DXA scans, FRAX and other tests for osteoporosis

The standard way of measuring bone density is a simple test called dual x-ray absorptiometry (DXA). The DXA scan is an accurate and reliable technique of assessing the strength of bones. A DXA scan usually measures bone mass (the amount of bone) in the spine and hip and wrist – parts of the body which are more at risk of osteoporotic fractures. Ultrasound can also be used to assess bone strength but cannot be used to monitor treatment.
A DXA scan measurement provides an assessment of a person’s bone density and his/her likelihood of having a fracture; it is also used to help decide if medication is needed. There is no national screening programme for osteoporosis but at present a doctor would request a DXA scan for a patient with strong risk factors such as maternal history of the condition, early menopause and use of oral corticosteroids. Using risk factors, together with height and weight, your GP can use the WHO FRAX tool to decide whether you need a DXA scan or whether the risk is high enough to warrant treatment (see also Who develops osteoporosis?).
A DXA scan involves lying on a couch whilst a thin metal arm moves up and down taking an image of the spine and hips. Clothes do not need to be removed, except for garments with metal at the hips or along the spine (trouser zips are fine). No injection or mechanical tunnel (like for an MRI scan) is involved in the procedure.
The level of radiation of a DXA scan is lower than that of an ordinary x-ray and more similar to natural daily radiation levels. The whole procedure takes between ten to twenty minutes and no one we talked to found it unpleasant.

Valerie talks about her experience of having a DXA scan.

Age at interview 67

Gender Female

Age at diagnosis 63

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I initiated the bone scan because having been initially told that HRT prevented bone loss I just counted on that and continued to drink all my milk and I have an extremely good diet. I eat no junk food.

Well that was why I felt that since his death was precipitated by what seemed to be osteoporosis that if I was not taking the HRT I wanted to know. So I didn’t get diagnosed through a breakage which seems to be the way that most people get diagnosed. So I’m feeling quite lucky about that.

I’ll say it from that point of view my doctor is excellent. She’s very sympathetic and I had the scan within about 10 days in the local hospital which depends on a teaching hospital. And there was. They make an appointment. You do not queue for it. This, it has been mentioned to me by a friend needs some scan and she won’t do it because she has to go into one of these tunnel things and she’s claustrophobic. Well it’s not that kind of scan anyway. You just you lay down and there’s a kind of block which goes backwards and forwards over you but you’re completely outside. You’re not in anything.

And how long, do you remember how long this test takes?

It takes about, less than 10 minutes. So you lay down on the table. The operator who seems to be medically, medically qualified doctor or at least a very highly qualified nurse, sits at the screen. And it doesn’t seem to have a great deal of radiation because she doesn’t get behind a screen or anything. So, she turns it on and it’s like a block about [phew] ten inches wide and the width of the table that goes slowly up your body and slowly back again. And that’s all there is to it. Well no I don’t know what distance but it’s probably 30 cms from you. It doesn’t go near your face. And seemingly because they then give you percentages for bone loss in different areas it then goes on to the computer and the operator can read the percentage of bone loss in each area as it goes over it and it apparently records it. Because when I went to see the doctor when I hadn’t bothered and she said that I had that wrong with me, she brought it up on the screen so it had been sent to her over the Internet from the hospital and she had all the details on screen.

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Many people requested their DXA scan through their GP, in many cases because their mother or father had osteoporosis, and/or after they had been using hormone replacement therapy (HRT). In other cases the GP initiated the scan after a wrist fracture or a complaint of back pain for some time – as in the cases of Carol and Alice respectively. In some cases x-ray results prompted hospital doctors to send patients like Jane for further investigations including a DXA scan. And others, like Iris, happened to attend fracture clinics in hospitals that routinely screen postmenopausal women with a fracture for osteoporosis. Doctors in fracture clinics made the postmenopausal women we talked to aware of the need to have a DXA scan. Gloria was told to ask her GP for one. Jenny however, had worried about osteoporosis long before her diagnosis and asked for a bone density scan to find out the impact of a dairy-free diet on her bones. For almost twenty years Jenny managed her ME and other allergies by not consuming dairy products. Joan made an appointment and paid for her first DXA scan at a private hospital because she realised her back was becoming bent and her mother had osteoporosis.

Linda had a DXA scan after stopping HRT which showed a slightly below normal result. Three years…

Age at interview 62

Gender Female

Age at diagnosis 60

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I had my first bone density test done I think when I was about fifty seven. I’d come I’d decided to come off my HRT and my GP suggested I have the bone density test which I did. And when the result came in she said that I was below normal, my bones were just a bit below normal just a bit below normal but she didn’t give me the impression that it was anything to worry about. So I really sort of forgot about it. And it was only about three years ago when my mother, aged eighty three, suddenly got osteoporosis and her posture changed radically.

