How to Read a Dexa Scan Result for Osteoporosis
This postal service teaches you lot everything you need to know near DEXA scans. Afterward reading this, you will be in a better position to ask your md the right questions and make informed decisions.
I will explicate what a DEXA scan is, walk you through how to prepare for the test, describe what will probable happen during the examination, identify any risks, and provide insight into how to interpret the results of the DEXA scan.
At the stop of this DEXA scan guide, there is a case study of a patient of mine who completed several DEXA scans. You will larn that a careful review of the results is critically important.
In this article I utilize the terms DEXA scan and Os Density Examination interchangeably.
This article was final updated on September 10, 2019
Table of Contents
- Definition
- History
- Who Performs and Administers the Exam?
- Agreement the Score
- How Does information technology Piece of work?
- The Procedure
- When You Should Accept One
- Preparation
- Instance Study
How I Use the DEXA Scan
I always review the DEXA results with my clients. The data information technology provides is not only useful to them, merely it gives me considerable insights into the wellness of their bones. This is especially true if the client provides DEXA tests over a period of several years.
Often, I use the data from the DEXA in the FRAX Computer to gain insight into the patient'southward fracture risk.
The DEXA Scan
When your physician wants to understand the health of your bones, the starting point is the DEXA scan. They will schedule a DEXA examination at a medical imaging facility and review the results with yous.
A Radiologist, a specialist in medical imaging, uses a DEXA browse examination to translate the health of your bones. The DEXA scan report is shared with your physician.
If the results indicate y'all have osteoporosis, osteopenia or low bone density, your dr. uses these results to recommend an appropriate treatment protocol for you lot.
The recommendations could include a combination of therapeutic exercises, modifications of activities of daily living, changes to your diet and, perhaps, pharmaceutical intervention.
Given the important function that a DEXA browse examination plays in the decisions and recommendations that wellness professionals make, it is disquisitional that the DEXA scan results accurately correspond the wellness of your bones.
In the majority of instances, you should non have to worry. The medical squad responsible for your DEXA scan will do an fantabulous chore. However, DEXA scans can get disruptive and it helps for you to have a full general idea on what is involved in the procedure. Let's become into that!
What is a DEXA Bone Density Browse?
DEXA is an abridgement of Dual Energy Ten-ray Absorptiometry. DEXA is a medical imaging applied science that measures the os mineral content or density of your basic. Bone mineral density is a reliable predictor of fracture gamble.
The Central DEXA measures bone density of the proximal femur in the hip and pelvis, and lumbar spine in the back. It is the method most preferred by clinicians.
A Peripheral DEXA evaluates the bone mineral density in the forearm, the heel bone (or calcaneus), the wrist and the hand. Some clinicians include this examination during the test.
In full general, the medical community considers the Central DEXA a more accurate representation of os mineral density and a better indicator of fracture chance compared to the Peripheral DEXA. While a report in 2017 challenged that position, the current consensus is to rely upon the Central DEXA results. (1)
A Brusque History of the DEXA
In 1987 DEXA scanners entered routine clinical practice. (2) In 1990, a group interested in the utilise and interpretation of bone mineral testing started.
In 1993, a group of clinicians formed the Club for Clinical Densitometry. They changed their name to the International Social club for Clinical Densitometry in 1997 and their mission is "to advance excellence in the assessment of skeletal health." This Club oversees international training and standards for DEXA testing.
In 1997, a group of clinicians taught the first os densitometry course in Toronto, Canada. Certification exams became bachelor across the US simply over a decade later in 2008.
Who Performs DEXA Testing?
A Os Densitometry Technologist or medical imaging professional trained by a recognized institution administers the DEXA scan.
To perform a DEXA in most jurisdictions, the clinician has to have either:
- Two year undergraduate training in medical imaging sciences.
- Four year caste in medical imaging sciences.
- The Certified Os Densitometry Technologist (CBDT®) professional certification.
Well-nigh clinicians maintain credentials through ongoing standing teaching courses and testing. A number of jurisdictions have standardized accreditation tests for both the technologists and the institutions that offering DEXA scans to the public.
For example, in Canada, where I live, the Ontario Clan of Radiologists manages the Canadian Bone Mineral Densitometry (CBMD) Facility Accreditation plan "to ensure that accredited sites provide the highest standard of BMD services in Canada".
