How should bone mineral density (BMD) be measured in the workup of osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Answer

BMD should be measured at both the posteroanterior (PA) spine and hip in all patients undergoing DXA. [5] Forearm BMD should be measured under the following circumstances:

  • Hip and/or spine cannot be measured or interpreted
  • Hyperparathyroidism
  • Very obese patients (over the weight limit for DXA table)

For information on American College of Radiology (ACR) recommendations for evaluating the appropriateness of BMD measurement tests for osteoporosis in patients at risk of developing this condition, see ACR Appropriateness Criteria for osteoporosis and bone mineral density. For assessment of fracture risk, numerous risk calculators are available for fracture prediction. The Fracture Risk Assessment Tool (FRAX) with BMD and the Garvan Frature Risk Calculator with BMD have the best performance according to areas under the receiver operating characteristic (ROC) curve (AUC). [117]


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