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The following indicate an increased risk for bone loss (osteoporosis) and might require BMD assessment to confirm osteoporosis.1 Although BMD scanning can be carried out for any of these risk factors, only some satisfy Medicare re batable indications, as specified in the MBS handbook. These indications are generally applicable to patients at increased risk of fracture and include:
The only distinct prerequisites for a BMD scan is that the individual should not have had a previous radiological or nuclear medicine investigation in the last week and that they are known not to be pregnant (see what are the absolute contraindications for a BMD scan).
Pregnancy is the only absolute contraindication. Pregnancy is contraindicated because of the ionising radiation involved in the study. Documentation of the last normal menstrual period or the results of a pregnancy test should be provided.
Bilateral hip replacements or bilateral hip pins or screws would prevent the hip sites from being scanned. Unilateral metallic surgical implants in the hip necessitate the opposite hip being scanned. Similarly, metallic rods or spinal fusion devices in the lumbar spine would preclude scanning at this site. Forearm scans are carried out where either the hip or spine sites are unavailable.
DXA scans are safe for patients with permanent pacemakers and implantable defibrillators.
There are no apparent adverse effects of a BMD scan.
There is no specific post-procedural care required.
Although the currently accepted gold standard for assessing bone density is the DXA scan, an assessment of bone density can also be made by CT scan of the lumbar spine, or by heel ultrasound. There are significant limitations of both of these latter two methods.
CT scan of the lumbar spine is accurate and reproducible; however, it involves significantly higher doses of ionising radiation, and provides information about only one region. The hip and spine are composed of different types of bone, which are variably susceptible to medical or therapeutic insults. Having information about two sites is therefore preferred.
Heel ultrasound is a useful screening method to assess bone structure and density. It does not use ionising radiation, but requires formal DXA assessment for osteoporosis in those patients who have been identified as potential high fracture risk after heel ultrasound measurements.
WHO criteria for BMD results are based on T score values; that is, measurements compared with normal young same sex population:
BMD scanning is also indicated for follow up or monitoring of response to therapy aimed at preventing fracture and bone loss, or monitoring of progress according to medical condition or therapy. The frequency of repeated studies covered by Medicare in Australia varies according to the underlying condition, for example 12-monthly intervals for hypogonadism and glucocorticoid exposure, and 24-month intervals for the remainder.
There are a number of manufacturers of DXA scanners. It is important that follow-up DXA scans be carried out on the same scanner. Scans from different manufacturers, and to some extent those from the same manufacturer at different sites, cannot be directly compared.
Although diffuse bone loss in the elderly is commonly due to osteoporosis, the results of other investigations and clinical presentations need to be taken into account. For example, diffuse metastatic disease or myeloma could also present with vertebral body fractures and reduced BMD. Reduced bone loss in the younger adult warrants further investigation or specialist referral.
WHO Fracture Risk Assessment Tool:
Page last modified on 29/3/2017.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.