When a nontreated patient has a statistically significant decrease in BMD on follow-up DXA, therapy initiation may be considered in the setting of confirmed primary osteoporosis or when there is clinical correlation identifying potential secondary causes of osteoporosis [57]. Serial BMD testing combined with clinical risk factors, bone turnover markers, and other factors such as height loss and TBS may also be used to determine whether treatment should be initiated. Patients receiving treatment who demonstrate decreasing BMD on follow-up scans may require an adjustment in their pharmacotherapy regimen [24]. In the majority of patients, the time interval for monitoring is based on the change rate of bone mineralization, which is typically about 2 years; however, it is preferable for this interval to be shorter (1 to <2 years) after therapy has been initiated [23]. Patients who are at high risk for a more rapid decline of bone mass, such as those receiving glucocorticoid therapy, also require shorter intervals between imaging; 1-year intervals after initiation or change of therapy is appropriate with progressively longer intervals once therapeutic effect is established [58]. Scan intervals <1 year are discouraged [24]. Serial BMD testing is encouraged in individuals after cessation of pharmacologic therapy for osteoporosis as well. DXA VFA In this setting, use of VFA is not supported. This differs from variant 3 in which VFA may be considered in patients with documented spine fractures or if they have been diagnosed with osteopenia and meet certain age criteria, have experienced height loss or undocumented VFs, or have a history of use of glucocorticoid medication for >3 months [17]. QCT QCT is regarded as a secondary or adjunct tool to DXA. QCT may be useful in unique populations in which there is a need for added precision.
Osteoporosis and Bone Mineral Density. When a nontreated patient has a statistically significant decrease in BMD on follow-up DXA, therapy initiation may be considered in the setting of confirmed primary osteoporosis or when there is clinical correlation identifying potential secondary causes of osteoporosis [57]. Serial BMD testing combined with clinical risk factors, bone turnover markers, and other factors such as height loss and TBS may also be used to determine whether treatment should be initiated. Patients receiving treatment who demonstrate decreasing BMD on follow-up scans may require an adjustment in their pharmacotherapy regimen [24]. In the majority of patients, the time interval for monitoring is based on the change rate of bone mineralization, which is typically about 2 years; however, it is preferable for this interval to be shorter (1 to <2 years) after therapy has been initiated [23]. Patients who are at high risk for a more rapid decline of bone mass, such as those receiving glucocorticoid therapy, also require shorter intervals between imaging; 1-year intervals after initiation or change of therapy is appropriate with progressively longer intervals once therapeutic effect is established [58]. Scan intervals <1 year are discouraged [24]. Serial BMD testing is encouraged in individuals after cessation of pharmacologic therapy for osteoporosis as well. DXA VFA In this setting, use of VFA is not supported. This differs from variant 3 in which VFA may be considered in patients with documented spine fractures or if they have been diagnosed with osteopenia and meet certain age criteria, have experienced height loss or undocumented VFs, or have a history of use of glucocorticoid medication for >3 months [17]. QCT QCT is regarded as a secondary or adjunct tool to DXA. QCT may be useful in unique populations in which there is a need for added precision.