The CBMD "Accreditation signifies to the public that the facility BMD equipment, BMD technologists and the services they provide, and the physicians reporting DXA scan results have met the rigorous standards set by the CBMD Plan."
Accreditation under the program is for a 5 year period and requires that technologists complete and laissez passer a standardized test called the Bone Densitometry Precision Computer.
Where Can You Get a DEXA Browse?
When y'all have to take your DEXA, I encourage you to visit medical imaging facilities accredited by a recognized medical trunk such equally a national Radiologists clan.
The Ontario Association of Radiologists publishes a list of CBMD accredited medical imaging institutions on its website for the public.
The American College of Radiologists (ACR) publishes a directory of ACR-accredited facilities qualified to behave DEXA scans.
Tin Untrained Individuals Perform DEXA Scans?
As I mentioned earlier in my commodity, your Radiologist and primary care md make important decisions and recommendations based on the results of a DEXA browse. A proper DEXA scan will generate accurate and meaningful results.
As a result, it is important that you consummate your DEXA scan with a qualified and accredited medical imaging establishment.
Who Interprets DEXA Tests?
A Radiologist reviews and signs the DEXA report. A Radiologist is a physician who undergoes four years of training on medical imaging afterward medical school.
Radiologists who interpret DEXA results complete specialized preparation on bone density and DEXA.
The Radiologist volition prepare a report which will be sent to your primary care physician. Y'all should allow a infinite of two weeks before visiting your physician in lodge to discuss the DEXA scan os density test results.
Understanding DEXA Scan Results
I have seen instances where a os density test (DEXA scan) generates what looks like strange, inconsistent and hard to understand results. Individuals have loftier os density test results scores in 1 area of their body and low results in other parts. This is non unusual amidst people who have been very agile in sure sports and activities. Let me explain in the next sub section.
Bone Building is Site Specific.
The effect of exercise on os is specific to area stressed during the exercise. If yous want stronger leg bones, then brisk walking, squats and lunges will aid. But if you desire stronger arm bones, use the bones and muscles in your arms past performing arm–specific exercises such as push button-ups or bicep curls.
Studies have shown that bones in the correct arm of a right–handed tennis player accept a greater density than bones in the left arm of the same player.
This means that if yous want a stronger body, you should have an do program that targets as many muscles and bones as possible. This is a special feature of the Exercise for Ameliorate Basic program. You lot go a progressive strength-training programme that covers fourteen dissimilar exercises — that gradually builds over twelve weeks. The exercises specifically target the areas nearly commonly affected by depression bone density.
Exercise Recommendations for Osteoporosis
Your physician informs you that your Bone Mineral Density DEXA examination results indicate that yous take osteoporosis and y'all need to commencement a treatment plan.
You practice your research and learn that if you lot have osteoporosis, osteopenia or low bone density that therapeutic exercise needs to be office of your osteoporosis handling program.
But what exercises should y'all do and which ones should you avoid? What exercises build bone and which ones reduce your hazard of a fracture? Is Yoga good for your bones? Who should you lot trust when information technology comes to exercises for osteoporosis?
A dandy resource on exercise and osteoporosis is my free, seven day email grade called Do Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on os health — one lesson each day. You can look at the videos at anytime and as often as you lot similar.I cover important topics related to osteoporosis exercise including:
- Can exercise opposite osteoporosis?
- Finish the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis practise program.
- Key principles of bone building.
- Exercises you should avoid if you take osteoporosis.
- Yoga and osteoporosis — should y'all exercise yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength of import if y'all have osteoporosis?
Enter your email address and I volition start you lot on this free course. I do not SPAM or share your e-mail accost (or whatsoever data) with tertiary parties. You can unsubscribe from my mail list at any time.
How Does a DEXA Scan Work?
During the DEXA browse examination the technician places yous in a supine position on the tabular array role of the DEXA auto. Your knees will exist flexed and shins elevated. This position decreases the lumbar lordosis and flattens the spine confronting the table.
