Abstract
Bone mineral density (BMD) testing is used to diagnose osteoporosis, assess fracture risk and monitor changes in BMD over time. A variety of devices and technologies are used to measure BMD or other surrogate markers of bone strength. Measurements obtained with these devices are often reported according to different proprietary standards, and the comparability of values obtained with different instruments is often poor. In addition, there is a high degree of variability in the skills of the technologists performing the tests and the clinicians interpreting the results. Heterogeneity in the guidelines for using BMD measurements together with poor-quality BMD testing and reporting can result in inappropriate clinical decisions, causing unnecessary worry and expense for the patient and possible harm due to unnecessary treatment or treatment being withheld. This Review describes and discusses the mistakes commonly made in BMD testing, and emphasizes the importance of maintaining high-quality standards in order to optimize patient management.
Key Points
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Dual-energy X-ray absorptiometry (DXA) can be used to diagnose osteoporosis, assess fracture risk and monitor changes in bone mineral density (BMD) over time
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Quality control, acquisition, analysis, interpretation and reporting of DXA studies require training and experience for the DXA technologist and interpreter
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Quantitative comparison of BMD values on the same instrument cannot be made unless precision assessment has been done and the least significant change calculated
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Quantitative comparison of BMD values obtained on different instruments cannot be made unless a cross-calibration study has been done
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Poor-quality DXA reports may result in inappropriate patient care decisions that can be costly and sometimes harmful to patients
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Lewiecki, E., Lane, N. Common mistakes in the clinical use of bone mineral density testing. Nat Rev Rheumatol 4, 667–674 (2008). https://doi.org/10.1038/ncprheum0928
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DOI: https://doi.org/10.1038/ncprheum0928
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