion and not evidence-based. Firstly, we always rule out hyperparathyroidism when there is forearm bone discordance compared to spine and hips since hyperparathyroidism can have this effect on bone density scores. If the patient has not had a fracture and has normal spine and hip bone density values, I tend to ignore the forearm value and not...

One of the problems with using forearm DXA for dx is that clinical studies with anti-fracture interventions have only used hip and spine BMD measurements as inclusion criteria, so there is no evidence of anti-fracture efficacy in patients based on forearm DXA.