What type of doctor checks bone density?

What Type of Doctor Checks Bone Density?

Bone mineral density (BMD) testing is typically performed and interpreted by radiologists, though various specialists including endocrinologists, rheumatologists, orthopedic surgeons, and primary care physicians may order and interpret these tests depending on the clinical context. 1

Types of Specialists Who Handle Bone Density Testing

Primary Ordering Physicians:

• Endocrinologists: Specialists in metabolic bone disorders who commonly manage osteoporosis
• Rheumatologists: Often manage patients with inflammatory conditions that affect bone health
• Orthopedic surgeons: Particularly for preoperative assessment before spine surgery 2
• Primary care physicians: For routine screening and prevention
• Gynecologists: Particularly for postmenopausal women

Technical Performance and Interpretation:

• Radiologists: Primary specialists who perform and interpret DXA scans
• Nuclear medicine specialists: May perform and interpret bone density scans
• Medical bone health specialists: As defined in guidelines, these may include endocrinologists, internists, pediatricians, rheumatologists, or family physicians depending on setting 2

Bone Density Testing Methods

Gold Standard Method:

• Dual-energy X-ray absorptiometry (DXA): The globally accepted "gold standard" for non-invasive diagnosis of osteoporosis 3
  • Primarily measures BMD at the lumbar spine and hip
  • One-third radius (distal forearm) is measured when hip or spine cannot be accurately assessed 1

Alternative Methods:

• Quantitative CT (qCT): Can measure volumetric BMD but with higher radiation exposure 2
• Opportunistic CT (oCT): Uses routine CT scans to assess bone density via Hounsfield units 2
• Calcaneal ultrasonography: Less sensitive but radiation-free alternative 2

When to Get Bone Density Testing

Screening Recommendations:

• Women aged 65 and older
• Men aged 70 and older
• Younger adults with risk factors 1

Risk Factors Requiring Earlier Screening:

• Low body weight (BMI <20-25 kg/m²)
• Weight loss >10%
• Physical inactivity
• Prolonged corticosteroid use (>3 months)
• Previous osteoporotic fracture
• Androgen deprivation therapy 2, 1
• Cranial/craniospinal radiotherapy or total body irradiation 2

Follow-up Testing

• Typically performed every 2 years on the same machine as baseline scan
• Shorter intervals (1 year) for patients:
  • At risk for rapid bone loss
  • Initiating therapy
  • On glucocorticoid therapy 1
• Compare absolute BMD values (g/cm²), not T-scores, on follow-up scans 1

Common Pitfalls in Bone Density Testing

• Failure to use the same DXA machine and software for follow-up scans
• Not accounting for artifacts or degenerative changes that can falsely elevate BMD readings
• Comparing T-scores instead of absolute BMD values in follow-up assessments
• Inaccurate patient positioning during the scan 4, 5
• Falsely elevated lumbar spine BMD due to degenerative changes or osteophytes 2
• Inaccurate assessment in patients with scoliosis 2

Special Considerations

• For premenopausal women and men under 50, Z-scores should be used instead of T-scores 1
• In transgender individuals, reference data conforming with the individual's gender identity should be used for Z-score calculation 2
• Patients with spinal cord injuries require specialized assessment at the total hip, distal femur, and proximal tibia 2

When seeking bone density testing, it's important to be referred to a facility with experienced technicians and physicians who specialize in bone health to ensure accurate measurement and appropriate interpretation of results.