Bone Densitometry

NMT 631
Bone Densitometry
A technique to measure bone mineral
content (bone density). It is used to detect
osteoporosis, a disease that causes the
bone to become more porous and
susceptible to fracture.

Decreased bone density increases the risk

of bone fracture.
Bone Density Measurements
In the beginning……….
Shielding - lead (Pb)

Gamma Source

patient

Detector – gamma type camera

 The DEXA machine today contains an x-ray tube that
generates x-rays of two different photon energies
and a detector that measures the amount of
radiation that passes through the bone.

Hologic, Inc.
 Dual energy x-ray Absorptiometer
(DEXA)

Patient positioned for lumbar spine measurement

Clinical Indications
 Indicate if a person has low bone density before
a fracture occurs.

 Tell if a person’s bone are losing bone density

or staying the same when the test is repeated
at intervals of 1 year or more.

 Predict the chances that a person will have a

fracture in the future.

 Help decide a treatment plan.

Subject positioned for hip measurement
 Risk Factors for
Developing Osteoporosis
 Uncontrollable Factors
 Gender
http://courses.washington.edu/bonephys/opbmd.html
 Race
 Heredity
 Body habitus
 Age

This graph shows how

the bone density of the
total hip decreases with age.
The units are standardized bone
density in (mg/cm2). The lines show
the average values, and for each
age, race and gender a range of
values occurs in the ordinary
population.
Risk Factors for
Developing Osteoporosis
 Controllable Factors
 Calcium/vitamin D intake
 Regular exercise
 Alcohol consumption
 Estrogen intake
 Medications
Treatment Options – (no
cure)
 Fosamax - biphosphonate

 Reclast - biphosphonate

 Boniva - biphosphonate

 Forteo – anabolic (bone forming) – man –made parathyroid

hormone (subcutaneous injection daily) increases bone mass
& bone strength and decreases chance of fracture
 Clinical Procedure
for Bone Density
Measurements

1) Identify patient; confirm physician’s

order; review clinical indication for exam

2) Explain procedure to patient; obtain

relevant medical history
Relevant Medical History
 Height/weight  Recent surgery
 Any loss of height?  Bone surgery
 Amount of loss  Chronic illnesses
 Right or left handed?  Dietary habits
 Age at menopause  Tobacco use
 Medications  Family history
 Recent imaging tests?  Body type, eye/hair color
 Arthritis  Daily exposure to sunlight
 Osteoporosis  Exercise program
 Osteopenia  Pregnant?
 Fractures
Clinical Procedure: continued

3) Prepare patient: rule out recent x-ray and nuc med

procedures, pregnancy; remove attenuating objects

4) Perform bone density measurements

Measurement sites include lumbar spine (1st 4 lumber
vertebrae), hip, and forearm
Results
 Picture of the scanned area

 Comparison of the patient to a database of

measurements from age and gender matched peers and
to a database of gender matched young adults

Z score: comparison with age-matched peers

 T score: comparison with gender-matched young
adults
 Z-Scores

Pediatricians use percentiles to interpret the height of a child. A child at the 5th
percentile (same as Z-score of -1.65) is short for his or her age, and one at the
75th percentile is somewhat taller than average (Z-score of 0.68). The Z-score
does not tell how tall a child is, because the average child gets taller as she gets
older. On the other hand, if you know that a child is 40" tall, it does not mean
anything unless you also know his age. You must know both the age and the
percentile to know if this is a healthy height.

For bone density, the Z-score will tell you if the bone density is close to the
average value for the person's characteristics such as age, race and
gender, but that still does not tell you if the bone is strong. Elderly white
women have weak bones even if the bone density is average.
http://courses.washington.edu/bonephys/opbmdtz.html
T-Scores
Notice that when the
T-score is zero
(average peak bone
mass) the bone
density is highest in
black men and
lowest in white
women. At very low
T-scores, however,
the bone density is
the same. This is due
to differences in the
standard deviations
of the young
populations.

http://courses.washington.edu/bonephys/opbmdtz.html
http://courses.washington.edu/bonephys/opDEXA1.html
Causes of Artifacts
 Scoliosis
 Degenerative arthritis
 Compression fractures
 Spondylitis
 Aortic calcifications
 Navel jewelry
 Surgical changes
 Paget’s disease

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Additional Information

Susan Ott, MD. University of Washington,

Department of
Medicine
http://courses.washington.edu/bonephys/opDEXA1.h
tml

A comprehensive discussion of bone density

measurement
with lots of illustrations and case reviews.

http://courses.washington.edu/bonephys/index.html