Dual-Energy X-Ray Absorptiometry for Osteoporosis Screening: AJR Expert Panel Narrative Review.

Area of Science:

• Radiology and Imaging
• Endocrinology
• Geriatrics

Background:

• Dual-energy X-ray absorptiometry (DXA) is the standard for osteoporosis screening and monitoring bone mineral density (BMD).
• DXA also provides vertebral fracture analysis, trabecular bone score (TBS), and body composition analysis.
• Despite its utility, DXA has limitations, and other factors influence fracture risk.

Purpose of the Study:

• To review the current status of DXA in osteoporosis screening.
• To discuss current practice recommendations, risk prediction, and management strategies.
• To address challenges, limitations, and evolving solutions in DXA-based screening.

Main Methods:

• Narrative review of DXA applications in osteoporosis.
• Discussion of current screening recommendations and guidelines.
• Exploration of factors influencing fracture risk beyond BMD.

Main Results:

• DXA is central to osteoporosis screening but remains underutilized, leading to underdiagnosis.
• Factors like sex, race, prior fractures, and falls significantly impact fracture risk.
• Current screening recommendations have not evolved substantially despite an aging population.

Conclusions:

• Osteoporosis screening requires a comprehensive approach beyond solely relying on BMD measurements.
• Integrating additional clinical risk factors and tools like TBS can improve fracture risk assessment.
• Addressing DXA underutilization and evolving screening strategies are essential for better osteoporosis management.