what do i wear to a dexa scan

This post teaches y'all everything you demand to know most DEXA scans.  After reading this, you will be in a ameliorate position to ask your physician the right questions and make informed decisions.

I volition explicate what a DEXA scan is, walk you through how to gear up for the examination, describe what volition probable happen during the exam, place whatever risks, and provide insight into how to translate the results of the DEXA scan.

At the end of this DEXA browse guide, there is a instance report of a patient of mine who completed several DEXA scans.  You will learn that a careful review of the results is critically important.

In this article I apply the terms DEXA scan and Bone Density Exam interchangeably.

This article was last updated on September 10, 2019

Table of Contents

1. Definition
2. History
3. Who Performs and Administers the Exam?
4. Understanding the Score
5. How Does it Work?
6. The Procedure
7. When You lot Should Take One
8. Preparation
9. Case Study

How I Use the DEXA Scan

I always review the DEXA results with my clients. The information information technology provides is not only useful to them, only information technology gives me considerable insights into the health of their bones. This is specially true if the client provides DEXA tests over a period of several years.

Often, I use the data from the DEXA in the FRAX Estimator to gain insight into the patient'southward fracture chance.

The DEXA Scan

When your physician wants to empathize the health of your bones, the starting signal is the DEXA browse. They will schedule a DEXA examination at a medical imaging facility and review the results with you.

A Radiologist, a specialist in medical imaging, uses a DEXA browse examination to interpret the health of your bones. The DEXA scan report is shared with your physician.

If the results betoken y'all have osteoporosis, osteopenia or low bone density, your md uses these results to recommend an advisable treatment protocol for you.

The recommendations could include a combination of therapeutic exercises, modifications of activities of daily living, changes to your nutrition and, mayhap, pharmaceutical intervention.

Given the of import role that a DEXA scan test plays in the decisions and recommendations that health professionals make, information technology is disquisitional that the DEXA scan results accurately correspond the wellness of your bones.

In the majority of instances, yous should not have to worry. The medical team responsible for your DEXA browse volition practise an excellent job. All the same, DEXA scans can get confusing and it helps for you lot to accept a general idea on what is involved in the process. Let's get into that!

What is a DEXA Bone Density Scan?

DEXA is an abbreviation of Dual Free energy Ten-ray Absorptiometry. DEXA is a medical imaging technology that measures the os mineral content or density of your bones. Os mineral density is a reliable predictor of fracture risk.

The Fundamental DEXA measures bone density of the proximal femur in the hip and pelvis, and lumbar spine in the back. It is the method virtually preferred by clinicians.

A Peripheral DEXA evaluates the bone mineral density in the forearm, the heel bone (or calcaneus), the wrist and the manus. Some clinicians include this test during the test.

In full general, the medical community considers the Cardinal DEXA a more than accurate representation of bone mineral density and a better indicator of fracture adventure compared to the Peripheral DEXA. While a study in 2017 challenged that position, the current consensus is to rely upon the Cardinal DEXA results. (1)

A Short History of the DEXA

In 1987 DEXA scanners entered routine clinical practise. (2) In 1990, a group interested in the use and interpretation of bone mineral testing started.

In 1993, a group of clinicians formed the Guild for Clinical Densitometry. They changed their proper name to the International Lodge for Clinical Densitometry in 1997 and their mission is "to advance excellence in the cess of skeletal health." This Club oversees international grooming and standards for DEXA testing.

In 1997, a group of clinicians taught the first bone densitometry course in Toronto, Canada. Certification exams became bachelor across the US but over a decade later in 2008.

Who Performs DEXA Testing?

A Bone Densitometry Technologist or medical imaging professional person trained by a recognized institution administers the DEXA scan.

To perform a DEXA in most jurisdictions, the clinician has to accept either:

• Two year undergraduate grooming in medical imaging sciences.
• Four twelvemonth degree in medical imaging sciences.
• The Certified Os Densitometry Technologist (CBDT®) professional certification.

About clinicians maintain credentials through ongoing continuing education 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 alive, the Ontario Association 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 Program."

Accreditation under the program is for a five year menses and requires that technologists complete and pass a standardized test called the Os Densitometry Precision Estimator.

Where Can You Go a DEXA Scan?

When you have to take your DEXA, I encourage you to visit medical imaging facilities accredited past a recognized medical body such as a national Radiologists association.

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 bear DEXA scans.