And she was in a great deal of pain and her GP who was also from the same practice as the GP that had given me my first bone density but was a different doctor, said I should have a that she had osteoporosis and that he put her on some pills and that would help and anyway, she died about six months later of something completely unrelated. And then my GP said that I ought to have I ought to have a bone density test again to see whether I had it because he said it was hereditary.

So I had that test done, I think it would have been July O in July 05. And again I was a bit lax about going and getting the result and it wasn’t until September that I found out that I actually had osteoporosis which was quite a shock, actually, I was quite upset. I remember being quite upset about it. And I hadn’t really put two and two together with the previous bone density. That sort of dawned on me later that actually I should have been given some preventative advice at least like, Come back in a year. Have another one. Let’s keep an eye on it Something like that but anyway.

If you take me through to the first when you had your first bone density scan, were you given calcium?

No, I wasn’t given anything at that point. I was just told that it was a bit below average and that’s all I can remember. I wasn’t given any pills or any calcium or any particular advice. I wasn’t even told maybe I should come back and have another test in a year’s time so.

But my doctor said, I think you’d better have a bone density test because your mother had osteoporosis and it does run in families And he sent me off for that and that’s when they found it was osteoporosis. So it had obviously gone got quite a lot worse in whatever it was, two or three years, three years probably.

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Not all hospitals have DXA scans. Some GPs can offer a DXA scan on the NHS but in areas where resources are scarce, people may have to pay for the scan themselves. People who were diagnosed many years ago often had to travel to have a DXA scan since fewer scanners were available then. But the situation has improved. People diagnosed in the last five years tend to have a scan done on average every three years. A few have been told by their GP’s that subsequent scans will be done every five years. Apart from DXA scans other tests, like blood and urine tests are also used to measure bone loss, predict fracture risks and to check the person’s response to the medication (see below).

In a few cases and thanks to the fund raising activities of local support groups, hospitals have been able to get a DXA scanner and a printer to print the results that are sent to the GP. Pat, however, continues to pay for hers privately because in the city where she lives no NHS hospital has the facility.

Pat was involved in successfully campaigning for a DXA scanner which is now available at her…

Age at interview 68

Gender Female

Age at diagnosis 54

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I joined the group, which had only been formed not quite a year. And after discussions we decided between us that we would approach [city] Health Authority, as it was then, with a view to us setting up an appeal to purchase a bone density scanner for the hospital. And we were told by somebody in authority, As there was no cure, what is the point?" And, Thank you very much, no thank you Anyway the [name] Hospital, which was a private hospital in [city] contacted me. They’d heard about this and they would then buy a bone density scanner. So my advice to them was, Contact the consultants, contact GPs and get their feedback. And if they said, Go for it’ then go for it Which they did. And we got the bone density scanner at the [name] and I had my first bone density scan in 1998.

And you were diagnosed in?

And I was diagnosed then, I got to know my T-score and everything, which was four years after the original diagnosis.

No, I didn’t have to pay for that one. But my subsequent scans that I’ve had, I’ve had three, four, I’ve lost count, I have had to pay for. Because it’s only at the moment that the PCT is beginning to come round to that there is a problem called osteoporosis. The consultants in [city] now have been working a new scheme where the patients who go in with fractures are, the elderly patients, are then handed over to the Elderly Care consultants and they follow up the treatment, they put the treatment in line for osteoporosis. And that’s only been going six months.

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Valerie who was diagnosed four years ago waited ten days to have her first DXA and had her second…

Age at interview 67

Gender Female

Age at diagnosis 63

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And the second scan was done two or three years after?

Three years after. I asked her about after a couple of years and she said, Oh we wouldn’t see anything after that length of time So I reminded her this time that last year when I went the operator had said that I could come back, that I would get a notice to come every year. That doesn’t seem to be the information that my doctor has. She thinks it’s every two years or something. Anyway this time the person doing the scan didn’t mention when the next one would be but because I told the doctor she had said I could have one the following year she said, Ok here you are. I’ll write it out for you So and I had that also within two weeks.

Ok and this second scan showed what? Can you tell me?

Well I, I wasn’t listening and I didn’t write it down but basically that my back seemed to have slightly improved and but. And my, the worst seemed to be in my thigh area and that seemed to have stabilised. I had a scan about a week ago and I shall go into the doctor soon and find out what the result was of that. And see if there’s any improvement or not.

Did the doctor mention or explain or say anything about why the improvement has happened?

No. I think to give her credit that probably because I talk a lot and I seemed quite well-informed she probably didn’t think that I needed to have any more information. And you know it’s obvious I can use the Internet.

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Waiting times for a bone scan vary. After their GP requested a DXA scan some people received an appointment within a couple of weeks while others waited for 3-4 months. Moreover, people’s perception of ‘a long wait’ also differed. For Gloria a 3 months wait ‘wasn’t very long’ while Susan experienced 3 months as ‘waiting for ages’.

