Dexa Scan: Additional Information 2

Patients with a bone mass below the expected range for age should be investigated for conditions associated with secondary osteoporosis (see Table 3 on www.nogg.org.uk/full-guideline/section-3-fracture-risk-assessment-and-case-finding. 

A non-exhaustive list of these conditions is available at https://www.nice.org.uk/guidance/cg146. 

Also, assess the patient’s medication history, history of fractures (including during childhood) and family history. Consider X-rays of the thoracic and lumbar spine in patients with a bone density below the expected range for age and suspected vertebral fractures (e.g., thoracic kyphosis, height loss ≥ 4 cm, acute back pain) or at high risk (e.g., long-term oral glucocorticoid therapy in patients with muscular dystrophy), as vertebral fracture assessment (VFA) is not currently performed with DXA examinations.

Bone-specific treatment is usually not required in premenopausal women and young men as the fracture risk is low. Treatment of secondary causes, if present, is recommended.

Lifestyle recommendations should be given to all patients with bone mass below the expected range for age or with a history of fragility fractures. These include advice on smoking cessation, alcohol moderation (≤ 2 units daily), adequate intake of calcium and vitamin D, and weight-bearing exercise.

Consider requesting a specialist opinion via ‘Advice and Refer’ for patients with bone mass below the expected range for age, especially if the cause is not clear, further investigations are abnormal (e.g., low/high ALP, abnormal calcium or phosphate), treatment is considered, the patient has had recurrent low-trauma fractures or vertebral fracture(s), or if there is a decline in bone mass in sequential DXA scans.

FOLLOW-UP:

The frequency of BMD monitoring with DXA scan depends on the patient’s risk factors, history of fractures and treatments, and should be individualised. Monitoring of the BMD with repeat DXA scans every 2-3 years may be indicated in patients with risk factors, especially if there are active underlying causes. An earlier follow-up examination may be indicated if there are significant risk factors, such as glucocorticoids, androgen deprivation therapy or aromatase inhibitor therapy, new fragility fractures, or if there is a concern about ongoing bone loss which might require treatment.