{"id":3831,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dexa\/"},"modified":"2024-01-25T11:13:14","modified_gmt":"2024-01-25T11:13:14","slug":"dexa","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/osteoporosis\/dexa\/","title":{"rendered":"Dual Energy X-ray Absorptiometry (DEXA)"},"content":{"rendered":"\n<p><strong>Indications<\/strong><\/p>\n\n\n\n<p>Dual-energy x-ray absorptiometry (DEXA) is indicated in patients suspected to have osteoporosis. Repeat DEXA scans are indicated to monitor the response to osteoporosis treatment and to monitor loss of bone patients with osteopenia. The most reliable site for monitoring changes in BMD in older individuals (&gt;65) is the total hip.<\/p>\n\n\n\n<p><strong>Initial DEXA in those aged &gt;50 years<\/strong><\/p>\n\n\n\n<p>The main indications for an initial DEXA are shown below.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Low trauma fracture at any site (except skull, fingers and toes) age &gt;50.<\/li>\n\n\n\n<li>Suspected vertebral fracture (kyphosis, height loss &gt;2.5cm).<\/li>\n\n\n\n<li>Primary hyperparathyroidism, to decide on the need for parathyroidectomy.<\/li>\n\n\n\n<li><strong>Clinical risk factors for osteoporosis in<\/strong> those &gt;50 with a <strong>10-year fracture risk of &gt;10% calculated by QFracture or FRAX. <\/strong>&nbsp;Clinical risk factors, taken from <a href=\"https:\/\/www.sign.ac.uk\/media\/1741\/sign142.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">SIGN142<\/a>. are summarised in Table 1.<\/li>\n<\/ul>\n\n\n\n<p><strong>Initial DEXA in those aged &lt;50 years<\/strong><\/p>\n\n\n\n<p>Exceptionally, DEXA may be considered in people younger than 50 with very strong clinical risk factors for osteoporosis or major low trauma osteoporotic fractures as summarised below:<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Low trauma hip or vertebral fracture<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Commitment to oral prednisolone &gt;7.5mg\/ day for 3months or annual dose &gt;630mg.<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Primary hyperparathyroidism, to decide on the need for parathyroidectomy.<\/p>\n\n\n\n<p>\u2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A 10-year fracture risk of &gt;= 10% <strong>and <\/strong>a major risk factor, defined as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Untreated early menopause (age&lt;45)<\/li>\n\n\n\n<li>Excess alcohol intake (&gt;3.5 units\/day)<\/li>\n\n\n\n<li>Low BMI (&lt;20 kg\/m2)<\/li>\n\n\n\n<li>Chronic inflammatory disease (RA, SLE, AxSPA, PsA, IBD)<\/li>\n\n\n\n<li>Malabsorption<\/li>\n\n\n\n<li>Coeliac Disease<\/li>\n\n\n\n<li>Neurological diseases (Alzheimer\u2019s, Parkinson\u2019s disease, Multiple sclerosis)<\/li>\n\n\n\n<li>Endocrine diseases<\/li>\n\n\n\n<li>Chronic liver disease<\/li>\n\n\n\n<li>Moderate to severe kidney disease (eGFR &lt; 60ml\/min\/1.73m2)<\/li>\n<\/ul>\n\n\n\n<p><strong>M.A &amp; S.R\/H.B. 25-01-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p> <\/p>\n\n\n\n<p>Referral for DEXA should be made via Sci Gateway to Medical Physics at the Western General Hospital.<\/p>\n\n\n\n<p><strong>Repeat DEXA for monitoring treatment of osteoporosis.<\/strong><\/p>\n\n\n\n<p>Repeat DEXA is indicated to monitor the response to osteoporosis treatment. Recommended intervals for repeat DEXA in these patients are as follows:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Every 5 years in patients on oral bisphosphonates<\/li>\n\n\n\n<li>Every 5 years in patients on intravenous bisphosphonates<\/li>\n\n\n\n<li>Annually for 2 years in patients on teriparatide and then at 5 years to monitor effects of&nbsp; antiresorptive therapy (usually oral or intravenous bisphosphonates)<\/li>\n\n\n\n<li>Annually for 2 years in patients receiving romosozumab then at 5 years to monitor effects of&nbsp; antiresorptive therapy (usually oral or intravenous bisphosphonates)<\/li>\n<\/ul>\n\n\n\n<p>Patients who fracture while on oral bisphosphonate treatment may be referred for a repeat DEXA, to assess treatment response but this should not be done unless at least two years of treatment has been completed.<\/p>\n\n\n\n<p><strong>Repeat DEXA for monitoring progression of osteopenia.