But Gloria waited a year for her second DXA scan after diagnosis and was anxious to know if the medication was working. After almost a year she learnt from the hospital that the request for another scan was pending and hadn’t even got on to the appointment list. She wrote to the Health Minister about it.

After waiting for a year to have a second bone density scan Gloria wrote to the Minister of…

Age at interview 66

Gender Female

Age at diagnosis 58

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Then I think I had to wait a fortnight it that that’s just it. Altogether it takes about two twenty minutes and then I waited about a fortnight to get the results at the doctor. The next time when I had to have the scan I waited nearly a year for it and I’m sure I only got it because I’d I the doctor had sent a letter to the hospital and I used to phone the hospital up and say, Has my appointment you know, am I near the top of the list?’ But first of all it was in the pending tray, not even on the list, So how long is it in the pending tray?’ Well until you reach the top of the pending tray then you get you go on the bottom of the list. Which I thought was awful.

But then as I was getting ready for work one day on the news it said that the that the minister of health had announced that the waiting lists had all gone down and nobody should wait more than three months. And I thought, Well I’ve waited nearly a year. So that night I wrote to the minister of health with all these details and said, You know, if I’m if I sort of been lost in the loop somewhere. And I got a letter back saying it was being looked into. Well I ended up getting a letter from the minister of health, the local health authority, the local hospital everybody wrote and apologised and my appointment came through immediately. So I then got an appointment but I had waited altogether by this I’d waited a year for it.

And then the next appointment when I went when I had the next scan in December 2004, it came through in about a fortnight so and but the hospital had changed. Where before I’d gone to the local hospital in [borough] I had to go to the hospital in [town] which was no trouble, we’d went by car. And it was a new machine, a brand, spanking new machine, yeah, but the same the same procedure but just a new sort of more modern machine.

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A DXA scan is generally used to decide if a person needs medication. A few people hadn’t needed medication at first because their bone density was not sufficiently low, but a later scan showed the need for it.

Many people felt that regular scanning gave them an accurate assessment of the strength of their bones and reliably monitored their treatment. Many were eager to know whether the medication had produced the expected improvement, had made no difference or, worse, if their bones had got thinner. Knowing that the bone density had improved made people confident about their treatment.

Emma is taking strontium ranelate and would like her GP to refer her to have a scan more…

Age at interview 61

Gender Female

Age at diagnosis 47

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And how many bone density scans have you had?

I have got a few. Every three years since 1990, since 1990 I think or 19yeah.

What are they revealing sort of in term of your

They have gone down. Each, each three years when they do the density’s gone completely down. Very bad.

And last I had only last year. One, the last one I had last year and I think since then my doctor has put me on Protelos. The medicine that I’m taking for my bones.

How does the doctor explain to you your density scan results?

He just said that it hasn’t like, I’m on HRT all the time but it hasn’t work a lot. That’s why he put me on the Protelos, that’s what he said. That’s why he put me on the Protelos now. But the radiographer in the hospital, she said that actually they should take my, every two years or even a year, so that they can keep an eye. If it is not, they, they can do something about it. But I don’t know what they can do something about it. But radiographer told me that they must, put me through the consultant, so that they, they can do something about it quicker. So, but I cannot understand, I cannot make my doctor understand.

No, he has only told me that it has gone down. I don’t’ understand exactly what this bone, it only says the figure says that it is more deteriorating rather than steady.

And do you think they are going to change how often they do the bone scan?

I don’t know, I haven’t, I never had chance to talk with my doctor. I will ask him again, that is he going to do it earlier or not. Because in between, a little while they, nobody did anythingabout my bone scan. There was gap of long period. Hmm.

How long?

Maybe more than five years, because I had in 92, that started, then they had once, so far I have only three times.

Since 92?

Yeah. Three or maybe four times. This time it was fourth time. So there was a big gap in between. But now I’m going to, I think I will have to insist my doctor as well.

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David who has had arthritis most of his life and was diagnosed with osteoporosis when he was 23,…

Age at interview 25

Gender Male

Age at diagnosis 23

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I have like a bone density scan about every six months, you know the DXA scan, I have that every six months, and from when it was measured before I broke my hip it’s gone up by like you know something, I think they gave us 17%, you know my bone strength, which doesn’t seem that much I know but obviously you know it’s a difference, and I think that is a combination of you know the drugs, the Alendronic acid and the calcium. You know so, you know so hopefully that will continue to go up you know, whilst it can but I don’t know if it’ll get much higher than that. But as long as you can reduce the risk of fractures cos obviously I mean I was when I broke my leg, I had to be on, I mean I couldn’t get up I was on total bed rest for eight weeks. So, I mean I couldn’t have that keep on happening. You know it’d be ridiculous. I mean it when I was, when I was at Uni, so it took eight weeks out of my Uni you know course. Which meant that everything was pushed back, you know so I can’t be having that.

