Kienböck's disease on forearm DXA in a hemodialysis patient with a stented arteriovenous fistula: A case report

Forearm dual-energy X-ray absorptiometry (DXA) is frequently employed for fracture risk assessment in patients with certain chronic conditions such as end-stage renal disease (ESRD), in whom the lumbar spine and hip measurements may be confounded. We report a case of a 72-year-old postmenopausal woman with ESRD maintained on hemodialysis through a stented left forearm arteriovenous fistula (AVF) and type 2 diabetes mellitus, referred for forearm DXA. Bone mineral density measurement of the access-bearing left forearm yielded a T-score of -4.8, consistent with osteoporosis. The acquired image incidentally demonstrated sclerosis of the carpal lunate concerning for Kienböck's disease, in addition to a partially visualized AVF stent. This case underscores the rationale for imaging the non-access forearm in patients with vascular access undergoing DXA evaluation, while illustrating the importance of scrutinizing the full DXA image set rather than the numerical output alone.