You are ordering a Dexa Scan (Bone Density/Bone Mineral Density Test) for your 64-year-old

patient. She is asking you the following questions about the test. How would you answer them
for her?

1. What is a Dexa Scan (Bone density test)?

A dual-energy x-ray absorptiometry exam is a low dose X-ray that is used to measure the
calcium content as well as other minerals in areas of bones. The most common Dexa scan
preformed is the central dexa scan. This scan is used to view the bones of the lumbar spine and
hip. Another that is used is a peripheral dexa scan. This specific type is used to view the lower
arm, wrist, fingers, and heels. Often a peripheral dexa scan would be used to identify those who
may benefit from a central dexa. This bone density test is used to predict osteoporosis which is
the loss of density in the bone. Not only can this test be used to diagnose, but it can also be
used to monitor how a patient is responding to treatment for osteoporosis. Another use would
be to identify osteopenia and start treatment early in order to maintain more bone density.
Men over the age of 70 and women over the age of 65 should receive these scans. However,
this age may be lowered if there are significant risk factors in the patient’s history including
broken bones, rheumatoid arthritis, chronic kidney disease, early onset menopause, smoking,
malnutrition or eating disorders, long term use of corticosteroids, or family history of
osteopenia or osteoporosis.
2. How is the test done?
This test is noninvasive and is relatively quick to complete. No preparation is needed for this
exam to be completed other than not taking a calcium supplement for 24 hours prior to the
exam, as this can give you a false read. A patient should also inform the practitioner if a test
was completed within the last 10 days including contrast, in which case the exam would have to
be held until the contrast was cleared.
This test is most often completed outpatient. The patient will lie on a padded table and the x-
ray will be performed above the patient. The detector slowly passes over the part of the body
being examined. If the hip is being examined, it will be rotated inward using a foot brace. A
padded box would be used to flatten the pelvic floor if the pelvis was being evaluated. The X-ray
tech would then ask the patient to hold still and take a deep breath while the images are taken.
The peripheral machines are often a much smaller device that a patient just slips their hand or
foot into. The results are then interpreted, and the patient receives their scores.
3. What is a normal score and what does it mean?
Dexa scan results are measured in standard deviations. A T score and Z score are received. The
T score compares the patient’s results to that of a healthy 30-year-old of the same gender. The
Z score compares the patient’s results or other people their age, race, and gender. A normal T
score range is -1.0 and above. This would indicate the patient has minimal (if any) bone thinning
compared to a healthy individual in their 30s of the same sex.
4. What is a low score and what does it mean?
A low T score would be anything below a -1. This indicates that there is some sort of bone
thinning occurring in the patient, causing the patient to lose bone density. The lower the
number (more negative), the more at risk a patient is for bone fractures and the more severe
the diagnosis.
5. What is the difference between a score indicating osteopenia and osteoporosis?  
A T score indicating osteopenia would be -1 to -2.5. This would indicate moderate bone density
changes. Osteopenia is a weakening of bones due to the loss of bone density. A t score greater
than -2.5 would indicate osteoporosis. This is the loss of bone density and thinning of tissues
which increases the risk of fractures. The more negative this number is, the more severe the
osteoporosis is.
With either diagnosis of osteopenia or osteoporosis, a 500mg calcium supplement PO once a
day would most likely be started along with 20mcg Vitamin D PO once a day. Along with these
supplements, the practitioner would educate the patient on smoking cessation, weight-bearing
exercises to build muscle mass, and fall prevention. Hormone therapy may be used in severe
cases but has risk of stroke, cognitive impairment, DVTs, and for women an increased risk for
breast cancer.

References:

ACR, R. S. N. A. and. (2019, May 17). Bone Densitometry (Dexa , DXA). Radiologyinfo.org.

Retrieved April 13, 2022, from https://www.radiologyinfo.org/en/info/dexa 

Bone densitometry. Johns Hopkins Medicine. (n.d.). Retrieved April 13, 2022, from
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-densitometry 

U.S. Department of Health and Human Services. (n.d.). Bone mass measurement: What the
numbers mean. National Institutes of Health. Retrieved April 13, 2022, from
https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measure