INDICATIONS FOR ADULT BONE DENSITOMETRY MEASUREMENT REFERRALS (DXA SCANS), HAMMERSMITH HOSPITALS TRUST 2001
To optimise the correct usage of the Hammersmith Hospital Trust Bone Densitometry Service and to comply with IR(ME)R 2000 regulations, only individuals at high risk of osteoporosis should be scanned. If the DXA result does not alter your patient's management then the scan is not indicated. Below are listed the indications to be used in identifying individuals for bone densitometry:
Premature ovarian failure
(surgical, drug or disease induced)
Early menopause (<45 years)
Prolonged amenorrhoea (>1year)
Anorexia nervosa/bulimia
Malabsorption Diseases eg Coeliac, Crohn's
Chronic liver/kidney disease
Severe malnutrition
Major gastric surgery
Vitamin D or Calcium deficiencies
(only after checking that Vitamin D levels are normal)
Primary Hypogonadism
Cushing's
Hyperparathyroidism
Thyrotoxicosis
Hyperprolactinaemia
Proven family history of osteoporotic fracture
High alcohol intake
Poor diet (especially low Calcium intake)
Slender build (BMI <20kg/m2)
Long-term immobility
Heavy smoking (only in conjunction with other Major risk factors)
High dose or long term oral corticosteroids, (>7.5mg/d or
more of prednisolone or equivalent dose or another corticosteroid for 6 months
or more or about to commence long-term treatment)
Chronic heparin administration especially during pregnancy.
LHRH agnonists
Anticonvulsants
History of multiple atraumatic/minimal trauma fracture
Radiological appearances of osteoporosis eg. previous unknown vertebral collapse
Myeloma
Known osteoporotic fracture
Marked loss of height, thoracic kyphosis (after radiological confirmation of vertebral collapse)
For comparability these need to be performed on the same manufacturer and model type of DXA scanner and analysed using the same software version.
Monitoring therapy: 2 years post commencement or previous DXA measurement.
Monitoring borderline BMD results (Zscore=1-1.5SD):
perimenopausal women = 1-2 years post menopause
within 10 years of menopause = 2-3 years post initial DXA scan
all other groups = 4-5 years post initial scan
Following major alteration in treatment type: this provides a new baseline measurement (e.g HRT to bisphosphonates but not from one HRT to another).
Patient wishing to stop treatment but with a known reduced BMD or with very strong OP risk factors.
Patients with normal BMD's - there is no indication for a follow-up scan unless something dramatically changes in the patient's clinical history that could cause a reduction in their known normal BMD to the 'at risk' level.
Patient with known OP fracture and treated with bisphosphonates for 1 year: 1 year following commencement of treatment and then 1-3 years depending upon results.
BMD T score below - 1.5 +/= treatment with bisphosphonates for 1 year: 1 year following baseline DXA scan and then depending upon results.
BMD T score between - 1 and 1 1.4: 1 year following baseline DXA scan and then depending upon results. (>4% loss in spine or 7% at hip after 1 year - start or change in therapy).
Patients with normal BMD's - nil indication for follow-up scans unless there are dramatic changes in the patient's clinical history that could cause a reduction in their known normal BMD to the 'at risk' level.
Guidelines are required by the Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R) for justification of a DXA bone densitometry measurement.
These guidelines have been produced using the Royal College of Physicians Clinical Guidelines on Osteoporosis (1999 & 2000), Department of Health Advisory Group on Osteoporosis Report (1994), WHO Study group report on Assessment of fracture risk and its application to screening for Osteoporosis (1994), the National Osteoporosis Society 'Guidance on the prevention and management of corticosteroids induced osteoporosis' (1998), and in consultation with clinicians from Hammersmith Hospitals Trust.