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NHS Tayside's protocol for access to DEXA scanning
Consider DEXA scanning where assessment would influence management in the following groups :
1. Previous fragility fracture (especially of wrist, hip or spine).
- # sustained from a fall from standing height or less
2. Use of glucocorticoids (prednisolone >5mg) for > 3/12
- if >65yrs, on >15mg prednisolone or if previous fragilityfracture, may
want to consider treatment anyway (see "steroid and osteoporosis"
guideline)
3. Secondary amenorrhoea of 1 year in women < 45y - excluding breast-feeding
women (including early natural menopause)
4. Radiological osteopaenia (especially if associated with family history or other risk factor)
5. FH of osteoporosis in mother, sibling or father i.e.proven diagnosis,development of kyphosis or low trauma #
6. Perimenopausal or postmenopausal if considering whether to start or continue HRT
7. Low BMI (< 19 kg/m2)
8. Secondary osteoporosis suspected : eg.
| i) Coeliac disease | viii) Organ transplant |
| ii) Inflammatory bowel disease | ix) Inflammatory arthritis |
| iii) Chronic liver disease | x) Cystic fibrosis |
| iv) Primary hyperparathyroidism | xi) Primary hypogonadism |
| v) Functioning pituitary tumours | xii) Osteogenesis imperfecta |
| vi) Thyrotoxicosis | xiii) Multiple sclerosis |
| vii) Chronic renal failure |
Possible initial investigations in patients with osteoporosis:
| U's&E's | LFT's | Calcium | TSH | FBC | PV/ESR |
If PV raised, check myeloma screen (Bence Jones protein and protein electrophoresis)
If male, also check testosterone, and if low also check SHBG
| Consider | 25OHVitD | PTH | Coeliac Antibodies | if clinically relevant |
Ó NHS Tayside; 2006; version 1.0
Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.