In a postmenopausal woman who is an avid marathon runner with no prior history of fractures, how would you approach treatment if DEXA shows severe osteoporosis at the distal radius (T-score −4.1) but only osteopenia at the hip and lumbar spine?

None of the guidelines recommend treating an isolated osteoporosis in the radius 33% when two other sites measured reveal only osteopenia. I would perform a frax calculation as I would for any patient with osteopenia to determine if she meets the treatment threshold and proceed accordingly. Robin K....

I would also make sure there was no error. I had a patient who had similar results and it was a machine error- machine not calibrated correctly.