Can Untrained Individuals Perform DEXA Scans?

As I mentioned before in my commodity, your Radiologist and primary care physician brand of import decisions and recommendations based on the results of a DEXA scan. A proper DEXA scan volition generate authentic and meaningful results.

As a outcome, it is important that you complete your DEXA scan with a qualified and accredited medical imaging institution.

Who Interprets DEXA Tests?

A Radiologist reviews and signs the DEXA report. A Radiologist is a physician who undergoes four years of grooming on medical imaging after medical school.

Radiologists who interpret DEXA results complete specialized training on os density and DEXA.

The Radiologist will prepare a report which volition be sent to your primary care md. You lot should allow a space of two weeks earlier visiting your md in lodge to hash out the DEXA scan bone density exam 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 bone density exam results scores in ane area of their torso and low results in other parts. This is not unusual among people who have been very active in certain sports and activities. Permit me explain in the next sub section.

Bone Building is Site Specific.

The effect of exercise on os is specific to surface area stressed during the practise. If y'all desire stronger leg bones, so brisk walking, squats and lunges will help. But if you want stronger arm bones, use the bones and muscles in your artillery by performing arm–specific exercises such as button-ups or bicep curls.

Studies accept shown that basic in the right arm of a right–handed lawn tennis histrion take a greater density than bones in the left arm of the same player.

This ways that if you want a stronger body, you lot should take an do plan that targets every bit many muscles and bones as possible. This is a special feature of the Practice for Ameliorate Bones program. Y'all get a progressive strength-training program that covers xiv dissimilar exercises — that gradually builds over twelve weeks. The exercises specifically target the areas almost commonly afflicted by low bone density.

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Exercise Recommendations for Osteoporosis

Your physician informs you that your Bone Mineral Density DEXA test results indicate that you have osteoporosis and you need to offset a treatment program.

You do your research and acquire that if you accept osteoporosis, osteopenia or low os density that therapeutic do needs to be part of your osteoporosis treatment plan.

But what exercises should you exercise and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga practiced for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resources on exercise and osteoporosis is my gratuitous, seven twenty-four hours email course chosen Exercise Recommendations for Osteoporosis. Subsequently you provide your electronic mail accost, y'all will receive 7 sequent online educational videos on bone health — one lesson each day. Yous tin can look at the videos at anytime and as often every bit y'all like.I encompass important topics related to osteoporosis exercise including:

• Can exercise reverse osteoporosis?
• Cease the stoop — how to avoid kyphosis and rounded shoulders.
• Cardinal components of an osteoporosis exercise program.
• Central principles of os building.
• Exercises y'all should avoid if yous accept osteoporosis.
• Yoga and osteoporosis — should you do yoga if you lot have osteoporosis?
• Core strength and osteoporosis — why is core strength important if you lot have osteoporosis?

Enter your email address and I will start you on this costless form. I practice not SPAM or share your email accost (or any data) with third parties. Y'all can unsubscribe from my mail listing at any fourth dimension.

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How Does a DEXA Browse Work?

During the DEXA scan examination the technician places you in a supine position on the tabular array part of the DEXA machine. Your knees will be 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 y'all and the screen that captures the photons (the target) that pass through your trunk is located in front the abdomen. This allows the DEXA motorcar to measure the os mineral density in L1 through L4 in the spine. (3)

To measure out the bone density of the proximal femur (in the hip surface area), the DEXA technician volition accept 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 accurate. (3)

Like the test for BMD in the spine, the generator in the DEXA scan machine will generate the photons that will pass through your hip and pelvis area and hit the target. The photon count volition indicate the density of the bone mass in your femoral neck area.

The effect is like to sunlight passing through defunction and hitting the floor of a room. The denser the drape and the closer the lats, the less light that passes through and shows on the floor. In your instance, the denser the bone, the fewer photons that pass through your body and arrive at the target.

[DEXA Automobile photo attribution: Nick Smith photography [CC BY-SA iii.0 (https://creativecommons.org/licenses/by-sa/3.0)]]

The DEXA Scan Process

The technologist will ordinarily mensurate two areas of the torso:

• To a higher place the pelvis, specifically the lower back (known as the lumbar spine).
• Below the pelvis, specifically the thigh bone (known as the proximal role of the femur).

If you have had surgery in either of these 2 areas in the past, the medical professional may perform the measurement on one your forearms, as well known as a Peripheral DEXA (divers above).

