Wednesday, November 15, 2006

Bone mineral density

Early diagnosis and treatment of osteoporosis can reduce fracture risk. RadiologyInfo has an excellent page on bone densitometry and DEXA scans for osteoporosis. A dexa scan is currently the gold standard for measuring bone mineral density (BMD). There is growing interest in quantitative ultrasound as an alternative, but it still needs to go a long way to prove itself. Other less widely used techniques are peripheral quantitative computed tomography, quantitative magnetic resonance (QMR) and magnetic resonance microscopy.

The WHO recommendations for who to test for BMD are
for women -
    1. In postmenopausal women if there is x ray evidence of demineralisation, evidence of vertebral fracture/deformity or if steroid therapy for more than 3 months is contemplated.
    2. In all postmenopausal women above 65 years of age.
    3. In postmenopausal women below 65 years of age if they have risk factors like maternal history of fragility fractures, low body weight or medical conditions associated with bone loss like premature menopause, hyperparathyroidism, hyperthyroidism, chronic renal failure, chronic liver disease, malabsorption or use of anti convulsants.
    4. In premenopausal women who have medical conditions associated with bone loss listed above.
    5. In healthy premenopausal women, BMD testing is not indicated.

for men -

  1. BMD testing is definitely indicated in the presence of vertebral deformity, fragility fracture, hypogonadism or chronic steroid therapy.
  2. BMD is less definitely indicated in case of alcohol abuse, low weight, x ray evidence of demineralisation or medical conditions associated with bone loss listed above.
  3. BMD testing is not recommended for healthy men with no risk factors.

BMD testing is not for everyone. Consider getting it done only if you fall in one of the above categories. Potential harms of DEXA are radiation and cost. Bone mineral density should be measured only to assist in making a clinical management choice.

Besides DEXA quality matters. BMD measurement is not a simple procedure & errors can lead to therapeutic decisions that can harm patients.

BMD measurements have today become essential for fracture prevention and osteoporosis treatment, but due care is needed in utilising this asset.

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