TBS enhances FRAX in patients whose BMD level lies close to the intervention threshold and may provide data that facilitates treatment decisions, but TBS should not be used by itself in monitoring patients with VF risk factors [47]. Variant 4: Initial imaging for premenopausal females or males less than 50 years of age. Individual with risk factors that could alter bone mineral density. 1. Individuals with medical conditions that could alter BMD, such as: DXA The data providing imaging guidance in premenopausal women are few. The literature indicates that DXA remains the primary screening modality for evaluating bone mineralization in patients with these clinical scenarios [99]. Screening BMD should not be performed in premenopausal women. The 2 exceptions are young women with a history of fractures from minor trauma and those who have known causes of bone loss [100,101]. Chronic disease damage and low BMI are reported as risks factors for low BMD in premenopausal systemic lupus erythematosus patients, and early monitoring and/or treatment may prevent severe bone loss and future fractures [102]. In the 2017 American College of Rheumatology guidelines on glucocorticoid-induced osteoporosis, adults receiving Osteoporosis and Bone Mineral Density glucocorticoid therapy for >3 months and who have had a prior fracture or other risk factors should have their BMD evaluated every 2 to 3 years [103]. In organ transplant patients, owing to rapid bone loss in the first 6 to 12 months after transplantation, the same imaging guideline was proposed [103]. A baseline DXA should be considered in women age <40 years of age who experience premature menopause for any reason, especially when menopause was induced by chemotherapy. In untreated women undergoing initiation of an aromatase inhibitor, bone loss is most marked in the 12 to 24 months [104]. Men who undergo androgen deprivation therapy have substantially elevated risk of fracture.
Osteoporosis and Bone Mineral Density. TBS enhances FRAX in patients whose BMD level lies close to the intervention threshold and may provide data that facilitates treatment decisions, but TBS should not be used by itself in monitoring patients with VF risk factors [47]. Variant 4: Initial imaging for premenopausal females or males less than 50 years of age. Individual with risk factors that could alter bone mineral density. 1. Individuals with medical conditions that could alter BMD, such as: DXA The data providing imaging guidance in premenopausal women are few. The literature indicates that DXA remains the primary screening modality for evaluating bone mineralization in patients with these clinical scenarios [99]. Screening BMD should not be performed in premenopausal women. The 2 exceptions are young women with a history of fractures from minor trauma and those who have known causes of bone loss [100,101]. Chronic disease damage and low BMI are reported as risks factors for low BMD in premenopausal systemic lupus erythematosus patients, and early monitoring and/or treatment may prevent severe bone loss and future fractures [102]. In the 2017 American College of Rheumatology guidelines on glucocorticoid-induced osteoporosis, adults receiving Osteoporosis and Bone Mineral Density glucocorticoid therapy for >3 months and who have had a prior fracture or other risk factors should have their BMD evaluated every 2 to 3 years [103]. In organ transplant patients, owing to rapid bone loss in the first 6 to 12 months after transplantation, the same imaging guideline was proposed [103]. A baseline DXA should be considered in women age <40 years of age who experience premature menopause for any reason, especially when menopause was induced by chemotherapy. In untreated women undergoing initiation of an aromatase inhibitor, bone loss is most marked in the 12 to 24 months [104]. Men who undergo androgen deprivation therapy have substantially elevated risk of fracture.