Bone densitometry, also called a bone density test, is used to measure the bone mineral content and density. This measurement can indicate decreased bone mass, a condition in which bones are more brittle and more prone to break or fracture easily. Bone densitometry is used primarily to diagnose osteoporosis and to determine fracture risk. The testing procedure measures the bone density of the bones of the spine, pelvis, lower arm, and thigh.
Bone densitometry testing may be done using X-rays, dual-energy X-ray absorptiometry (DEXA or DXA) or by quantitative CT scanning using special software to determine bone density of the hip or spine. These procedures are generally done in a clinic, hospital, or free-standing radiology facility.
However, for mass screening purposes, there are portable types of bone densitometry testing. The portable testing is done using either a DEXA (or DXA) X-ray device or a quantitative ultrasound unit. Both types of portable testing may use the radius (one of the two bones of the lower arm), wrist, fingers, or heel for testing. The portable testing, while useful for general screening, is not as precise as the nonportable methods because only one bone site is tested.
Standard X-rays may detect weakened bones. However, at the point where bone weakness is obvious on standard X-rays, the bone weakness may be too far advanced for treatment to be effective. Bone densitometry testing can determine decreasing bone density and strength at a much earlier stage when treatment of the bone weakness can be beneficial.
The bone densitometry test determines the bone mineral density (BMD). BMD is compared to two norms: healthy young adults (a T-score) and age-matched (a Z-score).
First, the BMD result is compared with the BMD results from healthy 25- to 35-year-old adults of the same sex and ethnicity as the patient. The standard deviation (SD) is the difference between the patient’s BMD and that of the healthy young adults. This result is the patient’s T-score. Positive T-scores indicate the bone is stronger than normal; negative T-scores indicate the bone is weaker than normal.
According to the World Health Organization, osteoporosis is defined based on the following bone density levels:
- A T-score within 1 SD (+1 or -1) of the young adult mean indicates normal bone density.
- A T-score of 1 to 2.5 SD below the young adult mean (-1 to -2.5 SD) indicates low bone mass.
- A T-score of 2.5 SD or more below the young adult mean (more than -2.5 SD) indicates the presence of osteoporosis.
In general, the risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of one SD below normal (T-score of -1) has twice the risk for bone fracture as a person with a normal BMD. A person with a T-score of minus two has four times the risk for bone fracture as a person with a normal BMD. When this information is known, people with a high risk for bone fracture can be treated with the goal of preventing future fractures. Severe (established) osteoporosis is defined as having a bone density that is more than two and a half SD below the young adult mean with one or more past fractures due to osteoporosis.
Secondly, the patient’s BMD is compared to an age-matched norm. This is called the Z-score. Z-scores are calculated in the same way, but the comparisons are made to someone of the patient’s age, sex, race, height, and weight.
In addition to bone densitometry testing, a doctor may recommend other types of tests, such as blood tests, which may be used to detect the presence of renal (kidney) disease, evaluate the function of the parathyroid gland, evaluate the effects of cortisone therapy, and/or assess the levels of minerals in the body related to bone strength, such as calcium.
Bone densitometry testing is primarily performed to identify persons with osteoporosis and osteopenia (decreased bone mass) so that the appropriate medical therapy and treatment can be implemented. Early treatment helps to prevent future bone fractures. It may also be recommended for persons who have already had a fracture and are considered at risk for osteoporosis.
The complications of broken bones resulting from osteoporosis are often severe, particularly in the elderly. The earlier osteoporosis can be identified, the sooner effective treatment can be implemented, thus most likely lessening the severity of the condition.
Bone densitometry testing may also be used:
- To confirm a diagnosis of osteoporosis if a patient has already had a fracture
- To predict chances of fracturing in the future
- To determine the rate of bone loss and/or monitor the effects of treatment