The X-ray tube (the generator) that generates the photons is behind you and the screen that captures the photons (the target) that laissez passer through your body is located in front the abdomen. This allows the DEXA machine to measure out the bone mineral density in L1 through L4 in the spine. (three)
To measure the bone density of the proximal femur (in the hip surface area), the DEXA technician volition have you abduct and internally rotate your leg. If the leg is not adequately abducted and rotated, the bone density measurement of the femoral cervix will likely not be authentic. (3)
Like the test for BMD in the spine, the generator in the DEXA scan motorcar will generate the photons that will pass through your hip and pelvis expanse and hit the target. The photon count volition indicate the density of the bone mass in your femoral neck surface area.
The effect is similar to sunlight passing through curtains and striking the floor of a room. The denser the curtain and the closer the lats, the less light that passes through and shows on the floor. In your example, the denser the bone, the fewer photons that pass through your trunk and get in at the target.
[DEXA Car photograph attribution: Nick Smith photography [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]]
The DEXA Scan Procedure
The technologist will usually mensurate two areas of the body:
- Above the pelvis, specifically the lower back (known equally the lumbar spine).
- Beneath the pelvis, specifically the thigh bone (known as the proximal office of the femur).
If y'all accept had surgery in either of these two areas in the by, the medical professional may perform the measurement on one your forearms, as well known as a Peripheral DEXA (defined in a higher place).
In cases where the patient has had surgery to the back and both of the hips, the medical professional person may consider acquiring a bone density test of the whole torso, where applicable. This style is also of option for the younger population — for example, children and teens.
During the bone density exam procedure, you lot will need to lie on your back on a padded tabular array. You will be kept in a comfortable position until the DEXA scan is complete and yous should remain as still as possible during the measurement. Yous will not have to hold your breath.
In most cases the facility volition mensurate the bone density of 1 hip (femoral cervix). If your health insurer provides coverage for a measurement of the 2nd hip, the facility will record the 2nd hip as well.
Top Loss Measurement and Computation
During your visit, the staff volition non only measure your bone densitometry, they volition carefully mensurate your superlative without your shoes on.
Height loss can be an important indicator of fractures of the spine. As a result, height measurements should be taken each time y'all have a Cardinal DEXA.
A clinician measures height loss either with Historical Height Loss (HHL) or Prospective Top Loss (PHL).
Prospective Superlative Loss (PHL)
The Prospective Height Loss (PHL) calculates the divergence between two measurements of your height taken during a period of up to three years. In this case, the clinician has two accurate points to measure out superlative decline.
A PHL score greater than two centimetres suggests a new vertebral pinch fracture. The data is based on studies of women merely can be practical to men.
Historical Top Loss (HHL)
The Historical Peak Loss (HHL) is used by a clinician when in that location is no exact measurement of the client's height in by years. In this case, the clinician will use the recalled pinnacle and compare information technology to the current height.
An HHL greater than six centimetres for an individual over 60 and greater than four centimetres for someone under 60 suggests a new vertebral compression fracture. (iv)
How Long Does a DEXA Scan Take
The duration of the Cardinal BMD DEXA scan procedure is relatively short, however, yous should let fifteen to twenty minutes from the fourth dimension you lot walk into the room until you leave — simply to be condom.
What Volition a DEXA Scan Tell You lot?
The report presents your bone mineral density results in 3 ways:
- Os mass in grams per cm foursquare.
- T-score: a calculation made from the DEXA manufacturer comparing your bone mass to that of their salubrious control group.
- Z-score: a calculation fabricated from the DEXA manufacturer comparing your bone mass to that of your peers.
How Accurate is DEXA Scan?
Like most measurement technologies, the DEXA is bailiwick to some degree of error. While they are generally accurate when it comes to measuring bone density, several factors can influence the degree of accuracy. Allow's talk over these in item.
Osteoarthritis
Osteoarthritis tin can touch your DEXA scan in several ways. First, if you have osteoarthritis of the spine, it volition cause the cartilage to deteriorate. This will create pits and spaces effectually the joint, giving it a rough texture. This rough texture can affect the photons as they pass through the spine.
2nd, if you have arthritis in the hip, it can reduce your range of move and limit your ability to internally rotate your leg. As you lot recollect, this internal rotation is required to measure bone mineral density in the femoral neck.
Compression Fractures
A compression fracture in the spine tin crusade the spinal body to collapse. This volition brand the bone in the spine appear denser than it really is and lead to an inaccurate reading.
