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DEXA / BONE MINERAL DENSITOMETRY

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About DEXA/BONE MINERAL DENSITOMETRY

BMD TEST is also known as

  • BONE DENSITY TEST
  • BONE DENSITOMETRY
  • DEXA SCAN
  • DXA
  • DUAL-ENERGY X-RAY ABSORPTIOMETRY

What is Bone Mineral Densitometry?

Bone Mineral Densitometry, also commonly referred to as BMD, is the examination that uses a special machine to scan the lower spine and hips, to assess for possible osteoporosis or reduced bone density. DEXA uses low-dose x-rays. A bone mineral density (BMD) test measures how much calcium and other types of minerals are there in an area of your bone. This test helps to detect osteoporosis

Who all should do BMD?

Increased age :

Post menopausal women Men above 50 years

Strong family history of osteoporosis Previous fracture injuries : 

Breaking a bone, especially after age 50, may be a sign that you’re at greater risk. Porous (less dense) bones break more easily.

Medications : 

History of hormone treatment for prostate cancer or breast cancer Taking thyroid hormone replacement Some medications, such as the steroid , cancer drugs, and drugs used after an organ transplant can weaken your bones.

Your overall health : 

Early menopause (either from natural causes or surgery) Many chronic medical disorders can make your bones more likely to break - Risky conditions include rheumatoid arthritis, lupus, diabetes, liver disease and kidney disease. Three or more drinks of alcohol a day on most days

Bone mineral density (BMD) tests are used to

Track bone health changes over time - Diagnose bone loss ( osteopenia ) and osteoporosis . Monitor your response to treatment, such as an osteoporosis medication . Predict your risk of future bone fractures . Evaluate body composition , such as how much fat and muscle mass your body has (and where) . The new Advanced Body Composition feature measures the distribution of fat mass,lean mass and total mass for the entire body translating the information into an easy to interpret report for improved patient weight management and counselling.

How often should a DEXA scan be done?

Current practice recommends BMD testing maybe done every 1 or 2 years.


What preparation is required?

  • DEXA bone density tests are outpatient procedures
  • It is necessary to make an appointment for a BMD examination, although in most cases we can fit you in on the day
  • No specific preparation is necessary for this test. Eat, drink and take any medications as you normally would, unless your doctor tells you otherwise.
  • The test should not be performed within a period of 72 hours following a nuclear bone scan or within one week following a barium study (barium meal, small bowel barium follow-through or barium enema) or a contrast study .
  • Please bring along any previous x-rays scans which you have
  • Before the scan you will need to fill out a medical history questionnaire which assists in the assessment of your results
  • Avoid calcium supplements and multivitamins 24 -4 8 hours prior to the test.
  • Wear loose-fitting comfortable clothing . Avoid wearing clothes with metal buttons , buckles , zippers
  • Tell your doctor if you might be pregnant: DEXA scans use low levels of radiation. Medical experts recommend avoiding all radiation exposure during pregnancy to protect an unborn baby.
  • You may also be required to remove any jewellery that could interfere with the test. .

What happens during a DEXA exam?

  • We may ask you to change into a gown to avoid clothing creating confusing shadows on the image
  • You will be required to lie comfortably on your back on the scanner table. The technologist will help position you correctly .
  • Under the table, a photon generator will pass slowly beneath you, while an X-ray detector camera will pass above the table parallel to the photon generator beneath, projecting images of the lumbar spine and hip bones onto a computer monitor.
  • The computer will calculate the amount of photons that are not absorbed by the bones to determine the bone mineral content.
  • The scanner translates the bone density measurement data into pictures and graphs.
  • You will hear a humming noise when the scanner moves above you.
  • There will be no discomfort and no breath hold is required.
  • However, it is important to remain as still as possible for the examination.
  • It is a completely painless procedure

How long does it take?

  • The BMD examination can take upto 20 - 30 minutes .
  • The results are usually made available within another one hour.
  • You will be informed in the event of any inadvertent delay.

How accurate are DEXA scans?

  • DEXA scans offer a high degree of precision and accuracy.
  • Medical experts consider DEXA scans to be an accurate test for diagnosing osteoporosis
  • Unlike x-ray machines, DEXA machines are checked daily for their ability to measure bone mineral density accurately

What should I expect after a DEXA scan?

  • You should be able to resume your usual activities immediately after the test.
  • You could approach an Orthopaedician to interpret DEXA images and review your results .
  • Your consultant could explain your test results and help you understand what they mean for your health.
  • Your consultant can help you make decisions about how to keep your bones strong.
  • Your consultant can also recommend diet and lifestyle changes that may help to lower your risk of a fracture.
  • In case of body composition analysis , you could consult a certified medical practitioner / dietitian

Medical experts consider DEXA scans the“gold standard” for diagnosing osteoporosis and fracture risk.
Many individuals lose bone density as they age.
But that doesn’t mean you have to accept fragile bones simply as a reality of getting older.
It is never too early to learn how to take care of your bones!
Do a DEXA scan to help assess your bone health today.
Then , take steps you can to protect your bones for years to come.

