Clinical indications for bone densitometry

These include:

• a patient with a history of a low trauma fracture e.g. spine, hip, distal forearm
• an incidental X-ray finding of osteopenia or vertebral collapse or in the investigation of thoracic kyphosis or loss of height
• if there is maternal history of hip fracture
• if the patient has a low body mass index (BMI < 19 kg/m^2)
• if the patient has received corticosteroid treatment (prednisolone 7.5 mg or more) for greater than three months
• oestrogen deficiency:
  • in a patient with premature menopause (< 45 years of age)
  • primary hypogonadism
  • secondary amenorrhoea (which lasts more than six months) e.g. secondary to GnRH anologues
• where there are conditions that predispose to secondary osteoporosis including:
  • malabsorption syndromes e.g. coeliac disease, inflammatory bowel disease
  • long-term treatment with anticonvulsants
  • organ transplantation
  • eating disorders
  • chronic renal failure
  • thyrotoxicosis
  • primary hyperparathyroidism
  • Cushing's syndrome
  • male hypogonadism
  • prolonged immobilisation

Therefore it is inappropriate to scan premenopausal women without any additional risk factors apart from a family history of osteoporosis or patients with back pain unless there is X-ray evidence of a recent vertebral crush fracture (1).

Monitoring therapy - at intervals of at least 18 months (2)

Reference:

1. GP magazine (16/3/01), 52.
2. ARC.Hands On 2007;11:1-6.
3. Osteoporosis Clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. Royal College of Physicians, Bone and Tooth Society of Great Britain July 2000.