Historic period and Mobility
I mentioned earlier in the post that the technician will ask you to movement into various positions when you lot are on the examination table. You will also have to flex your knees and flatten your back.
Some people tin can observe these movements a challenge. This is especially the case for older individuals who are less mobile than they were in the past.
Obesity
Obesity can be a challenge for the DEXA equipment. First, the extra size can block the photons as they laissez passer through the body and bear upon the score. Second, some manufacturers limit the size of the people who can accept the test. One manufacturer has a weight restriction of 350 pounds.
Thinness
Information technology tin can be a challenge to go consistent bone mineral density scores for people who are thin. A Densitometry Technologist indicated to me that they can become 3 unlike scores when they take a DEXA scan of a thin person.
A thin person likely has porous bones and this can cause the distribution pattern of the photons to vary each time the scan is executed.
Skills and Qualifications of the Technologist
A technologist who is capable and conscientious will yield more than authentic and dependable DEXA browse results compared to a poorly trained technician. Make sure your Technologist is accredited through a recognized body.
Quality and Maintenance of the DEXA Car
DEXA applied science is quite circuitous and the quality of machines tin can vary. DEXA experts we accept spoken with recommend machines from GE Prodigy and Norland.
Another important factor that influences the measurement of the machine is the frequency and maintenance of the equipment. One of the leading medical imaging institutions I spoke to in Ontario indicated that they calibrate and examination their DEXA machines every working twenty-four hour period for accuracy.
In addition, they indicated that while their DEXA machines were 10 years onetime, they replaced the chief components every 3 to 5 years. These upgrades and replacements accept improved accurateness and reduced radiation levels in their DEXA machines. The components that they alter out include the tube, filter, target and the generator.
When Should You Have a DEXA Scan?
In many jurisdictions, including the U.s.a. and Canada, women over the age of 65 and men over the historic period of 70 are encouraged to have a DEXA browse for preventative screening purposes.
After the initial DEXA scan, individuals in this group are encouraged to have an examination every twenty four months.
In the U.s.a., Medicare volition cover the cost of a DEXA scan for women 65 or older and men who are 70 and older.
If you are a woman under the age of 65, you should consider a DEXA scan if the following applies to you:
- Family history of osteoporosis and, in particular, hip or vertebral compression fractures in your mother or father.
- Long term employ of glucocorticosteroids, prednisone or other steroid-type drugs.
- Diagnosed with primary hyperparathyroidism.
- You smoke cigarettes.
- Menopause before the age of 40.
- History of a depression impact fracture.
- Radiations therapy or chemotherapy for chest cancer.
Baseline DEXA
Information technology is a skilful idea to take a baseline DEXA scan as you enter menopause. The results of this examination will give yous an accurate record of the change of your os density equally you progress through menopause. It tin can too motivate you to maintain (or even ameliorate) your bone density through exercise and diet, thereby reducing the gamble that y'all will have take a pharmaceutical like Prolia, Fosamax or Forteo later in life.
Once you have the baseline DEXA, at that place is no need to have another test for a number of years unless the baseline test identifies that y'all have low bone mass.
A baseline DEXA scan is appropriate for most men. Osteoporosis is not a woman's but condition and men should not be dismissive of information technology. Os density can decline at a more rapid rate during andropause when compared to menopause.
Baseline DEXA Score for Richard
Later on reading this mail in June of 2019, my husband Richard, asked his physician to prescribe a baseline DEXA to mensurate his bone mineral density. Richard is in his late 50'south and younger than the typical age when males get a DEXA scan. Fortunately, Richard has an enlightened physician who supports the DEXA test for men and encouraged him to establish his baseline score.
Several weeks after receiving the prescription, Richard visited an imaging centre in Ottawa and completed the examination. The intake process and process was similar to that described in this postal service. When he was setting upwardly the appointment, the organizer made it clear that he should not accept calcium supplements before the test and should wear clothing that did non have metallic.
When Richard arrived for the procedure he had to complete a short intake form. Information technology asked him if he had a history of fractures, took steroids in the past, and other relevant questions.
The intake grade was handed to the Radiology Technologist. When she reviewed his grade, she was surprised that he was taking the test at this fourth dimension. He had no history of fracture and, co-ordinate to guidelines she followed, he was likewise young to take the exam. When Richard pointed out that he wanted a baseline score and that his mother and sister had osteoporosis, the Technologist was dismissive.
