Scanning in Primary Care

Referral for hip and spine DEXA measurement in secondary care is not always practical or available. The use of a peripheral densitometer in a primary care setting has shown to have satisfactory precision errors, and to have a sensitivity in providing clinical advice similar to that which would be given had measurements of the spine and hip BMD (bone mineral density) been made.

Diagnosing osteoporosis as defined by WHO (T score below -2.5) can be made with DEXA of the hip, spine, and forearm.

Peripheral DEXA of the forearm can be performed using smaller, dedicated and less expensive scanners, which have the potential to be used more widely in the community. However, as with all bone density techniques it is essential that these scanners are operated by appropriately trained and experienced personnel, and with all methods involving ionising radiation, that statutory regulations are adhered to.

The revised NOS position statement on the use of peripheral X-ray absorptiometry in the management of osteoporosis recommends a triage approach using T-score thresholds specific to each type of peripheral device. Device specific upper and lower cut-points are defined so that patients with osteoporosis at the hip or spine are identified with 90% sensitivity and 90% specificity when compared to axial scanners.

Southern Osteo Scanning has implemented these specific thresholds. Appropriate clinical advice can be given by evaluation of a patient questionnaire and performing a forearm scan. There will always be an in-between group who, because of their clinical history or borderline bone mineral density, would require hip and spine measurement.

However around 60% of patients scanned can be treated without the need for further DEXA investigations.