Recommended dual-energy X-ray absorptiometry (DXA) bone densitometry report format

Introduction: In the last 2 years the number of DXA bone densitometry devices in the Czech Republic has increased substantially. The number of patients examined and the number of reports of individual DXA studies have increased proportionally. The accuracy and precision of the description is essential for the quality of care of patients with osteoporosis and other osteopathies. No recommended form of DXA examination report has been published in the Czech literature so far.

Methods: The key items of the Recommended Format were designed and developed by the SMOS Working Group using literature search and gathering experience from established DXA centres. The final form emerged from a detailed editing process within the Working Group.

Results: The Header includes the data relevant for all examinations performed on a given DXA device. The Results section may include an explanation of why the examination was performed differently from the standard examination and a comment on the evaluability of the examination. The original copy of the examination is a standard attachment to the description and failure to provide it is fundamental misconduct. The interpretation of the findings according to the T-score (postmenopausal women, men ≥ 50 years) for each Region of Interest (ROI) separately (Lumbar spine, Total Hip of one or both sides, Femoral Neck of one or both sides) is crurcial: BMD corresponds to the range (alternatively: BMD meets DXA criteria) of osteoporosis, osteopenia, or is within the range of normal values. The lowest BMD value found in any relevant ROI is decisive for the final classification. In premenopausal women and men < 50 years, the criteria for categorizing the findings are both the Z-score (within the normal range for age and sex at ≥ -1 SD, decrease at < -1 SD, significant decrease at ≤ -2 SD) as well ase the expression in the T-score system (i. e., normal/osteopenia/osteoporosis). In the case of BMD value(s) in the osteoporosis range, inclusion of the following (or similar) wording is essential: "Before a definitive diagnosis of primary osteoporosis can be established, it is necessary to exclude other osteopathies and possible causes of (secondary) osteoporosis". On repeated exams, it is necessary to compare with the previous examination, to describe the change in each ROI, to evaluate its significance/insignificance (taking into account both the above mentioned Least Significant Changer (LSC) value and the interval between examinations).

Conclusion: Implementation of the Recommended DXA Bone Densitometry Report Format should ensure a standard quality of DXA examination reports, which would ultimately help improve the care of patients with metabolic and other osteopathies.

Keywords: DXA bone densitometry, bone mineral density, BMD, reporting.