She begrudgingly administered the test and followed the procedures described in this post and Richard got what he wanted — a baseline score.
It is good to monitor your health and a baseline DEXA score is a step in that management. Unfortunately, you might meet some resistance merely I encourage you to printing frontwards and manage your bone health proactively.
Room for Improvement
A study published in March, 2019 in The Spine Journal,Rates of osteoporosis screening and treatment following vertebral fracture, showed that, in some jurisdictions, that non plenty people are getting DEXA scans.
Betwixt 2008 and 2014, ii,933 unique patients visited emergency department for one or more than vertebral fractures. The patients were fifty years and older. Of the patients that visited the emergency department, "90-eight percent did non receive a DEXA scan within the preceding 2 years or i twelvemonth post-obit fracture." (5)
According to 1 of the co-authors, Jonathan J. Carmouche, M.D., Section Chief of Spine and Pediatrics for the Department of Orthopaedic Surgery at Carilion Clinic in Roanoke, Virginia, "Nosotros found that we, as the region's premier 3rd intendance center, were dropping the ball on over ninety% of vertebral fracture patients. They weren't getting DEXA [bone density] scans to formally screen them for osteoporosis or diagnosed clinically and were therefore not being treated or were being nether treated significantly." (6)
Some of these patients probably fell through the cracks because they were under the age of 65, some might accept been overlooked considering their health care plans did not provide adequate screening coverage. However, it seems every bit though we should be more than aggressive with this screening in order to get in front of vertebral and hip fractures.
How Much Radiation is in a DEXA Scan?
The DEXA scan examination is very safe. DEXA machine accept been reducing the corporeality of radiation exposure to the point where radiation exposure from a DEXA machine is 1/100 or less compared with a lateral view X-ray of the spine.
Additionally, a Vertebral Fracture Assessment (VFA) can be done at the same fourth dimension and location as measurement of BMD past DEXA.
How Often Should Yous Have a DEXA Browse?
How often yous get a DEXA scan depends on a number of variables including your age and changes in health. The recommendations tin can vary beyond jurisdictions.
As I mentioned earlier, Medicare will provide a DEXA scan every 20 four months for women later on the age of 65.
What are the Limitations of a DEXA?
The DEXA has several limitations:
- A DEXA browse is not able to tell yous if you volition have a fracture. It can only provide yous with a measurement that gets interpreted into your relative risk for a fracture.
- The DEXA cannot tell yous almost your bone quality. If there is a feature to measure TBS, it can provide some insight into your lumbar spine.
- Spinal measurements are limited in individuals with spinal deformities such equally scoliosis, moderate to severe osteoarthritis, pre-existing pinch fractures, or spinal surgeries. (7)
What is TBS (Trabecular Bone Score)?
In the past two years I have noticed more information being provided in DEXA reports. One of the more than common new features is something referred to as TBS. TBS is an abbreviation for Trabecular Bone Score.
As mentioned in past articles, bone density is but role of the equation that relates to bone strength. The other role is the quality of the os. When it comes to research studies, bone quality is assessed with tools such as a QCT, Quantitative Computer Tomography. Due to the loftier levels of radiation exposure, the few number of machines bachelor, and the cost of the examination, few individuals outside of research studies will e'er exist referred for a QCT.
The makers of DEXA machines have attempted to provide physicians with more insight into the quality of the bone through a measurement they call TBS. The TBS score is derived from the grey-level texture measurement of the lumbar spine DEXA.
A high TBS score indicates a stronger "internal scaffolding of the vertebra" — more trabecular that are closer together. Whereas a low TBS score indicates the opposite, more trabecular separation, fewer trabecula and therefore a higher risk of vertebral (spinal) compression fracture.
Although not widely used within existing DEXA machines, studies have shown a correlation betwixt low lumbar spine TBS with the incidence of an old and new fracture. (8) (9)
DEXA Bone Scan Grooming
The following are some of import guidelines for your DEXA bone scan training. Read these to prepare for a DEXA browse procedure.
- You lot should delay the DEXA browse if yous are pregnant or if there is a possibility of yous condign meaning. Should you decide to accept the exam anyway, notify the medical professional performing the test.
