What are the ISCD guidelines for use of peripheral dual-energy x-ray absorptiometry (pDXA) 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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The following are the official positions of the ISCD on peripheral DXA (pDXA) [5] :

  • pDXA can be used in postmenopausal women for fracture risk assessment (vertebral and global fragility fracture risk), although its vertebral fracture predictive ability is weaker than central DXA and heel quantitative ultrasonography (QUS); evidence for use in men is insufficient

  • The WHO diagnostic classification can be applied only to DXA a the femur neck, total femur, lumbar spine, and the 33% radius region of interest (located in the distal forearm) measured by DXA or pDXA devices utilizing a validated young-adult reference database

  • If central DXA cannot be done, radius pDXA measurements can be used to identify patients in whom pharmacologic treatment should be initiated; the fracture probability, based on both device-specific thresholds and clinical risk factors, should be high in those patients

  • pDXA cannot be used to monitor the effects of osteoporosis treatments

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