Bone Density Scan (DXA) Clinical Pathway – Outpatient Specialty Care and Primary Care – Guidance for DXA Scan Sites Based on Age

Bone Density Scan (DXA) Clinical Pathway – Outpatient Specialty Care and Primary Care

Guidance for DXA Scan Sites Based on Age

  • Selecting the appropriate extremity or body part to scan is essential to providing useful guidance about possible treatments or initiation of therapies
  • There are different preferred scan sites based on a child's age

CHOP currently does not provide sedation for DXA scans. Do not order a DXA scan if child is unable to lie still for a minimum of 3-5 mins.

Age Standard Scan Sites Alternative Scan Sites Comments
1-2 yrs Lumbar spine  
  • Do not order if:
    • Lumbar compression fractures, or
    • Lumbar scoliosis, or
    • Lumbar spine hardware
  Forearm
  • Order if:
    • Lumbar spine cannot be assessed, or
    • Forearm bone density is needed clinically
  • Do not order if:
    • Indwelling hardware in forearm
  • Can scan either side; left side is standard
≥ 3-4 yrs Lumbar spine  
  • Do not order if:
    • Lumbar compression fractures, or
    • Lumbar scoliosis, or
    • Lumbar spine hardware
Whole body  
  • Do not order if:
    • Indwelling hardware, or
    • Contractures that prevent child from lying flat on back
  Forearm
  • Order if
    • Lumbar spine and whole body cannot be assessed, or
    • Forearm bone density is needed clinically
  • Do not order if:
    • Indwelling hardware in forearm
  • Can scan either side; left side is standard
≥ 5-17 yrs Lumbar spine  
  • Do not order if:
    • Lumbar compression fractures, or
    • Lumbar scoliosis, or
    • Lumbar spine hardware
Whole body  
  • Do not order if:
    • Indwelling hardware, or
    • Contractures that prevent child from lying flat on back
  Hip
  • Order if:
    • Adolescent and DXA monitoring into adulthood is expected, or
    • Hip bone density is needed clinically
  • Do not order if:
    • Hip dysplasia
    • Indwelling hip hardware
  • Can scan either side; left side is standard
  Forearm
  • Order if:
    • Lumbar spine, whole body, or hip cannot be assessed, or
    • Forearm bone density is needed clinically
  • Do not order if:
    • Indwelling hardware in forearm
  • Can scan either side; left side is standard
  Lateral distal femur
  • Order if:
    • Non-ambulatory and/or cannot tolerate laying supine, or
    • Distal femur bone density is needed clinically
  • Do not order if:
    • Under 6 yrs or over 18 yrs old
    • Has indwelling hardware in the distal femur
≥ 18 yrs Lumbar spine  
  • Do not order if:
    • Lumbar compression fractures, or
    • Lumbar scoliosis, or
    • Lumbar spine hardware
Hip  
  • Do not order if:
    • Hip dysplasia
    • Indwelling hip hardware
  • Can scan either side; left side is standard
  Whole body
  • Order if:
    • Whole body scans have been obtained previously and ongoing monitoring is required
    • Whole body bone density or body composition is clinically needed
  • Do not order if:
    • Indwelling hardware, or
    • Contractures that prevent lying flat on back
  Forearm
  • Order if:
    • Lumbar spine or hip cannot be assessed, or
    • Forearm bone density is needed clinically
  • Do not order if:
    • Indwelling hardware in forearm
  • Can scan either side; left side is standard

Recommended Regions of Interest (ROI) for Clinical Evaluation

  • AP Lumbar Spine: total L1-L4
  • Whole Body: subtotal (total body less head)
  • Hip: total hip and femoral neck
  • Forearm: distal 1/3 radius and ultradistal radius