Updates on the Role of DXA in the Evaluation and Monitoring of Osteoporosis
Shahane Anupama, Sian Yik Lim, Marcy B. Bolster
Abstract
PURPOSE OF REVIEW: Osteoporosis, the most common metabolic bone disease and a global health problem, is the result of abnormal bone architecture and bone loss, leading to bone fragility and an increased risk of fractures. A fragility or low-trauma fracture is the first clinical sign of osteoporosis and is typically associated with a significant risk of future fractures. Practical screening tools and guidelines are critical for fracture prevention. Dual X-ray absorptiometry (DXA) is the gold standard for risk stratification and diagnosis of osteoporosis. In this review, we report recent advances in in DXA screening and bone density evaluation for patients at risk of fragility fracture. RECENT FINDINGS: DXA measures bone density as an absolute measure (g/cm2) and also reports the patient's bone mineral density (BMD) as a comparison to a standard population, which is the basis of the World Health Organization (WHO) classification for osteoporosis. DXA also provides vertebral fracture assessment (VFA), an additional tool to assess vertebral fracture presence and increased fracture risk. Understanding the methodology, reporting, and limitations of DXA use is critical for appropriate utilization of the test. BMD is validated as a predictor of fracture risk and may be used with or without clinical risk factors as part of the FRAX fracture risk assessment tool to accurately assess an individual's fracture risk. In this review, we discuss the role of DXA in screening, diagnosis, and treatment of osteoporosis. We include FRAX and its limitations, trabecular bone score (TBS), quantitative computed tomography (qCT) the American College of Rheumatology (ACR) updates on the management of glucocorticoid-induced osteoporosis, the updated International Society of Clinical Densitometry (ISCD) Position Statements, and report the key features of DXA testing, reporting, and utilization in clinical practice. DXA plays a critical role in BMD evaluation and fracture risk assessment. Appropriate utilization of this tool in clinical practice, through accurate interpretation and application of results, is essential for effective fracture prevention.