Who should and should not have DEXA scan

Osteoporosis is a clinical diagnosis, and the DEXA scan is the single most helpful test.

Less than 2 in 10 patients who should be investigated following a fracture are tested.

Osteoporosis is a clinical diagnosis, and the DEXA scan is the single most helpful test.

A DEXA scan is a quick and painless procedure that involves lying on your back on an X-ray table so an area of your body can be scanned.

No special preparations are needed before having a DEXA scan.

You may be able to remain fully clothed, depending on the area of your body being scanned.  However, you must remove any clothes with metal fasteners, such as zips, hooks or buckles.

Criteria for having a DXA scan
All women 65 years of age and older
All men age 70 years and older (asymptomatic screening)
Women under age 65 have an additional risk for osteoporosis.

1. Women discontinuing oestrogen or oestrogen deficiency (peri-menopausal and post-menopausal women)
2. Early or premature menopause (before age 45 years old)
3. History of amenorrhoea (no periods) for more than one year under the age of 42 years
4. History of maternal hip fracture that occurred after the age of 50 years

Men and women with other risk factors:

1. Eating disorders (current/past)
2. Men younger than 70 with hypogonadism/ testosterone deficiency
3. Adults of any age with fragility fractures
4.  Men or women receiving or expected to receive steroid treatment for more than three months (e.g. >5mg Prednisolone for more than three months in a year)

Individuals beginning or receiving long-term therapy with a medication known to affect bone mineral density adversely:

• Anti-coagulants – warfarin, heparin
• Anti-epileptics
• Aromatase inhibitors, etc. (many other medicines that may cause osteoporosis)

Individuals of any age with radiologic evidence of:

• Low bone mass (osteopenia),
• Vertebral deformity (kyphosis)
• Presence of vertebral compression fractures.

Men and women of any age with a disease associated with a defect in bone development, low bone mass or bone loss, such as:

• Osteogenesis imperfect
• Hyperthyroidism (overactive thyroid gland)
• Inflammatory bowel disease (IBD)
• Rheumatoid arthritis
• Growth hormone deficiency

Men and women of any age who have the following risk factors;

• Height by more than 2cm
• Low BMI (less than 18kg/m2)
• Severe malnutrition or poor nutrition
• Excessive alcohol intake (>14 units a week for women and > 21 units/week for men)
• Been or currently smokers
• Excessive exercise, particularly with inadequate caloric intake.

Medications that may cause osteoporosis

• Chemotherapy
• Radiation
• Thyroxine
• Anticonvulsant therapy or anti-epileptic medications (phenytoin and phenobarbitone)- interfere with calcium absorption and production of Vit. D
• Chronic heparin or Warfarin therapy
• Long-term lithium therapy
• GnRH analogues
• LHRH analogues; testosterone suppression
• Prolactin-raising drugs such as antipsychotic medications, e.g. some SSRI and aromatase inhibitors for the treatment of Prostatic and Breast.
• Cancers e.g. Arimidex
• Diuretics such as Burinex and Lasix (ferusemide)
• Proton Pump Inhibitors

Reasons against performing DXA:

1. Pregnancy
2. Recently had gastrointestinal contrast or radionuclides.
3. Severe degenerative changes or fracture deformity in the measurement area
4. Inability to attain the correct position and/or remain motionless for the measurement
5. Extreme obesity or extremely low body mass index may inversely affect the technique and the ability to obtain accurate and precise measurements