- If you are scheduled to have an imaging examination that requires you to receive a dye or other contrast media either by intravenous (4) injection or orally or rectally, the Central BMD exam should be performed prior to or at to the lowest degree 7 days after such an imaging examination; due east.yard.: nuclear scan, CT scan, MRI, Barium studies etc.
On the day of your scheduled Key DEXA BMD (bone density test) examination and equally part of your bone density test preparation, you should follow these patient training guidelines:
- Bring the Key DEXA BMD (bone density test) test request your physician has provided along with your health insurance card to the examination facility.
- Show upward 15 to twenty minutes prior to your engagement. This will give you ample time to register. Exams are usually booked dorsum-to-dorsum. Hence, punctuality is appreciated.
- Consume a normal diet on the day of the examination.
- Have your medications as y'all normally would.
- Bring an up-to-engagement listing of the medications you are taking.
- Leave whatsoever valuables or jewelry y'all normally wearable at home.
Bone Density Examination Training Calcium Intake
DO Not take calcium supplements for at least 24 hours before the test.
Can You lot Consume Earlier a DEXA Scan?
Y'all can eat your regular meals the 24-hour interval of the DEXA scan examination, however, you should not take calcium supplements at least 24 hours in advance of the browse.
Do You Take to Undress for a Os Density Examination?
In most cases you will non have to undress for a bone density test. The staff and clinician will make every effort to proceed y'all in your own wearing apparel during the test. All the same, the staff may ask you to clothing a gown.
Depending on the exam heart, the staff might request that you remove items that interfere with the DEXA scan including:
- Belts
- Metal buttons
- Keys
- Wallets
- Removable dental appliances
- Middle glasses
What to Article of clothing for Os Density Test
Here are guidelines on what to wearable for bone density test, as well every bit what not to vesture:
- Vesture loose fitting apparel and avert wearing accessories such as belts, clasps, hooks, zippers, thick buttons or glitter ornamentation.
- Note that bra hooks and metal buttons on back pockets may be unnoticeable to the eye but will interfere with the measurement process.
- Try not to wear torso-piercing ornamentation to the test.
Do Recommendations for Osteoporosis
Your physician informs yous that your Os Mineral Density DEXA test results bespeak that you take osteoporosis and you demand to start a handling program.
You practice your research and larn that if you take osteoporosis, osteopenia or depression bone density that therapeutic exercise needs to be part of your osteoporosis handling programme.
But what exercises should yous exercise and which ones should you lot avoid? What exercises build os and which ones reduce your take a chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A smashing resource on exercise and osteoporosis is my free, seven day email class called Exercise Recommendations for Osteoporosis. After you provide your email accost, you lot will receive seven consecutive online educational videos on bone wellness — one lesson each twenty-four hour period. You tin look at the videos at anytime and as oftentimes every bit you like.I cover important topics related to osteoporosis exercise including:
- Tin exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis practice program.
- Fundamental principles of bone edifice.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you do yoga if yous accept osteoporosis?
- Cadre strength and osteoporosis — why is core strength important if you accept osteoporosis?
Enter your e-mail address and I will showtime you lot on this complimentary course. I practice non SPAM or share your electronic mail accost (or any information) with third parties. You tin can unsubscribe from my mail service list at any time.
What Should Y'all Practise if Your DEXA Indicates Your Bone Density Declines?
Patients often visit me because of a decline in their DEXA score. The reasons for the decline vary from individual to individual. The reasons for the change in scores include their unique genetic makeup, lifestyle, practice habits, diet and medical history.
Response to DEXA Score Turn down
The appropriate response to the decline can vary, as well. Y'all should always talk over the right strategy with your doctor. Your response tin can include a combination of changes to your:
- Exercise program.
- Activity level.
- Movement patterns (for example, how you lot lift things).
- Diet.
- Supplementation.
- Lifestyle activities (for instance, if you are a gardener, consider hiring younger people to practise the heavy activity around the garden.)
Depending on the degree of change, pharmaceutical intervention may be required to reduce fracture chance.
Factors to Consider Afterward a DEXA Score Reject
Here are several factors to consider when you meet a change in your DEXA scan scores:
- Is the bone density pass up significant — to the point where your risk of a fracture is elevated?