In cases where the patient has had surgery to the back and both of the hips, the medical professional may consider acquiring a bone density test of the whole body, where applicable. This manner is also of choice for the younger population — for example, children and teens.

During the bone density test procedure, you will need to prevarication on your back on a padded table. You volition be kept in a comfortable position until the DEXA scan is complete and you should remain as even so as possible during the measurement. You will non accept to concur your jiff.

In nearly cases the facility will measure the bone density of i hip (femoral cervix). If your wellness insurer provides coverage for a measurement of the 2nd hip, the facility will record the second hip as well.

Pinnacle Loss Measurement and Computation

During your visit, the staff will not only measure your os densitometry, they will carefully measure your height without your shoes on.

Meridian loss can exist an important indicator of fractures of the spine. As a effect, height measurements should be taken each fourth dimension you take a Central DEXA.

A clinician measures tiptop loss either with Historical Height Loss (HHL) or Prospective Top Loss (PHL).

Prospective Tiptop Loss (PHL)

The Prospective Summit Loss (PHL) calculates the deviation between two measurements of your peak taken during a period of up to iii years. In this case, the clinician has two authentic points to mensurate superlative decline.

A PHL score greater than two centimetres suggests a new vertebral compression fracture. The data is based on studies of women but tin can exist applied to men.

Historical Height Loss (HHL)

The Historical Meridian Loss (HHL) is used by a clinician when there is no exact measurement of the customer's height in past years. In this case, the clinician will use the recalled peak 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. (four)

How Long Does a DEXA Scan Accept

The duration of the Central BMD DEXA scan procedure is relatively brusk, however, yous should permit fifteen to xx minutes from the time you walk into the room until you leave — just to be safe.

What Volition a DEXA Scan Tell Yous?

The study presents your bone mineral density results in three ways:

• Bone mass in grams per cm square.
• T-score: a calculation made from the DEXA manufacturer comparison your bone mass to that of their healthy control group.
• Z-score: a calculation made from the DEXA manufacturer comparison your bone mass to that of your peers.

How Accurate is DEXA Browse?

Similar about measurement technologies, the DEXA is field of study to some degree of fault. While they are generally accurate when it comes to measuring bone density, several factors tin influence the degree of accuracy. Allow's talk over these in detail.

Osteoarthritis

Osteoarthritis tin touch your DEXA scan in several means. Starting time, if you have osteoarthritis of the spine, it volition cause the cartilage to deteriorate. This will create pits and spaces around the joint, giving it a rough texture. This rough texture tin affect the photons as they pass through the spine.

2nd, if y'all take arthritis in the hip, it can reduce your range of motion and limit your power to internally rotate your leg. As yous recall, this internal rotation is required to measure bone mineral density in the femoral neck.

Compression Fractures

A compression fracture in the spine tin can cause the spinal trunk to plummet. This will make the os in the spine announced denser than information technology really is and lead to an inaccurate reading.

Age and Mobility

I mentioned before in the post that the technician will ask yous to movement into various positions when you are on the test table. You will as well have to flex your knees and flatten your dorsum.

Some people tin can observe these movements a challenge. This is particularly 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. Showtime, the extra size can block the photons equally they pass through the trunk and affect the score. 2d, some manufacturers limit the size of the people who can have the test. 1 manufacturer has a weight restriction of 350 pounds.

Thinness

It can be a claiming to get consistent os mineral density scores for people who are thin. A Densitometry Technologist indicated to me that they can go iii different scores when they take a DEXA browse of a sparse person.

A thin person likely has porous basic and this can cause the distribution pattern of the photons to vary each fourth dimension the scan is executed.

Skills and Qualifications of the Technologist

A technologist who is capable and careful will yield more authentic and dependable DEXA scan results compared to a poorly trained technician. Make sure your Technologist is accredited through a recognized body.

Quality and Maintenance of the DEXA Machine

DEXA engineering science is quite complex and the quality of machines tin vary. DEXA experts nosotros accept spoken with recommend machines from GE Prodigy and Norland.

Some other of import gene that influences the measurement of the car 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 test their DEXA machines every working 24-hour interval for accuracy.

In add-on, they indicated that while their DEXA machines were 10 years old, they replaced the primary components every 3 to five years. These upgrades and replacements take improved accuracy and reduced radiations levels in their DEXA machines. The components that they change out include the tube, filter, target and the generator.

