The role of DXA bone density scans in the diagnosis and treatment of osteoporosis

Blake, Glen M.; Fogelman, Ignac

Affiliations

¹King’s College London School of Medicine, London, UK

Abstract

Dual energy x ray absorptiometry (DXA) scans to measure bone mineral density (BMD) at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.

Links

DOI: 10.1136/pgmj.2007.057505

PubMed: 17675543

WoS: 000248580200002

History

Received: 2007-01-16

Accepted: 2007-03-30

Cited Works (27)

Year	Entry
1997	Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. July 1997;7(4):390-406.
2004	Chesnut CH III, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, Felsenberg D, Huss H, Gilbride J, Schimmer RC, Delmas PD; Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. August 2004;19(8):1241-1249.
2005	Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA, Pols H, Tenenhouse A. Alcohol intake as a risk factor for fracture. Osteoporos Int. July 2005;16(7):737-742.
1999	Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. March 13, 1999;353(9156):878-882.
1999	Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR; Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. August 18, 1999;282(7):637-645.
2004	Johansson H, Oden A, Johnell O, Jonsson B, de Laet C, Oglesby A, McCloskey EV, Kayan K, Jalava T, Kanis JA. Optimization of BMD measurements to identify high risk groups for treatment: a test analysis. J Bone Miner Res. June 2004;19(6):906-913.
1996	Genant HK, Engelke K, Fuerst T, Glüer C, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res. June 1996;11(6):707-730.
2005	De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ III, Meunier PJ, Pols HAP, Reeve J, Silman A, Tenenhouse A. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. November 2005;16(11):1330-1338.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
2002	Cummings SR, Melton LJ III. Epidemiology and outcomes of osteoporotic fractures. Lancet. May 18, 2002;359(9319):1761-1767.
1993	Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palmero L, Scott J, Vogt TM; Study of Osteoporotic Fractures Research Group. Bone density at various sites for prediction of hip fractures. Lancet. January 9, 1993;341(8837):72-75.
1998	Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ; Fracture Intervention Trial Research Group. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. December 23, 1998;280(24):2077-2082.
2001	Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster J-Y, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mellström D, Oefjord ES, Marcinowska-Suchowierska E, Salmi J, Mulder H, Halse J, Sawicki AZ, Mitlak BH. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. NEJM. May 10, 2001;344(19):1434-1441.
1999	Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH III, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD; Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA. October 13, 1999;282(14):1344-1352.
2000	Kanis JA, Glüer C-C; Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. March 2000;11(3):192-202.
1998	Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468-489.
2004	Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton LJ III, Tenenhouse A, Reeve J, Silman AJ, Pols HAP, Eisman JA, McCloskey EV, Mellstrom D. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. June 2004;19(6):893-899.
1996	Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. December 7, 1996;348(9041):1535-1541.
1993	Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. May 1, 1993;137(9):1001-1005.
1990	Storm T, Thamsborg G, Steiniche T, Genant HK, Sørensen OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. NEJM. May 3, 1990;322(18):1265-1271.
2001	McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Wasnich RD, Greenwald M, Kaufman J-M, Chesnut CH, Reginster J-Y; Hip Intervention Program Study Group. Effect of risedronate on the risk of hip fracture in elderly women: Hip Intervention Program Study Group. NEJM. February 1, 2001;344(5):333-340.
2005	Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int. June 2005;16(6):581-589.
2004	Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey E, Mellstrom D, Melton L, Pols H, Reeve J, Silman A, Tenenhouse A. A meta-analysis of previous fracture and subsequent fracture risk. Bone. August 2004;35(2):375-382.
2001	Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. December 2001;12(12):989-995.
2002	Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. June 1, 2002;359(9321):1929-1936.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
1996	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.

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2022	Goff E. Osteocyte Lacunar Biomarkers in Human Rare Bone Diseases [PhD thesis]. Swiss Federal Institute of Technology Zürich; 2022.
2022	Lu T. Leveraging Complex Disease Polygenic Risk Scores for Improved Risk Prediction and Identification of Rare Genetic Conditions [PhD thesis]. McGill University; April 2022.
2019	Strakhov I. The Nanoscale Structure of Human Female Osteoporotic Bone Investigated by Transmission Electron Microscopy [Master's thesis]. Hamilton, ON: McMaster University; September 2019.
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2018	Doering JA. Understanding Musculoskeletal Changes With Aging: Stiffness in Muscle-Tendon Units and Cellular Crosstalk [PhD thesis]. North Carolina State University; 2018.
2016	Berman AG. Influence of Mechanical Stimulation on the Quantity and Quality of Bone During Modeling [Master's thesis]. Purdue University; August 2016.
2022	Reiner E. Application of Optical Photothermal Infrared (O-PTIR) Spectroscopy to Assess Bone Composition At the Submicron Scale [Master's thesis]. Temple University; May 2022.
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2019	Kroker AM. The Progression of Bone Microarchitecture Changes Following an Acute Knee Injury in Young Adults [PhD thesis]. Calgary, AB: University of Calgary; March 2019.
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2022	Nandi S. HRAS GTPase, a Novel Regulator of Bone Homeostasis: Understanding the Cellular Base of Bone Loss in Costello Syndrome [PhD thesis]. University of Ulm; 2022.
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2022	Winsor C. Femoral Bone Quantitative CT Analyses With Internal Tissue-Based Phantomless Densitometric CT Calibration [PhD thesis]. University of Wisconsin – Madison; 2022.