![]() The considerations for secondary osteoporosis include: type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition or malabsorption, and chronic liver disease. Because estimation of fracture risk is most commonly performed by use of the FRAX ® calculator, a history sheet should include, at least, the questions used by FRAX ®, i.e.: age, sex, weight, height, history of previous fracture (any location), parental history of hip fracture, current smoker, glucocorticoid usage, history of rheumatoid arthritis, history of secondary osteoporosis, and alcohol use. If information is not available from an electronic medical record, a history sheet or questionnaire should be completed by the patient and confirmed by discussion with the technician or the physician. To provide the most clinically useful DXA interpretation, the context for the patient must be known. The examination should not be scheduled close to a nuclear medicine scan where emitted radiation could interfere with accurate BMD measurement. When a patient is scheduled for the examination, s/he should be told to wear comfortable clothing that can be easily exchanged for a gown and to avoid any jewelry that cannot be easily removed. In this approach, initial screening examinations are regarded as straightforward, follow-up examinations as mildly complex, and examinations that require recalculation of data as complex. The approach includes division of examinations into straightforward, mildly complex, and complex. We describe below an approach to evaluation of these factors and production of clinically relevant DXA reports. The patient’s fracture risk is usually estimated by use of the FRAX ® model, which estimates the patient’s hip fracture risk for the next 10 years. The T-score enables categorization of patients into one of three diagnoses: normal, low bone mineral density, or osteoporosis. The DXA information includes the BMD, T-score, and Z-score. The most important aspect of DXA interpretation is estimating a patient’s risk of developing an osteoporosis-related fracture. A quality-control program must be implemented and followed to assure clinicians and patients that the information obtained falls within accepted ranges for precision and accuracy.ĭepending on specific factors, related to the clinical status of the patient or technical aspects of the test itself, interpretation of DXA examinations ranges from straightforward to complicated. It is extremely important that facilities performing DXA examinations recognize that the main output of this test is quantitative. This definition uses the bone mineral density (BMD) measured by use of dual-energy X-ray absorptiometry (DXA) as the feature defining the disease.ĭuring a DXA examination, a patient is irradiated with an X-ray beam of two different energies, which enables bone attenuation to be separated from soft tissue attenuation. The densitometric definition of osteoporosis was first established by consensus of a panel convened by the World Health Organization (WHO) in 1994. Hip, vertebral, and radius fractures increase the risk of future fractures.Ī decrease in bone mineral and modification of bone structure is a common part of aging. Hip fractures are associated with increased short-term mortality and high morbidity. The proximal femur, the vertebral bodies, the distal radius, and the proximal humerus are the most common sites of fracture and thus the most studied. These fractures are referred to as fragility fractures-ones that occur as a result of a force equal to or less than that caused by a fall from standing height. The primary complication of osteoporosis is fractures occurring after minimum trauma. Although most patients are women older than 50 years, men also commonly develop osteoporosis. In the United States, there are at least 1.5 million osteoporotic fractures every year. Because of this variability, diagnosis and treatment of osteoporosis can be confusing. Osteoporosis is a systemic yet regionally heterogeneous disease that affects different regions of the skeleton with different severity.
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