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Bone Densitometry

Bone, Muscle, & Joint
Health & Wellness
Contributed byKrish Tangella MD, MBAJul 01, 2018

Background Information:

What are the other Names for the Procedure?

  • Bone Density Scan
  • Dual-Energy X-ray Absorptiometry (DXA)
  • DXA (Dual-Energy X-ray Absorptiometry)

What is Bone Densitometry radiology procedure? (General Explanation)

  • Bone Densitometry (or a Bone Density Scan) is a noninvasive procedure that is used to measure bone mineral density (BMD)
  • X-ray, CT scan, or an ultrasound exam, may also be used to measure the bone mass; however, a Bone Densitometry is used more frequently

What part of the Body does the Procedure involve?

A Bone Densitometry test is often performed on the hips and lower spine.

Why is the Procedure Bone Densitometry radiology procedure Performed?

Bone Densitometry is often used to diagnose and track treatment of osteoporosis, a condition which is seen in women after menopause.

  • It can also be used to check an individual’s risk of developing fractures
  • Older patients may need to go through a lateral vertebral assessment (LVA), for which a Bone Densitometry machine is used to examine the spine, to find any vertebral fractures
  • Bone density tests are recommended for individuals with the following conditions:
    • Post-menopausal women, who are less than 125 pounds, or taller than 5 feet 7 inches
    • Women with history of fracture
    • Women having a history of smoking
    • Post-menopausal women, who are not taking estrogen
    • Those with thyroid or parathyroid conditions
    • Any individual with signs and symptoms of osteoporosis
    • Patients with clinical conditions involving bone loss
    • Individuals taking medications, such as corticosteroids, thyroid replacement drugs, anti-seizure medications, and some barbiturates
    • Patients suffering from diabetes, kidney disease, liver disease, or with a family history of osteoporosis

What is the Equipment used? (Description of Equipment)

The equipment for a Bone Densitometry procedure includes the following:

  • The Bone Densitometry machine consists of a central device and peripheral device
  • A peripheral device is a small portable device, often used to measure the density of a finger, wrist, or heel
  • The central device is much larger than the peripheral device. It is often employed in hospitals to measure density of the hip and spine

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Bone Densitometry procedure.

What is the Cost of performing the Bone Densitometry radiology procedure?

The cost of the Bone Densitometry procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Bone Density Scan procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources? (accessed on 08/03/3014)

Prior to Bone Densitometry radiology procedure:

How does the Bone Densitometry radiology procedure work?

The Bone Density Scan works in the following manner:

  • The DXA machine sends two x-ray energy peaks, one of which is absorbed by soft tissues and the other by bones
  • Energy peak from the soft tissue is subtracted from the total absorbance value; the remaining value is the patient’s bone mineral density 

How is the Bone Densitometry radiology procedure Performed?

The Bone Density Scan is performed in the following manner:

  • In the examination using a central device, the patient lies on the examination table, with an x-ray machine placed at the bottom, and an imaging machine on top
  • During a hip examination, the foot is placed in a brace, and the brace rotates the hip inwards
  • During a spine examination, the legs are placed in a box in order to obtain better images
  • The patient is asked to remain still, in order to avoid any blurriness of the image
  • During tests using peripheral devices, foot, hand, forearm, or finger, is placed in the device and images are taken
  • Patients are asked to fill-out a survey (questionnaire) in order to determine, if they have any underlying condition. The results from the survey is combined with the DXA bone density test, to determine the risk of fracture

Where is the Procedure Performed?

The Bone Densitometry procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

The Bone Densitometry procedure is usually performed by a radiology technologist.

How long will the Procedure take?

The entire Bone Densitometry procedure takes about 10-30 minutes.

Who interprets the Result?

  • Results from DXA Bone Density tests are interpreted by a radiologist, rheumatologist, or an endocrinologist
  • The physician interprets the Bone Densitometry test and gives the results as a T score and Z score

T score: It shows the amount of the bone the patient has in comparison to a young adult of the same gender, with peak bone mass.

  • A T score of -1 is normal.
  • A T score between -1 and -2.5 indicates low bone mass, which is called osteopenia
  • A T score below -2.5 is called osteoporosis
  • A T score helps in determining the risk of a fracture

Z score: It refers to the amount of bone the patient has in comparison to individuals in the same age group, gender, and size.

  • A very high or very low Z score requires more medical tests to determine the underlying medical condition

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Bone Densitometry procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
  • The patient must avoid eating or drinking at least 8 hours prior to the procedure, depending on when the procedure is arranged
  • The patient is advised not to take any calcium supplements, 24 hours before the exam
  • If the patient had any procedure, where a contrast material was injected, the patient may have to wait for about 2 weeks, for the DXA Test

What is the Consent Process before the Procedure?

A physician will request your consent for a Bone Densitometry procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Bone Densitometry procedure:

  • The procedure is quick, painless, and simple
  • Very little radiation is used in the procedure; the radiation does not remain in the patient’s body
  • It is a very reliable method to diagnose osteoporosis and fracture risk
  • The equipment for the procedure is widely available

Following are the risks of the Bone Densitometry procedure:

  • Since radiation is used during the procedure, there is a slight chance of getting cancer
  • Women should inform their physician, if they are pregnant

What are the Limitations of the Bone Densitometry radiology procedure?

Following are the limitations of the Bone Density Scan:

  • Central devices are more expensive than peripheral devices; nevertheless, central devices are also more accurate
  • This procedure only provides the relative risk of a fracture. It cannot provide information on who will experience the fracture
  • It cannot be used in patients with previous spinal injury or spinal deformity
  • Peripheral scans of heel or wrist cannot be used to observe the response of the treatment for spine and hip fractures. But, these scans are useful in predicting the risk of developing a fracture in the spine and hip

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is the Bone Densitometry procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Bone Densitometry radiology procedure:

What is to be expected during the Bone Densitometry radiology procedure?

The procedure is painless; however, the individual needs to be as still as possible, during the scan.

What kind of Anesthesia is given, during the Procedure?

No anesthesia is given during a Bone Densitometry procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss involved, during a Bone Densitometry procedure.

What are the possible Risks and Complications during the Bone Densitometry radiology procedure?

The possible risks during the Bone Densitometry procedure include:

  • Since radiation is used during the procedure, there is a slight risk of cancer
  • Women should inform their physician, if they are pregnant

What Post-Operative Care is needed at the Healthcare Facility after the Bone Densitometry radiology procedure?

There is no postoperative care necessary after a Bone Densitometry (Bone Density Scan) procedure, at the healthcare facility 

After the Bone Densitometry radiology procedure:

What is to be expected after the Bone Densitometry radiology procedure?

The following may be expected after the Bone Densitometry procedure:

  • The patient usually has a follow-up visit with the physician, to discuss the findings of the Bone Densitometry study
  • Patients on steroid medication are advised to follow-up after 6 months
  • All the other patients are advised to have an evaluation every 2 years.

When do you need to call your Physician?

If the patient is experiencing any unusual signs and symptoms, then do contact the physician.

What Post-Operative Care is needed at Home after the Bone Densitometry radiology procedure?

There is no postoperative care necessary after the Bone Densitometry procedure.

How long does it normally take to fully recover, from the Procedure?

The patient needs no recovery time after a Bone Densitometry procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue is extracted from the patient, during a Bone Densitometry procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Bone Densitometry radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • A radiologist, performing the procedure
  • Healthcare providers, physicians, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Bone Densitometry procedure is performed.

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Krish Tangella MD, MBA

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