Intervals between bone mineral density testing with dual-energy X-ray absorptiometry scans in clinical practice

  • H. Lyu
  • K. Yoshida
  • S.K. Tedeschi
  • S. Zhao
  • C. Xu
  • S.U. Nigwekar
  • B.Z. Leder
  • D.H. SolomonEmail author
Short Scientific Communication



Intervals between dual-energy X-ray absorptiometry (DXA) scans were evaluated in a large cohort of typical clinical practice. Intensive DXA scanning (intervals < 23 months) decreased substantially, from 16.7% in 2006 to 6.7% in 2015.


Serial dual-energy X-ray absorptiometry (DXA) measurements are suggested for patients at high risk of fractures. However, little is known about how often DXA testing occurs in clinical practice.


We examined time intervals between DXA testing for monitoring purpose at two academic medical centers in the US between 2004 and 2017. The primary outcome was the presence of testing intervals < 23 months (termed “intensive DXA testing”). A generalized linear mixed model was used to evaluate the association between selected patient-level clinical factors and intensive DXA testing.


Forty-nine thousand four hundred ninety-four DXA tests from 20,200 patients were analyzed. The mean time interval between scans was 36 ± 21 months. Only 11.1% of the repeated DXA testing met the criterion for intensive testing. The percentage of intensive DXA testing dropped from 16.7% in 2006 to 6.7% in 2015 (p for trend < 0.001). After adjusting for age, gender, number of outpatient visits, and calendar year, correlates of intensive DXA testing included a baseline T-score < −2.5 at any anatomic site (OR, 4.8; 95%CI, 4.0–5.7), active use of drugs for osteoporosis (OR, 1.6; 95%CI, 1.3–1.9), and active use of glucocorticoids (OR, 1.3; 95%CI, 1.2–1.4).


The predictors of intensive DXA testing suggest that this practice is used preferentially in patients with multiple risk factors and to monitor the response to pharmacotherapy. However, intensive DXA testing has become less common in real-world clinical practice over the last decade. Further studies are required to better define the optimal use of bone mineral density testing in this vulnerable population.


Dual-energy X-ray absorptiometry Osteoporosis Repeated scan Short interval 


Funding information

This work was supported by the NIH-P30-AR072577 (VERITY). HL received scholarship from Chinese PLA General Hospital. KY received financial support for his doctoral study from Harvard T.H. Chan School of Public Health (partially supported by training grants from Takeda, Pfizer, Bayer, and ASISA) and Honjo International Scholarship Foundation. SKT received support from the Lupus Foundation of America Career Development Award. DHS receives salary support from NIH-K24AR055989.

Compliance with ethical standards

Conflict of interest


Supplementary material

198_2019_4847_MOESM1_ESM.pdf (188 kb)
ESM 1 (PDF 187 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • H. Lyu
    • 1
    • 2
  • K. Yoshida
    • 3
  • S.K. Tedeschi
    • 4
  • S. Zhao
    • 4
    • 5
  • C. Xu
    • 4
  • S.U. Nigwekar
    • 6
  • B.Z. Leder
    • 7
  • D.H. Solomon
    • 4
    • 8
    Email author
  1. 1.Department of MedicineHarvard Medical SchoolBostonUSA
  2. 2.Department of OrthopedicsChinese PLA General HospitalBeijingChina
  3. 3.Departments of Epidemiology and BiostatisticsHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Division of Rheumatology, Immunology and AllergyBrigham and Women’s HospitalBostonUSA
  5. 5.Institute of Ageing and Chronic DiseaseUniversity of LiverpoolLiverpoolUK
  6. 6.Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonUSA
  7. 7.Endocrine Unit, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  8. 8.Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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