Indications for medication in addition to preventative strategies / Osteoporosis New Zealand

Indications for medication in addition to preventative strategies

Dual energy x-ray absorptiometry (DEXA) scanning is the most widely used and internationally accepted standard for measuring bone density.

The WHO definition of osteoporosis and Pharmac funding criteria are based on DEXA scores.
DEXA generates measurements at the sites of major clinical relevance - spine and hip. The risk of fracture at any skeletal site is best estimated by measuring the BMD at that site.
Spinal measurements are sensitive in detecting change (including response to treatment), but can be falsely elevated by degenerative change, vertebral fractures and aortic calcification.
Since hip fractures are associated with significant morbidity and mortality it is chosen site for use with the FRAX tool.
Wrist scanning is a useful additional area of assessment when spinal scanning is affected by artefact and or hip scanning not possible due to previous surgery.
Guidelines for providing a densitometry service including quality control, interpretation and reporting standards, have been developed and workshops for reporting physicians and technicians have been provided in conjunction with Osteoporosis New Zealand. Details are available via e-mail to info@bones.org.nz

Ultrasound of the heel is sometimes used as a screening technique.

Is a good predictor of fractures.
Results indicating a low bone density by heel ultrasound should be confirmed by DEXA scan before therapy is instituted.
It cannot be used monitor treatment (slow rate of change at peripheral sites).

With the above provisos it is a reasonable option in regions where DEXA is not available.