Dual X-ray Absorptiometry (DXA)
Scan Request
(Please see also Guidelines for Referral 2005)
The Ipswich Hospital NHS Trust
Please send request to Rheumatology Department (S601)
Hospital number: Patient hospital number
NHS number:
NHS number
Date of Birth:
Date of birth
Report and copies to be sent to:
Name: Title Forename Surname
Address: Patient address house Patient address road
Patient address post town Patient post code
Telephone: Patient home telephone number
Mobile: Patient mobile telephone number
GP/Consultant:
Clinical details and reasons for obtaining DXA scan (see below):
Previous DXA scan and date (s):
Please sign:
Print name:
Date:
Reasons to consider obtaining a DXA scan
Primary osteoporosis risk factors
Menopause age <45 (+ < 5y HRT)
Prolonged secondary amenorrhoea
Radiological osteopenia (especially spine)
History of maternal hip fracture
Previous fragility fracture*
Heavy long-term smoking
Low BMI (kg/m²) of <19
Prolonged immobilisation (e.g. MS)
Excessive long-term alcohol consumption
Secondary osteoporosis
(Diseases associated with osteoporosis/bone fragility)
Rheumatoid arthritis, ankylosing spondylitis, SLE
Hyperparathyroidism**, hyperthyroidism
Male Hypogonadism
Chronic liver disease, e.g. primary biliary cirrhosis
Chronic inflammatory bowel disease e.g. Crohn’s disease**
Previous gastrectomy, Malabsorption** e.g.Coeliac disease**
Chronic renal failure** (CKD3-5)
Hypopituitarism, Cushing’s syndrome, Type I DM
Haemochromatosis
Organ Transplant patients
Anorexia/Bulimia Nervosa
Secondary osteoporosis
(Medications that can cause osteoporosis)
Commitment or exposure to oral glucocorticoids for 3/12 or more or equivalent parenteral steroid dose
Aromatase inhibitors or depoprovera
Androgen deprivation therapy for prostate cancer e.g. cyproterone, flutamide, buserelin etc.
Chronic excessive exposure to thyroxine (endogenous or exogenous) or anticonvulsants(± osteomalacia)
Other situations
Monitoring change in bone density (to aid compliance and assess efficacy of treatment).
*Fracture sustained with no trauma or fall from standing height. Most usually spine, hip, forearm, pelvis and proximal humerus.
** DXA may identify low bone density due to osteomalacia or PTH* in these conditions (i.e. DXA is not specific for osteoporosis)
Using DXA to predict fracture

Low bone density measured by DXA is a strong predictor of future fracture. The
lower the bone density (or T score) the higher the risk.

Lumbar spine and hip (femoral neck or total hip area) DXA is the gold standard
technique for assessing the risk of fracture at each site. DXA results can be used as
part of a full fracture assessment (FRAX)

Lumbar spine DXA measures in the elderly may be invalid owing to degenerative
changes in the spine and soft tissue calcification skewing the results (essentially
over-estimating bone density). We recommend scans are rarely helpful in those >
80 years old given the above and that bones are invariably in the ‘osteoporotic range’
anyway at that stage. Be aware that the validity of DXA measures may need to be
substantiated by viewing corresponding lateral and AP spinal radiographs.
Using DXA to monitor changes in bone density

DXA may be useful to assess initial efficacy of therapy (2-5 years after starting
bisphosphonates or 12 months after starting strontium ranelate).

Repeat DXA assessments may be useful to aid adherence to drug therapy, but are
not routinely recommended.

In the future monitoring of anti-resorptive therapy such as bisphosphonates over the
short-term may be best done in practice by assessing biochemical measures of bone
collagen crosslinks in serum or urine.
If in doubt please contact Dr Gavin Clunie, Consultant Rheumatologist,
(gavin.clunie@ipswichhospital.nhs.uk, extension 1039 or bleep 332)
or administrator sue.holdaway@ipswichhospital.nhs.uk extension 1571 (702571)
V2 GC 03/05