Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Quality of DXA Scans and Reports |
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| Affiliation: | 1. Department of Endocrinology, Calcium Unit, Cleveland Clinic, Cleveland, Ohio;2. Divisions of Endocrinology and Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;3. Weill-Cornell Medical College, Division of Head Endocrinology and Chief of Endocrinology, Houston Methodist Hospital, Houston, Texas;4. 4;1. Department of Orthopedic Surgery, University of Arizona College of Medicine Phoenix, AZ, USA;2. Northern California Institute For Bone Health, Orinda, CA, USA;3. Ajou University School of Medicine, Suwon, South Korea;4. New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA;1. From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.;1. Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA;2. UCSD Bone Densitometry School, La Jolla, CA, USA;3. Department of Psychiatry, UCSD, La Jolla, CA, USA;4. Sam and Rose Stein Institute for Research on Aging, UCSD, La Jolla, CA, USA;1. Department of Nuclear Medicine, University of Ottawa, Ottawa, ON, Canada;2. Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada;3. Center for Metabolic Bone Diseases and Academic Unit of Bone Metabolism, Department of Oncology & Metabolism, University of Sheffield Medical School, Sheffield, UK;4. Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia;5. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK;6. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK;7. Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland |
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| Abstract: | Objective: High-quality dual-energy X-ray absorptiometry (DXA) scans are necessary for accurate diagnosis of osteoporosis and monitoring of therapy; however, DXA scan reports may contain errors that cause confusion about diagnosis and treatment. This American Association of Clinical Endocrinologists/American College of Endocrinology consensus statement was generated to draw attention to many common technical problems affecting DXA report conclusions and provide guidance on how to address them to ensure that patients receive appropriate osteoporosis care.Methods: The DXA Writing Committee developed a consensus based on discussion and evaluation of available literature related to osteoporosis and osteodensitometry.Results: Technical errors may include errors in scan acquisition and/or analysis, leading to incorrect diagnosis and reporting of change over time. Although the International Society for Clinical Densitometry advocates training for technologists and medical interpreters to help eliminate these problems, many lack skill in this technology. Suspicion that reports are wrong arises when clinical history is not compatible with scan interpretation (e.g., dramatic increase/decrease in a short period of time; declines in previously stable bone density after years of treatment), when different scanners are used, or when inconsistent anatomic sites are used for monitoring the response to therapy. Understanding the concept of least significant change will minimize erroneous conclusions about changes in bone density.Conclusion: Clinicians must develop the skills to differentiate technical problems, which confound reports, from real biological changes. We recommend that clinicians review actual scan images and data, instead of relying solely on the impression of the report, to pinpoint errors and accurately interpret DXA scan images.Abbreviations: AACE = American Association of Clinical Endocrinologists; BMC = bone mineral content; BMD = bone mineral density; DXA = dual-energy X-ray absorptiometry; ISCD = International Society for Clinical Densitometry; LSC = least significant change; TBS = trabecular bone score; WHO = World Health Organization |
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