Outpatient Specialty Care and Primary Care Clinical Pathway for Children who may need a Dual Energy X-ray Absorptiometry (DXA) Bone Density Scan

Goals and Metrics
Related Pathway
Patient Who May Benefit from a DXA Bone Scan
Diagnosed or Significant Risk
for Low Bone Mineral Density
At Risk for Bone Disease
Low Risk for Bone Disease
  • Diseases associated with:
Clinical recommendations by body system/clinical disorder
  • 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 judgement to
consider how the results will change patient care
Information about DXA Scans/Imaging Recommendations
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
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
Presence of
  • Primary Bone Disorder
  • Clinically Significant Fractures
Absence of
  • Primary Bone Disorder
  • Clinically Significant Fractures
Reassess bone mineral density
if clinical situation changes

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