When Should You Take a DEXA Browse?

In many jurisdictions, including the United States and Canada, women over the age of 65 and men over the age of lxx are encouraged to accept a DEXA scan for preventative screening purposes.

After the initial DEXA scan, individuals in this group are encouraged to take an examination every twenty four months.

In the United States, Medicare volition cover the toll of a DEXA scan for women 65 or older and men who are lxx and older.

If you are a woman under the age of 65, you should consider a DEXA scan if the following applies to y'all:

• Family history of osteoporosis and, in particular, hip or vertebral compression fractures in your female parent or begetter.
• Long term use 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 touch fracture.
• Radiation therapy or chemotherapy for breast cancer.

Baseline DEXA

Information technology is a good thought to have a baseline DEXA browse as y'all enter menopause. The results of this exam will give yous an accurate tape of the modify of your bone density as you lot progress through menopause. It tin can also motivate you lot to maintain (or even improve) your bone density through exercise and nutrition, thereby reducing the adventure that you will have take a pharmaceutical like Prolia, Fosamax or Forteo after in life.

Once you have the baseline DEXA, there is no need to have another test for a number of years unless the baseline test identifies that you accept low bone mass.

A baseline DEXA scan is appropriate for almost men. Osteoporosis is not a woman's just condition and men should not be dismissive of information technology. Bone density tin reject at a more than rapid rate during andropause when compared to menopause.

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Baseline DEXA Score for Richard

Later on reading this post in June of 2019, my husband Richard, asked his medico to prescribe a baseline DEXA to measure his bone mineral density. Richard is in his tardily 50's 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 afterwards receiving the prescription, Richard visited an imaging centre in Ottawa and completed the examination. The intake procedure and procedure was like to that described in this post. When he was setting up the appointment, the organizer made information technology clear that he should not take calcium supplements before the examination and should wear clothing that did not have metallic.

When Richard arrived for the procedure he had to consummate a brusque intake form. It asked him if he had a history of fractures, took steroids in the past, and other relevant questions.

The intake course was handed to the Radiology Technologist. When she reviewed his grade, she was surprised that he was taking the examination at this time. He had no history of fracture and, co-ordinate to guidelines she followed, he was too young to accept the examination. When Richard pointed out that he wanted a baseline score and that his mother and sis had osteoporosis, the Technologist was dismissive.

She begrudgingly administered the exam and followed the procedures described in this post and Richard got what he wanted — a baseline score.

Information technology is good to monitor your health and a baseline DEXA score is a step in that direction. Unfortunately, you might meet some resistance but I encourage yous to press forward and manage your bone health proactively.

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Room for Improvement

A study published in March, 2019 in The Spine Periodical,Rates of osteoporosis screening and treatment following vertebral fracture, showed that, in some jurisdictions, that non enough people are getting DEXA scans.

Between 2008 and 2014, 2,933 unique patients visited emergency department for one or more vertebral fractures. The patients were 50 years and older. Of the patients that visited the emergency department, "ninety-eight percent did not receive a DEXA scan inside the preceding 2 years or 1 year following fracture." (5)

According to one of the co-authors, Jonathan J. Carmouche, M.D., Department Principal of Spine and Pediatrics for the Section of Orthopaedic Surgery at Carilion Clinic in Roanoke, Virginia, "We found that we, as the region'south premier tertiary care center, were dropping the brawl on over xc% of vertebral fracture patients. They weren't getting DEXA [os density] scans to formally screen them for osteoporosis or diagnosed clinically and were therefore non being treated or were existence nether treated significantly." (6)

Some of these patients probably fell through the cracks because they were under the age of 65, some might take been overlooked because their health care plans did not provide adequate screening coverage. However, it seems equally though we should exist 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 browse examination is very safe. DEXA motorcar take been reducing the amount of radiations exposure to the point where radiation exposure from a DEXA auto is ane/100 or less compared with a lateral view X-ray of the spine.

Additionally, a Vertebral Fracture Assessment (VFA) tin be done at the aforementioned fourth dimension and location as measurement of BMD by DEXA.

How Oft Should You Accept a DEXA Scan?

How oftentimes y'all get a DEXA scan depends on a number of variables including your age and changes in health. The recommendations can vary across jurisdictions.

Equally I mentioned earlier, Medicare will provide a DEXA scan every twenty four months for women after the age of 65.

What are the Limitations of a DEXA?

