DXA Bone Scan — At Risk for Bone Disease — Clinical Pathway: Inpatient, Outpatient Specialty Care and Primary Care

Bone Density Scan (DXA) Clinical Pathway — Outpatient Specialty Care and Primary Care

Moderate Risk for Bone Disease

Assess the child's clinical presentation, family history of fractures, medication use/history, and other risk factors to determine if a DXA scan will help manage their care.

DXA scans should be considered for children who would benefit from low bone density treatment or disease activity monitoring.

Most common disease categories at CHOP that might receive treatment for low bone density:

  • Inflammatory bowel disease
  • Cerebral palsy/neuromuscular disease
  • Oncologic
  • Cystic fibrosis

Common At-risk Groups

Immobilization
  • Cerebral palsy
  • Neuromuscular disease
    • e.g., Duchenne muscular dystrophy
  • Spina bifida
  • Quadriplegia
Inflammation
  • Inflammatory bowel disease
  • Juvenile idiopathic arthritis
Malabsorption/Malnutrition
Gonadal Hormone Imbalance
  • Hypogonadism
  • Turner’s syndrome
  • Eating disorders
High-risk Medications
  • Chronic steroid use greater than 3 mos
  • Chronic parenteral nutrition
  • Chemotherapy
  • Cyclosporine
  • CYP3A4 inducers
    • e.g., phenobarbital
  • Anticoagulants
    • e.g., warfarin, heparin
  • Loop diuretics
    • e.g., furosemide, bumetanide
  • Radiation
  • Ketogenic diet
  • Hormone replacement/suppression therapy

References

2019 PEDS–ISCD Position Statement   and the 2016 AAP Guidelines for DXA Scans