Bone Density

INDICATIONS FOR SCANNING

* Women aged over 65
* Men aged over 70
* Those with major risk factors for osteoporosis as follows:

Previous fracture
Low body weight
Family history of osteoporosis or fracture
Smokers

* Other conditions include:

Asthma, COAD
Prednisone and anticonvulsants
Stopping HRT
Hypogonadism including males on treatment for prostate cancer

The scanner has a weight limit of 135 kg, we can only scan the forearm above this weight.

T SCORES AND Z SCORES

The ISCD have recommended that Z scores be used in preference to T scores for men under the age of 65 and women prior to menopause. Osteoporosis should only be diagnosed in these groups if there are additional factors such as fracture.

VERTEBRAL FRACTURES

Vertebral fractures are important, as a single vertebral fracture raises the risk of further vertebral fractures five times and also doubles the risk of hip fracture.

Vertebral morphometry uses the single energy xray beam from a dexa scan to screen for vertebral fractures.

This has the advantage of low energy xray exposure. It will detect 80% of all vertebral fractures but can miss subtle fractures.

We will aim to use this technique at the time of DEXA scan in those who would be eligible for Fosamax but give no history of fracture.

TREATMENT

The suggested Vitamin D regime is changing, Multivite 2 daily appears to underdose. Currently the preferred regime is Calciferol Strong 50000 iu (1.25mg), one tablet for 10 days followed by 3 tablets every 3 months for maintainence.

Fosamax can be applied for by any "vocationally registered" general practitioner.

If we can help with any special authorities or advice, we are always happy to do so.

John R Elliot
Southern Medical Specialists

Anna J Fenton
Oxford Clinic