DXA

Elke Hendrich
2015

DXA uses /indications

Hypogonadism
BMD

Glucocorticoid use/XS

Investigation of patients at
risk of low BMD / Fracture

Thyroxine use/XS

Previous # - sub/clinical
Low BMI

RhA
CKD/CLD

Age >70 yrs

VFA

Vit D def / Malabsorption

TBC

Hyperparathyroidism

All case studies in this presentation are under the permission of

Nick Pocock, Associate Professor of Medicine, Sydney

Case study 1
72 year old female
Sudden onset of
back pain
Sent for X-ray by GP

Not actual patient

X-ray findings Case Study 1

DXA report (Spine) Case Study

1

Points to consider
Is this osteoporosis?
Which should you do first (in this case): X-ray
or DXA?
Was there any point in doing a DXA
if the X-ray confirmed a fracture?

What are your treatment options and why?

What sort of fracture reduction would you
expect to see with ongoing treatment?

Case study 2
75 year old male
Heavy smoker 15 cigarettes a
day since early 20s
Very heavy drinker More than 4
standard drinks per day
Takes regular inhaled
glucocorticoids for COPD
Mostly stays at home
Fell at home

Not actual patient

Hip Fracture

DXA report (hip) Case Study 2

X-ray findings Case Study 2

Points to consider
What are the risk factors for osteoporotic
fracture in men?
Is there a pathological cause of fracture or is it
osteoporosis?
Would you initiate treatment?

What supportive therapy would you consider?

Case study 3
73 year old female
Patient requested a DXA as
part of well-woman screen
Asymptomatic at presentation
Family history of osteoporosis
Non-smoker
Social drinker

Not actual patient

DXA report (Spine) Case

Study 3

Points to consider
Is it osteoporosis?
Could the osteoporosis
be secondary to another pathology?
Would you send for an X-ray?
Would you refer to a specialist?

Case study 4
73 year old female
Experiencing some
intermittent back pain
Low body weight (5' 7",
50kg)

Older sister with hip

fracture

Not actual patient

DXA report (Spine) Case Study 4

DXA report (Hip) Case Study 4

Nb Femoral neck
does not satisfy the
new criteria

X-ray findings Case Study 4

probable mild

Points to consider
What are the osteoporotic risk factors
for this patient?
Would you treat the patient? If not why?
What are the indications for treatment
of osteoporosis in post-menopausal women?
What treatment options/lifestyle suggestions would you
consider first?

Case study 5
75 year old male
Routine DXA
Taking regular GnRH
(gonadotrophin-releasing
hormone) agonists for
prostate cancer
Non-smoker
Non-drinker

Not actual patient

DXA report (Spine) Case Study 5

DXA report (Hip) Case Study 5

Points to consider
What is the impact of his GnRH treatment on osteoporotic
risk?
Does he have osteoporosis?
Is he entitled to treatment according
to current PBS criteria?
Would you treat this patient?

References

1.

Personal communication from clinical cases (Nick Pocock, Associate

Professor of Medicine, Sydney).

Merck Sharp & Dohme (Australia) Pty Limited. 54-68 Ferndell Street South Granville NSW 2142.
TM Trademark of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A