- Are you able to brand the lifestyle modifications required to improve bone density and reduce fracture run a risk?
- Were there life issues during the by few years which caused you to spend less time on your own health? Mayhap an aging parent or a ill family fellow member took all of your energy and attending.
The correct response to the DEXA score turn down for you depends on your medical history and the take a chance of fracture. Information technology is important that you consult with qualified health professionals who can help yous make the right determination for you.
Susan's DEXA Story
Susan (not her real name) chosen me afterwards a recent motion from Virginia to Utah because she was concerned about the decline in her DEXA scan examination results. Her DEXA scans were only taken 14 months apart.
With she moved across the country, she changed health care providers and doctors. Her new medico requested a fresh DEXA test.
When I met with Susan she mentioned her surprise in the loss of BMD in just over a yr. Before discussing her practice authorities and how she could amend address bone loss, I took a wait at her BMD DEXA scores.
Different manufactures produce very different DEXA machines. Their results should not be be compared. Fifty-fifty machines produced from the same company will not be perfectly identical.
When I read that Susan had moved beyond the country, I requested all of her DEXA results to ensure that the appropriate intensity of practice was prescribed. Both locations used machines from the same manufacturer, which made me more comfy to put some weight in comparing results.
My Interpretation of Susan's DEXA
Subsequently looking at the different DEXA browse results, here is what I found.
DEXA Hip Scores
Information technology seemed like Susan had hit the perfect tempest of DEXA inconsistencies.
Many reports only provide the BMD of 1 hip. This was the case for her starting time DEXA scan in Virginia where they simply had a reading for her left hip. In Utah, she had a BMD of both hips only the written report simply reported on the right. Her right hip BMD was significantly lower than the left hip BMD. However, when you compared the BMD of her left hip from yr to year it was unchanged.
DEXA Spinal Scores
DEXA measurements of the spine are usually taken of the tiptop iv lumbar vertebra, L1, L2, L3, L4. The scores of all each vertebra was recorded in both locations. In the east coast, they took the average of all iv L1 – L4 measurements. In Utah, they only took the average of her acme two vertebra, L1 and L2, they had the weakest scores.
By merely using the average of her two weakest scores and not averaging the reading over all iv vertebra, it appeared that she had lost significantly more bone.
DEXA and the Upper Thoracic Area
Some of the newer DEXA centres have apps that allow them to go views of the spine from the upper thoracic surface area (just bellow the shoulders) to the low back. Fortunately, Susan sent me the entire report. Well into the report there was a very noticeable Phase two compression fracture.
The radiologist had noted it but her dr. had failed to tell her about it. When I asked her if she had a past episode of back hurting or a fall she did call up a astringent episode shortly later her move. In fact she did not accept a fall. During the movement she unpacked a lot of boxes and helped her husband with m work. The pain lasted 6 to 8 weeks. Because she had relief with Concrete Therapy, she forgot to mention it in her intake.
From my point of view her vertebral pinch was a game changer. Nosotros now had information on the quality of her os.
Lesson Learned from Susan's Story
There are several important lessons you can take from Susan's experience.
1. DEXA Browse Comparison for Femoral Neck
When comparison DEXA reports be sure you compare apples to apples. Right hip to right or left hip to left.
Several studies accept looked at the differences between BMD of the correct and left femoral neck (hip) in postmenopausal women. The 2012 study of 384 postmenopausal Korean women showed a discordance rate of about 30%. (ten)
A 2017 study with 133 individuals showed an inconsistency in 44% of the cases when they were classified by T or Z-scores, with the lowest scores found in the ascendant leg. (eleven) While discussing similar results with researchers at a os enquiry conference a few years dorsum, nosotros hypothesized that since nosotros atomic number 82 with the dominant leg the non-dominant leg gets more than of the weight bearing such as when boot a ball.
2. DEXA Scan Interpretation for the Spine Results
When comparing DEXA's of the spine, they should look alike. Bank check the size and appearance of the boxes. Also exist sure that they are comparing the same parts of the spine L1 to L1, L2 to L2, then on or as in Susan's example that they are taking the average of the same vertebra.
three. DEXA Scan and the Thoracic Spine
Another word of circumspection in regard to DEXA's and your spine. If the medical imaging institution that you have your DEXA washed does not take an app that looks at a bigger picture of your spine and then you lot take to be your own advocate.
