DEXA scan – screen for Osteoporosis

DEXA scans: (Dual-energy x-ray absorptiometry) Screen for osteoporosis – test bone density

  • T-score compares a patient’s bone mineral density to that of a healthy young adult
  • WHO criteria:
    • T-score within 1 standard deviation (SD) or better is NORMAL.
    • T-score of -1 to -2.5 SD is defined as OSTEOPENIA.
    • T-score of less than -2.5 SD is defined as OSTEOPOROSIS.
    • T-score of less than -2.5 SD with fracture is defined as SEVERE OSTEOPOROSIS.

“General screening in postmenopausal women +60 years is NOT clearly beneficial.” – DynaMed

“Testing for bone mineral density should be recommended for all women who are:

  • Postmenopausal and at least +65 years of age. – screen all women +65yo at least once!!!
  • Bone mineral density testing may be recommended for women who are postmenopausal and younger than 65 years who have at least one risk factor for osteoporosis.
  • Bone mineral density testing should be performed on all women who are postmenopausal with fractures to confirm the diagnosis of osteoporosis and determine the severity of disease.
  • In the absence of new risk factors, screening should not be performed more frequently than every 2 years.” – AAFP
    • DEXA report: 10 year % of probability of fracture (WHO Fracture Assessment Tool [FRAX]):
      • Major Osteoporotic fracture %
      • Hip fracture %
    • Should tell you if there is evidence of osteoporosis or osteopenia.
    • Should tell you whether the patient’s measurements reach the threshold suggested by the National Osteoporosis Foundation to initiate treatment for osteopenia.

Osteoporosis:

  1. mc NON-modifiable risk factor: age (others: race, family history, previous fractures)
  2. mc MODIFIABLE risk factor: quit smoking (smoking cessation) (others: Raloxifene, Calcium and Vitamin D supplements, and discontinue meds such as Heparin and Glucocorticoids)
    1. Other less effective suggestions: increase exercise (weight bearing exercises), decrease coffee/cokes/alcohol use.
  3. Hormone Replacement Therapy (HRT) is effective in preventing osteoporosis, but it is NOT recommended because it will increase the risk for cancer (breast and endometrial) as well as heart dz

Tx:

  1. Alendronate (bisphosphonate) [ADR: GI side effects]
    1. Alendronate 10mg PO qd (more side effects)
    2. Alendronate 70mg PO 1 tablet once a week (less side effects because less often administered)
      1. Only after the patient fails treatment with Alendronate can consider Zoledronic acid (injection).
  2. Zoledronic acid (use if cannot tolerate GI side effects of bisphosphonate)

Osteoporosis:

  • DEXA scan: Screen all women (post-menopausal) +65 years old at least once!
  • Tool used to Dx: https://www.shef.ac.uk/FRAX/tool.jsp
  • Tx: Calcium supplement and Vitamin D supplements.
    1. Vitamin D (Ergocalciferol) 50,000U PO capsule – Take 1 capsule each week for 12 weeks.
    2. OTC Calcium carbonate 1250mg tablets
    3. Alendronate Sodium (bisphosphonate) 70 MG Oral Tablet – Take 1 tablet once a week 30-60 minutes prior to breakfast or the patient can take 10mg PO qd each morning before breakfast.
      1. ADR: GI symptoms.
    4. Zoledronic acid (use if cannot tolerate GI side effects of bisphosphonate)
  • Other recommendations: quit smoking (smoking cessation), increase exercises (weight bearing exercises), decrease coffee/cokes/alcohol use.
  • Others: Raloxifene (if pt has breast cancer too), and discontinue meds such as Heparin and Glucocorticoids
    1. Hormone Replacement Therapy (HRT) is effective in preventing osteoporosis, but it is NOT recommended because it will increase the risk for cancer (breast and endometrial) as well as heart disease.

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