When to repeat Dual-Energy X-ray Absorptiometry (DEA) scan with osteoporosis?

From the Guidelines

Repeat the DEA scan in 1-2 years for a patient with osteoporosis, as this allows for monitoring of bone mineral density (BMD) and assessment of treatment response 1.

Key Considerations

• Risk factors: Patients with risk factors such as chronic renal failure, rheumatoid arthritis, or those receiving glucocorticoid therapy may require more frequent monitoring (every 1 year) 1.
• Treatment initiation or change: If a patient is starting or changing osteoporosis medication, consider repeating the scan after 2 years of treatment to assess response to therapy 1.
• High-risk features: Patients with a history of fragility fractures or other high-risk features may require more frequent monitoring (every 1 year) 1.
• DXA machine: It is essential to scan patients on the same DXA machine to ensure accurate comparison of BMD values 1.

Special Populations

• Premenopausal women and men <50 years: Follow-up intervals are based on underlying clinical conditions, with most expert groups recommending monitoring every 1-2 years if there is a high risk for accelerated bone loss 1.
• Patients with axial spondyloarthritis: Annual BMD measurement by DXA is recommended for patients with low BMD, osteoporosis, or fragility fractures, or those being treated with drugs related to reduced BMD or osteoporosis 1.

From the Research

Timing of Repeat Dual-Energy X-ray Absorptiometry (DEA) Scans

• The timing of repeat DEA scans for osteoporosis is not explicitly stated in the provided studies, but guidelines and studies suggest the following:
  • The Choosing Wisely campaign recommends against repeating DXA scans within 2 years of initial screening 2
  • A study found that among women not treated after initial DXA, 2-year cumulative incidence for low-risk, high-risk, and osteoporotic women was 8.0%, 13.8%, and 19.6%, respectively, increasing to 42.9%, 60.4%, and 57.4% by 5 years after initial screening 2
  • For treated women, median time to repeat DXA was over 3 years for all groups 2
• Factors that may influence the decision to repeat a DEA scan include:
  • Initial screening result (low-risk, high-risk, or osteoporotic) 2
  • Whether the patient is prescribed osteoporosis drugs after initial DXA 2
  • Change in patient's condition or risk factors 3

Considerations for Repeat DEA Scans

• Repeat DEA scans should be performed based on individual patient needs and risk factors, rather than a fixed interval 2, 3
• Adequate reporting and analysis of previous DEA examinations is crucial to manage patients correctly 3
• Technical limitations of DEA scans, such as positioning and definition of regions of interest, can affect the reproducibility of measurements 4