The DEXA has several limitations:

• A DEXA scan is not able to tell you if you lot will have a fracture. It can only provide you with a measurement that gets interpreted into your relative gamble for a fracture.
• The DEXA cannot tell you lot about your bone quality. If there is a characteristic to measure TBS, information technology can provide some insight into your lumbar spine.
• Spinal measurements are limited in individuals with spinal deformities such every bit 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 take noticed more data beingness provided in DEXA reports. Ane of the more mutual new features is something referred to equally TBS. TBS is an abbreviation for Trabecular Os Score.

As mentioned in past articles, bone density is only role of the equation that relates to os strength. The other part is the quality of the bone. When information technology comes to inquiry studies, os quality is assessed with tools such as a QCT, Quantitative Figurer Tomography. Due to the loftier levels of radiation exposure, the few number of machines available, and the cost of the examination, few individuals outside of research studies will ever be 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 chance of vertebral (spinal) compression fracture.

Although non widely used within existing DEXA machines, studies have shown a correlation between low lumbar spine TBS with the incidence of an old and new fracture. (eight) (9)

DEXA Bone Scan Preparation

The following are some important guidelines for your DEXA bone browse preparation. Read these to set up for a DEXA scan procedure.

• You should delay the DEXA scan if you are pregnant or if there is a possibility of you condign pregnant. Should you decide to accept the exam anyhow, notify the medical professional person performing the exam.
• If you are scheduled to take an imaging examination that requires y'all to receive a dye or other dissimilarity media either past intravenous (IV) injection or orally or rectally, the Central BMD examination should be performed prior to or at least 7 days afterward such an imaging examination; east.g.: nuclear scan, CT scan, MRI, Barium studies etc.

On the day of your scheduled Fundamental DEXA BMD (os density test) examination and equally function of your bone density test training, you should follow these patient preparation guidelines:

• Bring the Cardinal DEXA BMD (bone density test) exam asking your md has provided along with your health insurance card to the test facility.
• Bear witness up 15 to 20 minutes prior to your appointment. This will requite y'all ample fourth dimension to register. Exams are unremarkably booked back-to-dorsum. Hence, punctuality is appreciated.
• Swallow a normal diet on the day of the exam.
• Take your medications as y'all normally would.
• Bring an upwards-to-date list of the medications yous are taking.
• Leave any valuables or jewelry yous normally wear at dwelling.

Bone Density Exam Grooming Calcium Intake

Practise Non have calcium supplements for at least 24 hours before the examination.

Can Yous Eat Before a DEXA Scan?

You can eat your regular meals the 24-hour interval of the DEXA scan examination, however, you should not have calcium supplements at least 24 hours in advance of the scan.

Exercise You Have to Undress for a Bone Density Test?

In about cases you will non take to undress for a os density exam. The staff and clinician will make every attempt to keep you in your own dress during the examination. However, the staff may enquire you lot to wear a gown.

Depending on the test center, the staff might request that yous remove items that interfere with the DEXA scan including:

• Belts
• Metallic buttons
• Keys
• Wallets
• Removable dental appliances
• Eye glasses

What to Wear for Bone Density Test

Here are guidelines on what to wear for bone density test, as well as what not to habiliment:

• Wearable loose plumbing fixtures clothes and avoid 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 centre but will interfere with the measurement procedure.
• Try not to wear body-piercing decoration to the examination.

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Exercise Recommendations for Osteoporosis

Your md informs yous that your Bone Mineral Density DEXA test results indicate that yous have osteoporosis and you need to start a treatment plan.

You do your research and learn that if you accept osteoporosis, osteopenia or low bone density that therapeutic do needs to be part of your osteoporosis treatment program.

Only what exercises should you do and which ones should y'all avoid? What exercises build bone and which ones reduce your take a chance of a fracture? Is Yoga proficient for your basic? Who should you lot trust when it comes to exercises for osteoporosis?

A great resource on practise and osteoporosis is my free, vii 24-hour interval email course called Exercise Recommendations for Osteoporosis. Afterward you provide your email accost, you will receive seven consecutive online educational videos on bone health — i lesson each twenty-four hour period. You can look at the videos at anytime and as often as you lot similar.I embrace of import topics related to osteoporosis exercise including:

• Can practise contrary osteoporosis?
• Stop the stoop — how to avoid kyphosis and rounded shoulders.
• Cardinal components of an osteoporosis exercise program.
• Key principles of bone edifice.
• Exercises you should avert if you lot have osteoporosis.
• Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
• Core force and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will offset you on this complimentary course. I do not SPAM or share your electronic mail address (or whatsoever information) with tertiary parties. Yous tin unsubscribe from my post list at any fourth dimension.

