BONE DENSITOMETRY

( DEXA SCAN)

Dr Malith Kumarasinghe
MBBS (Colombo)
OSTEOPOROSIS
Osteoporosis is the most common metabolic bone disorder. It has
been defined by the National Institutes of Health as an age-related
disorder characterized by decreased bone mass and increased
susceptibility to fractures
in the absence of other recognizable causes of bone loss.
OSTEOPOROSIS
Risk factors
may be superimposed upon either involutional or secondary osteoporosis,
including
smoking, alcohol, poor diet, lack of exercise, an early menopause, strong
family history and small frame.
OSTEOPOROSIS
The normal rate of bone loss is 2% per year, hence 20-40%
of the female bone mass is already lost by the age of 65
years of age, beginning before the menopause and
accelerating afterwards
OSTEOPOROSIS
Bone mass is the major determinant of bone strength that
can be measured by non-invasive techniques, and accounts
for 75-85% of this parameter
 OSTEOPOROSIS
Bone densitometry is clinically indicated for the detection and assessment of osteoporosis
and for the evaluation and monitoring of several diseases and therapies. These include:

1. The detection of osteoporosis and assessment of its severity.

2. Evaluation of perimenopausal women for the initiation of estrogen therapy.
3. Evaluation of patients with metabolic diseases that affect the skeleton.
4. Monitoring of treatment and evaluation of disease course.

In addition it may be useful as an epidemiological tool and possibly in the future for
screening

American Society of Bone and Mineral Research

Osteoporosis Measurement

 Plain film, Subjective, Radiogrammetry, Osteogram

 SPA
 DPA
 DEXA
 QCT
 US
 MRI
DEXA
Because photons of different energy are differentially attenuated by bone and soft-
tissues, by measuring the percentage of each transmitted beam and then applying
simple simultaneous equations, the absorption by bone alone and hence bone density
can be calculated.

This measurement is not a true density but rather an areal density, represented in
gms/cm2
DEXA
DEXA has very high
accuracy (the difference in the measurement
from a known standard)
DEXA
DXA is at present the most precise
measurement of BMD
DEXA

Interpretation
Bone Densitometry
DEXA spine check list

 Note the age, sex, ethnicity and weight

 Does this match the reference ranges?
 Is the bottom of L4 roughly at the level of the iliac
crests
 Are there any ribs on L1
 Scoliosis
 Are the vertebrae correctly divided
 Anything in the soft tissue
DEXA, what makes a good scan?
 5-15 Lines of Iliac Crest. I recommend 1/2 of L5.
 5-10 Lines of T12.
 2 cm of tissue on both sides of the spine.
 Spine should be straight.
 No metal in spine.
Common problems with spine scans.

 Spine isn’t straight.

 Scan starts in sacrum.
 Scan stops too soon.
 Wrong scan mode.
 Scan doesn’t include L5.
46 F

Calcified bile