Radiology Ltd. Upgrades DEXA Services

Radiology Ltd. strives to provide the best imaging options for its patients and we’re excited to announce a complete upgrade of our DEXA services!

In addition to exceptional precision, accuracy and reproducibility, our new DEXA machines also provide advanced imaging and analysis options that are at the forefront of emerging trends in DEXA technology.

Osteoporosis is a silent disease until complicated by fractures that can occur following minimal trauma. These fractures are common and may result in significant morbidity and even death, in addition to high personal and national economic costs. Osteoporosis can be diagnosed and treated before these fracture occur.

Both women and men are at risk. Screening with DEXA (Dual Energy X-ray Absorptiometry) should commence in women age 65 and older and men age 70 and older.

DEXA should also be considered in:

  • adults with an osteoporotic fracture
  • patients with disease associated with low bone mass or bone loss
  • patients taking medications associated with low bone mass or bone loss

 

New diagnostic capabilities include:

  • FRAX 10-year Fracture Risk Assessment: FRAX was developed by the World Health Organization (WHO). The algorithm incorporates the measured bone mineral density (BMD) from the hip and eleven of the highest risk factors for osteoporosis, to calculate the 10-year probability of a hip fracture and the 10-year probability of a major osteoporotic fracture (spine, forearm or shoulder). If the 10-year probability of a hip fracture is ≥3% or the 10-year probability of a major osteoporotic fracture is ≥20%, FDA-approved medical therapies to treat low bone mass should be considered, as economic models show this to be cost effective. While T-score remains the standard of diagnosing osteoporosis, BMD misses other risk factors which are necessary to properly evaluate the fracture risk of patients. With FRAX, healthcare providers can identify patients who would benefit from preventative therapy that would not have been candidates using the traditional T-score assessment alone. FRAX is intended for post-menopausal women and men aged 50 or older. Only patients with low bone mass (osteopenia) will have FRAX included in the report.
  • Vertebral Fracture Assessment: Vertebral fractures are the most common osteoporotic fracture however many are clinically silent and undiagnosed. One in five women with an incident vertebral fracture will suffer a subsequent fracture within the following 12 months. These women also have a 2-fold increase in the incidence of hip fractures. A vertebral fracture is an indication for osteoporosis treatment irrespective of the BMD.
    Vertebral Fracture Assessment can now be performed accurately on DEXA machines (from T4 to L4) at a fraction of the radiation dose associated with standard radiography. It can be requested in addition to a routine DEXA exam. 20-25% of women over the age of 65 have clinically occult vertebral fractures and would not have qualified for treatment based on BMD alone.
  • Body Composition Assessment: DEXA has long been considered the gold standard in the precise measurement of a person’s percent body fat. Body composition assessment produces color images displaying the distribution of fat, lean mass, bone and fat mass index translating the information into a report for improved patient management and counseling. Incorporation of the National Health and Nutrition Examination Survey (NHANES) whole body composition reference data allows the accurate diagnosis of obesity. The Endocrine Society Practice Guideline recommends annual body composition exams for bariatric surgery patients.

 

Treatment for low bone mass is indicated if:

  • A vertebral or hip osteoporotic fracture has occurred
  • The measured DEXA T-score is ≤ -2.5 (osteoporosis)
  • DEXA reveals low bone mass (osteopenia) and the FRAX 10-year probability of a hip fracture is ≥3% or of a major osteoporotic fracture is ≥20%

 

Additional changes in accordance with the International Society for Clinical Densitometry (ISCD) recommendations;

  • Caucasian (non-race adjusted) normative databases for women and men will now be used for T-score assessment of all ethnic groups.
  • The NHANES III database will be used for T-score derivation of the hip regions.
  • Z-scores will be population specific where adequate reference data exist. For the purpose of Z-score calculation, the patient’s self-reported ethnicity will be used.
  • The 33% radius (one third radius) will be used for the region of interest in calculating the forearm BMD.

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