Outpatient Specialty Care and Primary Care Clinical Pathway for Children who may need a Dual Energy X-ray Absorptiometry (DXA) Bone Density Scan
- Primary bone disorders
- Clinically Significant Fractures
- Previous abnormal DXA scan
- Diseases associated with:
- Immobilization
- Malabsorption
- Inflammation
- Gonadal hormone imbalance
- High-risk medications:
- Vitamin D deficiency
- Obesity
- Malnutrition not due to eating disorder or chronic disease
Obtain DXA scan
Consider DXA scan
DXA scan not indicated
Before ordering a DXA scan, use clinical judgment to
consider how the results will change patient care
consider how the results will change patient care
DXA Scan Interpretation Based on Z-Score
Find results in EPIC within DXA Encounter
Find results in EPIC within DXA Encounter
Patient Age | Standard Scan Sites | Alternative Scan Sites |
---|---|---|
3-5 yrs | Lumbar Whole body |
|
5-18 yrs | Lumbar Whole body |
|
≥ 18 yrs | Lumbar Whole body Hip |
Forearm |
|
Z-score ≤ -2
Low bone mineral density
Low bone mineral density
Z-score > -2 up to +2
Bone density within expected reference range
Bone density within expected reference range
- Factors interfering with accurate interpretation:
- Barium studies in the 7 days prior DXA scan
- Contrast materials within the last 7 days
- Calcium supplements within the last 24 hours
- Other Ordering Considerations
- Spinal disease or positional challenges
- Hardware in scan sites
- Ventilator dependence
Presence of
- Primary bone disorder and/or
- Clinically significant fractures
Absence of
- Primary bone disorder and/or
- Clinically significant fractures
Presence of
- Primary bone disorder and/or
- Known risk factors for impaired
bone health
Absence of
- Primary bone disorder and/or
- Known risk factors for impaired bone health
Referral to bone health specialist
Treatment, DXA scan monitoring as indicated per specialist recommendations
Optimize treatment and management of underlying disease
Repeat DXA scan as clinically indicated and/or guidance by body system, DXA Scan Interpretation
Consider referral to bone health specialist
- BMD > -2 does not rule out impaired bone health
- Need for referral to bone health, further testing, and/or repeat DXA is determined by clinical situation. Consider if:
- Prior history of and/or new minimally traumatic long bone or spine fractures
- Condition where recovery is not expected
(e.g. neuromuscular disease, chronic immobility) - Ongoing and/or additional exposure to bone toxic medications
(e.g. steroids, anti-epileptic drugs)
- Contact Bone health team
with questions at: bonehealthcenter@chop.edu
Reassess bone mineral density if clinical situation changes
Posted: September 2018
Revised: February 2021
Authors: M. Mascarenhas, MD; J. Webster, MD; D. Barsky, MD; F. Jannelli, RN; A. Calabria, MD; M. Downing, MHA;
D. Weber, MD; A. Puma, MSN
Revised: February 2021
Authors: M. Mascarenhas, MD; J. Webster, MD; D. Barsky, MD; F. Jannelli, RN; A. Calabria, MD; M. Downing, MHA;
D. Weber, MD; A. Puma, MSN
Evidence
- American Academy of Pediatrics - Bone Densitometry in Children and Adolescents
- Skeletal Health Assessment In Children from Infancy to Adolescence
- 2019 ISCD Official Positions – Pediatric
- Bone Health in Children and Adolescents with Chronic Diseases That May Affect the skeleton: the 2013 ISCD Pediatric Official Positions
- Pediatric Osteoporosis: Diagnosis and Treatment Considerations