The virtually common fracture sites in the osteoporotic spine is in the thoracic spine, but around your bra strap. For men, this is only beneath the bottom of your shoulder blades. DEXA reports never capture the thoracic spine for BMD recording because of the interference of our ribs and breast bone.
Even so, if you have height loss or you have had sudden onset of dorsum pain that persisted for over 4 weeks then the possible source could be a compression fracture of your vertebra.
Contributors
Robert Hakim generously contributed to this article. He wrote the section dedicated to how to prepare for your DEXA exam. Robert M. Hakim Grand.R.T. (R.), RTR, CDT is a Clinical Densitometry Technologist atDiagnostic Imaging Department – Georgetown Infirmary, Halton Healthcare Services Corporation, Halton Hills, Ontario. Robert is a Fellow member of the International Society of Clinical Densitometry.
Primary Reference Material
- Abdelmohsen, A. Comparison of Central and Peripheral Os Mineral Density Measurements in Postmenopausal Women. Periodical of Chiropractic Medicine, September 2017.
- Blake, GM, Fogelman, I. The part of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgraduate Medical Journal, Baronial 2007.
- Abdelmohsen, Azza. Comparison of Fundamental and Peripheral Bone Mineral Density Measurements in Postmenopausal Women, Periodical of Chiropractic Medicine. September 2017.
- Siminoski K, et al. The accurateness of historical elevation loss for the detection of vertebral fractures in postmenopausal women. Osteoporosis International. February 17, 2006.
- Barton DW, et al. Rates of osteoporosis screening and treatment following vertebral fracture. The Spine Journal. March 2019. Volume xix, Consequence three, Pages 411–417.
- Over 90% of Fracture Patients exercise not get a Density Scan! Orthopaedics This week. February 28, 2019.
- Garg, MK. Dual energy Ten-ray absorptiometry: Pitfalls in measurement and interpretation of os mineral density. Indian Journal of Endocrinological Metabolism. Mar-Apr, 2013. 17(ii): 203–210.
- Harvey, NC, et al. Trabecular os score (TBS) every bit a new complementary arroyo for osteoporosis evaluation in clinical practice. A consensus report of a European Guild for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Working Grouping. Bone. September, 2015. 78: 216-224.
- Silva BC, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. Journal of Os Mineral Research. March 2014. ;29(3):518-thirty. doi: 10.1002/jbmr.2176.
- Hyun Jung Hwang, et al. Differences in Os Mineral Density between the Right and Left Hips in Postmenopausal Women. Journal of Korean Medical Science. June 2012. 27(6): 686–690.
- Afzelius P, et al. Dual-energy 10-ray Absorptiometry of Both Hips Helps Appropriate Diagnosis of Low Os Mineral Density and Osteoporosis. Diagnostics. 2017 Jul 9;vii(3). pii: E41. doi: 10.3390/diagnostics7030041.
Secondary Reference Cloth
- Siminoski K, "Tools and Techniques", Osteoporosis Update, Jump/Summer 2005, Volume 2.
- Winzenrieth R, Michelet F, Hans D. Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular os score using high-resolution computed tomographic acquisitions: effects of resolution and dissonance. J Clin Densitom. 2013 Jul-Sep; 16(3):287-296.
- Blackness DM, Arden NK, Palermo 50, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities only not wrist fractures. Study of Osteoporotic Fractures Research Group. J Os Miner Res. 1999 May; 14(5):821-8.
- Yong Jun Choi. Dual-Energy Ten-Ray Absorptiometry: Beyond Bone Mineral Density Determination. Endocrinological Metabolism. 2016 Mar; 31(1): 25–thirty.
- Han J, Hahn MH. Proximal Femoral Geometry as Fracture Risk Factor in Female person Patients with Osteoporotic Hip Fracture. Journal Os Metabolism. 2016 Aug;23(three):175-82. doi: x.11005/jbm.2016.23.3.175. Epub 2016 Aug 31.
Osteoporosis Guidelines
For more information, check out my Osteoporosis Guidelines.
Source: https://melioguide.com/osteoporosis-prevention/bone-density-test-preparation/
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