Clinical Pathway for Patient Who May Need a
Dual-Energy X-ray Absorptiometry (DXA) Bone Scan
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  • Diseases associated with:
  • Vitamin D deficiency
  • Obesity
  • Malnutrition not due to eating disorder or chronic disease
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Obtain DXA Scan
Consider DXA Scan
DXA Scan NOT Indicated
Before ordering a DXA scan, use clinical judgement to
consider how the results will change patient care
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DXA Scan Interpretation Based on Z-Score
Find Results in EPIC within DXA Encounter
Imaging Recommendations
Patient Age 3 - 18 yrs ≥ 18 yrs
Standard Scan Sites Lumbar
Whole body
Lumbar
Whole body
Hip
Alternative Scan Sites
If spinal disease, hardware, positional challenges
5 - 18 yrs Lateral Distal Femur
Distal Forearm
Lateral Distal Femur
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Z-score ≤ -2
Low Bone Mineral Density
Z-score > -2 up to +2
Normal Bone Mineral Density
  • 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
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Presence of
  • Primary Bone Disorder
  • Clinically Significant Fractures
Absence of
  • Primary Bone Disorder
  • Clinically Significant Fractures
Reassess bone mineral density
if clinical situation changes
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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

Posted: September 2018
Authors: Mascarenhas, M. MD; Webster, J. MD; Barsky, D. MD; Jannelli, F. RN; Calabria, A. MD; Downing, M. MHA