<\/strong><\/p>\n\n\n\n<p>Repeat DEXA is indicated in patients who are discovered to have osteopenia to monitor progression to osteoporosis. The interval between scans is dependent on the baseline DEXA. As a rule of thumb BMD decreases in postmenopausal women by 0.1 T-score unit per year. Suggested intervals are summarised in the table below.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Baseline DEXA T-score<\/strong><\/td><td><strong>Suggested interval for repeat DEXA<\/strong><\/td><\/tr><tr><td>-1.0 or greater<\/td><td>15 years<\/td><\/tr><tr><td>-1.1<\/td><td>14 years<\/td><\/tr><tr><td>-1.2<\/td><td>13 years<\/td><\/tr><tr><td>-1.3<\/td><td>12 years<\/td><\/tr><tr><td>-1.4<\/td><td>11 years<\/td><\/tr><tr><td>-1.5<\/td><td>10 years<\/td><\/tr><tr><td>-1.6<\/td><td>9 years<\/td><\/tr><tr><td>-1.7<\/td><td>8 years<\/td><\/tr><tr><td>-1.8<\/td><td>7 years<\/td><\/tr><tr><td>-1.9<\/td><td>6 years<\/td><\/tr><tr><td>-2.0<\/td><td>5 years<\/td><\/tr><tr><td>-2.1<\/td><td>4 years<\/td><\/tr><tr><td>-2.2<\/td><td>3 years<\/td><\/tr><tr><td>-2.3 or below<\/td><td>2 years<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Staff Members<\/strong><\/td><td><strong>Telephone<\/strong><\/td><\/tr><tr><td>Caoimhe McIntyre (Head of Department)<\/td><td>0131-537-3727<\/td><\/tr><tr><td>Dexa Secretaries<\/td><td>0131-537-3727<\/td><\/tr><tr><td>Carol Millar (Lead Clinical Technologist, Dexa)<\/td><td>0131-537-3761<\/td><\/tr><tr><td>Prof Stuart Ralston(Lead clinician Osteoporosis service)<\/td><td>0131-537-1813&nbsp;<\/td><\/tr><tr><td>Monica Gomez(Osteoporosis Specialist Nurse)<\/td><td>0131-537-2697<\/td><\/tr><tr><td>Tracey Reid&nbsp;(osteoporosis specialist nurse)<\/td><td>0131-537-2697<\/td><\/tr><tr><td>Karen Moohin (Osteoporosis Specialist Nurse)<\/td><td>0131-537-2697<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Royal Osteoporosis Society (<a href=\"http:\/\/www.theros.org.uk\" target=\"_blank\" rel=\"noreferrer noopener\">www.theros.org.uk<\/a> )<\/p>\n\n\n\n<p>Management of osteoporosis and prevention of fragility fractures (<a href=\"https:\/\/www.sign.ac.uk\/our-guidelines\/management-of-osteoporosis-and-the-prevention-of-fragility-fractures\/\" target=\"_blank\" rel=\"noreferrer noopener\">SIGN 142<\/a>)<\/p>\n\n\n\n<p>Dietary calcium calculator. <a href=\"https:\/\/webapps.igc.ed.ac.uk\/world\/research\/rheumatological\/calcium-calculator\/\" target=\"_blank\" rel=\"noreferrer noopener\">Calcium Calculator<\/a><\/p>\n\n\n\n<p>Osteoporosis risk benefit calculator: <a href=\"https:\/\/webapps.igmm.ed.ac.uk\/world\/research\/rheumatological\/ORBCalculator\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORB calculator<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Indications Dual-energy x-ray absorptiometry (DEXA) is indicated in patients suspected to have osteoporosis. Repeat DEXA scans are indicated to monitor the response to osteoporosis treatment and to monitor loss of bone patients with osteopenia. The most reliable site for monitoring changes in BMD in older individuals (&gt;65) is the total hip. Initial DEXA in those<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4233,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[623],"class_list":["post-3831","page","type-page","status-publish","hentry","category-dexa"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/osteoporosis\/dexa\/\" rel=\"tag\">DEXA<\/a>","rttpg_excerpt":"Indications Dual-energy x-ray absorptiometry (DEXA) is indicated in patients suspected to have osteoporosis. Repeat DEXA scans are indicated to monitor the response to osteoporosis treatment and to monitor loss of bone patients with osteopenia. The most reliable site for monitoring changes in BMD in older individuals (&gt;65) is the total hip. Initial DEXA in those","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3831","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3831"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3831\/revisions"}],"predecessor-version":[{"id":18024,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3831\/revisions\/18024"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4233"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3831"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3831"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}