Prevalence, patterns, and predictors of lumbar spine-femoral neck BMD discordance in Jordanian adults: A retrospective observational study.
BACKGROUND/OBJECTIVES Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and increased fracture risk. Dual-energy X-ray absorptiometry (DXA) is the reference standard for diagnosis, typically assessing the lumbar spine and femoral neck. Site-specific differences may result in spine-hip BMD discordance, potentially influencing clinical decision making. This study aimed to determine the prevalence, patterns, and predictors of spine-hip BMD discordance among Jordanian adults. METHODS This retrospective observational study included adults aged ≥18 years who underwent DXA for osteoporosis evaluation at two tertiary hospitals in Jordan between March 2024 and June 2025. Lumbar spine and femoral neck BMD were measured using standardized DXA protocols. Discordance was classified using T-scores or Z-scores as appropriate. RESULTS A total of 826 participants were included, comprising 576 evaluated using T-scores and 250 using Z-scores. In the T-score group, lumbar spine-femoral neck BMD discordance was observed in 66.0% of participants, including 50.5% with minor discordance and 15.5% with major discordance, while 34.0% were concordant. In contrast, discordance was present in only 18.4% of the Z-score group. After adjusting for principal demographic and high-prevalence clinical parameters, Multivariable analysis identified family history of osteoporosis and sex as independent predictors of discordance severity in the T-score group, whereas no significant predictors were identified in the Z-score group. CONCLUSIONS Spine-hip BMD discordance is common among Jordanian adults undergoing DXA, particularly in those assessed using T-scores, underscoring the importance of multisite DXA assessment to improve diagnostic accuracy and fracture risk evaluation.