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What Should You Do 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, exercise habits, nutrition and medical history.

Response to DEXA Score Reject

The appropriate response to the reject can vary, equally well. You should always discuss the right strategy with your physician. Your response can include a combination of changes to your:

• Practise program.
• Activeness level.
• Movement patterns (for instance, how you lift things).
• Diet.
• Supplementation.
• Lifestyle activities (for example, if you are a gardener, consider hiring younger people to do the heavy activity around the garden.)

Depending on the degree of modify, pharmaceutical intervention may be required to reduce fracture risk.

Factors to Consider After a DEXA Score Decline

Hither are several factors to consider when you see a change in your DEXA scan scores:

1. Is the os density decline significant — to the point where your risk of a fracture is elevated?
2. Are you able to make the lifestyle modifications required to improve os density and reduce fracture risk?
3. Were there life problems during the past few years which acquired you to spend less time on your own health? Perchance an crumbling parent or a sick family unit member took all of your free energy and attention.

The correct response to the DEXA score pass up for you depends on your medical history and the take a chance of fracture. It is important that you consult with qualified wellness professionals who can aid you make the right determination for you.

Susan's DEXA Story

Susan (not her existent name) called me afterward a recent move from Virginia to Utah considering she was concerned nearly the decline in her DEXA scan test results. Her DEXA scans were only taken 14 months autonomously.

With she moved across the country, she inverse health intendance providers and doctors. Her new doctor requested a fresh DEXA examination.

When I met with Susan she mentioned her surprise in the loss of BMD in just over a year. Before discussing her exercise authorities and how she could better address bone loss, I took a expect at her BMD DEXA scores.

Unlike manufactures produce very different DEXA machines. Their results should not be exist compared. Even machines produced from the aforementioned company will non be perfectly identical.

When I read that Susan had moved across the land, I requested all of her DEXA results to ensure that the advisable intensity of practise 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

After looking at the unlike DEXA scan results, here is what I found.

DEXA Hip Scores

It seemed like Susan had hit the perfect storm of DEXA inconsistencies.

Many reports only provide the BMD of one hip. This was the case for her first DEXA scan in Virginia where they merely had a reading for her left hip. In Utah, she had a BMD of both hips but the written report only reported on the right. Her right hip BMD was significantly lower than the left hip BMD. Nevertheless, when you compared the BMD of her left hip from year to yr it was unchanged.

DEXA Spinal Scores

DEXA measurements of the spine are usually taken of the top 4 lumbar vertebra, L1, L2, L3, L4. The scores of all each vertebra was recorded in both locations. In the eastward coast, they took the average of all 4 L1 – L4 measurements. In Utah, they only took the boilerplate of her summit 2 vertebra, L1 and L2, they had the weakest scores.

Past merely using the average of her 2 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 get views of the spine from the upper thoracic area (just blare the shoulders) to the low back. Fortunately, Susan sent me the entire report. Well into the study there was a very noticeable Stage 2 compression fracture.

The radiologist had noted it but her physician had failed to tell her about it. When I asked her if she had a by episode of dorsum hurting or a autumn she did think a severe episode soon after her move. In fact she did not have a fall. During the move 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 Physical Therapy, she forgot to mention information technology in her intake.

From my point of view her vertebral compression was a game changer. We now had information on the quality of her bone.

Lesson Learned from Susan's Story

In that location are several of import lessons y'all tin can take from Susan'due south experience.

one. DEXA Browse Comparison for Femoral Neck

When comparing DEXA reports be sure you compare apples to apples. Correct hip to right or left hip to left.

Several studies have looked at the differences between BMD of the right and left femoral neck (hip) in postmenopausal women. The 2012 study of 384 postmenopausal Korean women showed a discordance rate of about thirty%.  (10)

A 2017 report 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 dominant leg. (11) While discussing similar results with researchers at a os inquiry conference a few years back, we hypothesized that since nosotros pb with the dominant leg the non-dominant leg gets more than of the weight bearing such as when kick a ball.

ii. DEXA Scan Estimation for the Spine Results

When comparing DEXA'due south of the spine, they should expect akin. Check the size and appearance of the boxes. Besides be certain that they are comparison the same parts of the spine L1 to L1, L2 to L2, and so on or every bit in Susan's case that they are taking the average of the same vertebra.

