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Research Letter |

“Due” for a Scan: Examining the Utility of Monitoring Densitometry

Brandon P. Combs, MD1; Michelle Rappaport, BA1; Tanner J. Caverly, MD1; Daniel D. Matlock, MD, MPH1
[+] Author Affiliations
1Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora
JAMA Intern Med. 2013;173(21):2007-2009. doi:10.1001/jamainternmed.2013.8998.
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Opinions differ on the utility of monitoring dual-energy x-ray absorptiometry (DXA) to assess responses to treatment for low bone mineral density (BMD).13 Some argue that routine monitoring DXA may be unnecessary because approximately 98% of postmenopausal women treated with alendronate sodium experience an increase in BMD, and variation in subsequent BMD measurements by DXA may obscure the treatment effects.4

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Figure.
Clinical Action Following Monitoring Dual-Energy X-ray Absorptiometry (DXA)

A, Treatment changes following monitoring DXA for 196 scans. B, Treatment changes following significant decrease in bone mineral density (BMD) for 36 scans. A change was considered to be due to DXA if (1) drug treatment was started or changed in the setting of significantly decreased BMD, (2) treatment was stopped in the setting of stable or significantly increased BMD, or (3) treatment was stopped in a patient with osteopenia whose fracture risk score (determined by the Fracture Risk Assessment Tool [FRAX]; World Health Organization) would not merit treatment. A change was considered to be not due to DXA if (1) drug treatment was changed because of adverse effects or patient preference, (2) treatment was changed in the setting of stable or significantly increased BMD, or (3) treatment was stopped in the setting of significantly decreased BMD. A treatment change had to occur within 6 months of DXA or by the next clinical encounter.

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BMD scans check and encourage medication compliance
Posted on December 3, 2013
David L. Keller, MD
None
Conflict of Interest: None Declared
Many patients express anxiety regarding the risks of jaw osteonecrosis and atypical fractures (\"brittle bones\"), which are rarely-encountered but widely-reported harms associated with bisphosphonate therapy. Performing a DEXA scan every 2 to 3 years may be excessive for medication-compliant patients with moderate risk of fracture due to osteoporosis. However, feedback from these scans can lead to a self-directed \"change of treatment\" if a patient has been surreptitiously skipping pills due to the above concerns and learns that her BMD has decreased. This is a covert benefit of repeat BMD testing which the physician may never be informed about by the patient.
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