Exceptionally high lumbar spine DXA T-score in a nonagenarian: an artefact of degenerative spinal changes and vascular calcification.

Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis, but degenerative spinal changes and vascular calcifications can result in artefactual overestimation of bone mineral density (BMD) (3-5). Extreme elevations in T-scores in the absence of metabolic bone disease are exceptionally uncommon. We report a 95-year-old male with multiple chronic comorbidities who presented with poor oral intake and a urinary tract infection. DXA revealed a lumbar spine T-score of + 11.0. Laboratory and imaging evaluation showed no evidence of osteopetrosis, Paget's disease, secondary hyperparathyroidism, hematologic malignancy, or other metabolic bone disorders. Computed tomography demonstrated extensive abdominal aortic and iliac artery calcifications, vertebral deformities, endplate sclerosis, and severe degenerative changes. The extreme lumbar T-score was determined to be artefactual, caused by a combination of advanced vertebral degeneration and vascular calcification. This appears to be the first reported case of a lumbar spine T-score exceeding + 10 in a nonagenarian without metabolic bone disease. Clinicians should correlate DXA findings with clinical, laboratory, and imaging data to avoid misdiagnosis.