3. DEXA Scan and the Thoracic Spine

Another word of caution in regard to DEXA's and your spine. If the medical imaging institution that you have your DEXA done does not have an app that looks at a bigger picture of your spine then y'all accept to be your own advocate.

The most common fracture sites in the osteoporotic spine is in the thoracic spine, only around your bra strap. For men, this is but below the lesser of your shoulder blades. DEXA reports never capture the thoracic spine for BMD recording because of the interference of our ribs and breast bone.

Notwithstanding, if you accept tiptop loss or y'all take had sudden onset of back pain that persisted for over 4 weeks so the possible source could be a compression fracture of your vertebra.

Contributors

Robert Hakim generously contributed to this article. He wrote the department dedicated to how to prepare for your DEXA exam. Robert One thousand. Hakim M.R.T. (R.), RTR, CDT is a Clinical Densitometry Technologist atDiagnostic Imaging Department – Georgetown Hospital, Halton Healthcare Services Corporation, Halton Hills, Ontario.  Robert is a Fellow member of the International Society of Clinical Densitometry.

Primary Reference Material

1. Abdelmohsen, A. Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women. Journal of Chiropractic Medicine, September 2017.
2. Blake, GM, Fogelman, I. The role of DXA bone density scans in the diagnosis and handling of osteoporosis. Postgraduate Medical Periodical, August 2007.
3. Abdelmohsen, Azza. Comparison of Key and Peripheral Bone Mineral Density Measurements in Postmenopausal Women, Periodical of Chiropractic Medicine. September 2017.
4. Siminoski M, et al. The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women. Osteoporosis International. February 17, 2006.
5. Barton DW, et al. Rates of osteoporosis screening and treatment following vertebral fracture. The Spine Journal. March 2019. Volume 19, Outcome 3, Pages 411–417.
6. Over ninety% of Fracture Patients do not become a Density Scan! Orthopaedics This week. February 28, 2019.
7. Garg, MK. Dual free energy Ten-ray absorptiometry: Pitfalls in measurement and interpretation of os mineral density. Indian Periodical of Endocrinological Metabolism. Mar-April, 2013. 17(2): 203–210.
8. Harvey, NC, et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical exercise. A consensus report of a European Society for Clinical and Economical Aspects of Osteoporosis and Osteoarthritis (ESCEO) Working Group. Bone. September, 2015. 78: 216-224.
9. Silva BC, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA prototype. Periodical of Bone Mineral Research. March 2014. ;29(three):518-30. doi: x.1002/jbmr.2176.
10. 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.
11. Afzelius P, et al. Dual-energy 10-ray Absorptiometry of Both Hips Helps Appropriate Diagnosis of Low Bone Mineral Density and Osteoporosis. Diagnostics. 2017 Jul 9;seven(three). pii: E41. doi: 10.3390/diagnostics7030041.

Secondary Reference Material

1. Siminoski Chiliad, "Tools and Techniques", Osteoporosis Update, Spring/Summertime 2005, Volume two.
2. Winzenrieth R, Michelet F, Hans D. Three-dimensional (3D) microarchitecture correlations with 2nd project epitome grey-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: effects of resolution and noise. J Clin Densitom. 2013 Jul-Sep; 16(3):287-296.
3. Black DM, Arden NK, Palermo 50, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities simply not wrist fractures. Written report of Osteoporotic Fractures Research Grouping. J Os Miner Res. 1999 May; 14(5):821-8.
4. Yong Jun Choi. Dual-Energy Ten-Ray Absorptiometry: Beyond Bone Mineral Density Determination. Endocrinological Metabolism. 2016 Mar; 31(i): 25–30.
5. Han J, Hahn MH. Proximal Femoral Geometry equally Fracture Take a chance Gene in Female person Patients with Osteoporotic Hip Fracture. Periodical Bone Metabolism. 2016 Aug;23(three):175-82. doi: 10.11005/jbm.2016.23.iii.175. Epub 2016 Aug 31.

Osteoporosis Guidelines

For more than information, cheque out my Osteoporosis Guidelines.

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Source: https://melioguide.com/osteoporosis-prevention/bone-density-test-preparation/

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