OSTEOPOROSIS

( An initiative of Pulse preventive medicine best practices )

Osteoporosis is a term used to describe brittle bones . Osteoporosis literally means “porous bone.” Osteoporosis results when you tend to lose bone faster than your body can create new bone tissue. Brittle bones break more easily.


Osteoporosis is defined by the WHO ( WORLD HEALTH ORGANIZATION ) as a bone mineral density of 2.5 SD or more below the mean peak bone mass ( average of young healthy adults) as measured by DEXA (DUAL-ENERGY X-RAY ABSORPTIOMETRY)


Osteoporosis is the commonest metabolic bone disease in clinical practice . It’s prevalence in our country is increasing due to ageing population . It is mandatory to diagnose and treat osteoporosis, much before the occurrence of fracture .

Osteoporosis is considered a “silent” disease because it doesn’t hurt. Many people first realize they have osteoporosis after they break a bone from a minor fall.




Osteoporosis trends in India

In India, around 50 million people are estimated to be either osteoporotic with less than T-score 2.5 or have a low bone mass with T-Score ranging between 1 to 2.5.  Osteoporosis is one of the major health problems faced by the Indian population and therefore requires immediate attention by the medical and public health community.
However, compared to women, a low T-score in men indicates higher vulnerability to osteoporosis. Few studies conducted in India also suggests the risk of fracture due to osteoporosis is quite high in men. In a country like India, most of the osteoporotic cases go untreated and even undiagnosed.  Therefore, it is necessary for both men and post-menopausal women to have adequate measures to prevent osteoporosis in later years in life.

Osteoporosis around the world

Worldwide, it is estimated that after the age of 50 one in three women will experience osteoporotic fractures, as well as one in five men. It is estimated that globally there is one osteoporotic fracture that occurs every three seconds.

SYMPTOMS OF OSTEOPOROSIS

  • Prone to fractures
  • Joint pain
  • Swelling
  • Loss of height and stooped posture
  • Disfiguremen
  • Curved upper back
  • Debilitation

CAUSES OF OSTEOPOROSIS

Losing bone is a normal part of ageing, but some people lose bone much faster than normal. This can lead to osteoporosis and an increased risk of broken bones. Women also lose bone rapidly in the first few years after the menopause. Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45) or they've had their ovaries removed.

However osteoporosis can also affect men, younger women and children. Many other factors can also increase the risk of developing osteoporosis, including:

  • taking high-dose steroid tablets for more than 3 months
  • other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
  • a family history of osteoporosis – particularly a hip fracture in a parent
  • long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
  • having or having had an eating disorder such as anorexia or bulimia
  • having a low body mass index (BMI)
  • not exercising regularly
  • heavy drinking and smoking

DIAGNOSIS OF OSTEOPOROSIS

DEXA / BMD SCAN – GOLD STANDARD
X- RAY / CT

A bone density test is used mainly to diagnose osteoporosis .

Standard X-rays may show weakened bones. But at the point when bone weakness can be seen on standard X-rays, it may be too far advanced to treat. Bone densitometry testing can find decreasing bone density and strength at a much earlier stage when treatment can be beneficial.

TREATMENT OF OSTEOPOROSIS

MEDICATION

Biphosphonates
Bone strengthening medications( on advice of your consultant doctor )

What can i do to keep my bones healthy - Prevention of Osteoporosis ?

NUTRITION AND LIFESTYLE CHANGES
  • Regular , Routine exercise as prescribed
  • Adults are generally advised to work out for 30 minutes five days a week.
  • Healthy balanced diet in general - diet rich in calcium in particular.
  • Calcium supplements and Vitamin D ( on advice of your consultant doctor )
  • Adequate outdoor activities with exposure to sunlight is a general recommendation.
  • Avoid activities that may lead to bone fracture.
  • Cessation of smoking.
  • Moderation of alcohol intake .

What is a bone density test?

A bone density test is used to measure bone mineral content and density. The DEXA scan is considered the "gold standard" or most accurate test. It uses very low levels of x-rays to measure how dense your bones are.


BONE DENSITY TEST RESULTS

A bone density test determines the bone mineral density (BMD). Your BMD is compared to 2 norms—healthy young adults (your T-score) and age-matched adults (your Z-score). First, your BMD result is compared with the BMD results from healthy 25- to 35-year-old adults of your same sex and ethnicity. The standard deviation (SD) is the difference between your BMD and that of the healthy young adults. This result is your T SCORE. Positive T-scores indicate the bone is stronger than normal; negative T-scores indicate the bone is weaker than normal.

According to the World Health Organization, osteoporosis is defined based on the following bone density levels:

A T-score within 1 SD (+1 or -1) of the young adult mean indicates normal bone density.
A T-score of 1 to 2.5 SD below the young adult mean (-1 to -2.5 SD) indicates low bone mass ,osteopenia.
A T-score of 2.5 SD or more below the young adult mean (more than -2.5 SD) indicates the presence of osteoporosis.

In general, the risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of 1 SD below normal has twice the risk for bone fracture as a person with a normal BMD.
Secondly, your BMD is compared to an age-matched norm. This is called your Z-SCORE. Z-scores are calculated in the same way, but the comparisons are made to someone of your age, sex, race, height, and weight.