My Doctor [Gps name] sends me for DXA scans and you know I’m able to talk with doctors there you know and they send reports back to Doctor [Gps name] and to Mr. [consultant]. You know so there’s no-one specifically but, you know I kind of trust Doctor [Gps name], he’s really good. Really really good, and so I haven’t seen anyone specifically for a while.

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Margery has had six DXA scans that over the last twelve years have monitored the effectiveness of…

Age at interview 72

Gender Female

Age at diagnosis 58

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So I went and had this DXA scan and was seen by a consultant who informed me that my bone density particularly in my spine was really quite bad for my age. One of my vertebra had a T-score of minus 4.5 I think it was which at the age of 58 was really quite, by now I think I was 59, this was really quite severe. And his words to me were, If we don’t get you treated by the age of 70 you will be in a wheelchair because your bones are already those of a woman in her mid seventies to eighty

He straightaway said that I needed a new drug, a comparatively new drug, called Fosimax and Alendronate and he thought this was the best treatment for me.

I took this drug for eighteen months before I was sent, I was recalled for a further scan and unfortunately the results were not good. Not only had I not failed to lose any more bone, I had actually lost more and the consultant was very concerned and immediately put me on to a calcium and vitamin D and HRT.

All together I have had six DXA scans and once the HRT and the new treatment, the combined treatment began to take effect my bone density showed a tremendously encouraging improvement. I was kept on the HRT for I think altogether six or eight years. I had no adverse effects from it. I found that it improved my life quality in many ways. I had a lot of energy and I really felt very well on it, but at the end of that time because of various scares about breast cancer and so on my GP said he thought I had been on it long enough.

Since then I have kept on the Fosamax and the Calichew D3 Forte. There has been a slight falling off in my bone density but it’s not significant. Overall the density of my spine has gone up some 22% and as I have got older of course my bones would have got more porous anyway, so in fact I am now osteopenic for my age. I don’t actually have osteoporosis as such and I consider myself extremely fortunate that without this treatment I would not have been able to lead the active life that I have done.

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The frequency of scans varied. Some people were told they could have a scan on the NHS every two or three years to see if their medication was working. But most had to ask their doctor as it wasn’t automatically offered to them. Joan was taking strontium ranelate and had an annual bone density scan. People who paid for a scan privately could have one more frequently.

Some people had scans less often. Neville and Sarah had a scan at the time of their diagnosis several years ago but haven’t had one since. A few people said it had been five years or more since their last scan but they hadn’t felt the need to have another so hadn’t asked for one.

Clare took part in a couple of surveys on osteoporosis, which led her to see her GP and request a…

Age at interview 65

Gender Female

Age at diagnosis 64

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I think it was in 1989, somewhere around there, the [hospital] was doing a survey on osteoporosis. And I was one of the people who went up and had some tests. And the result was that I wasn’t osteoporotic. I was well into the proper area. And so I really forgot all about it.

I then had a period in my life where I didn’t do a great deal except work. Worked twelve hours a day but didn’t do a great deal of activity. And obviously being a physio I was aware of the fact I should do activity. And so I went for another test. And I was still all right.

And then it wasn’t until last November when there was some research going on at the [name] centre, that they did blood pressure and height and so on. I’d lost an inch and I was down on the scale of bone density.

So I went to my GP, who sent me off for a test at the [hospital] And while I was there I had a look at the results [laughs]. And it was quite horrendous really. The bone density in my lumbar spine was not very good at all. And so then I was put on alendronic acid and Adcal, two tablets a day. And I’ve been taking it ever since.

I didn’t see a doctor. I just saw the radiographer. And she and I looked at it. And she explained to a colleague that the bone density was not very good. And obviously she couldn’t explain to me that sort of thing because it had to come from my GP. So she was explaining all this to a colleague.

And I think I was quite shaken because I didn’t think I would end up with osteoporosis really.

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Chris hasnt had a scan for a while because her nearest DXA scanner is quite a distance away and…

Age at interview 52

Gender Female

Age at diagnosis 45

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I’ve had I think one or two. Now that’s a big issue in this area. I have been in contact with the MP, [name], in the past. Apparently at one point when I was being, being seen privately by the consultant, I should have been having one every two years. I’m now on the National Heath system and I haven’t been having one every two years. In fact they don’t think it’s necessary, as I understand. But apparently, they do have a bone density scanner and I’ve been to it once, and it’s in [city], which is quite a distance away, and apparently they only use it one morning a week. So in the whole big area that it covers, they can only scan eight people that one morning a week. I’m appalled. it’s all right if you can afford to do your own. But when you can’t, the provision isn’t there really. I waited a long time, have had a bone density scan, did wait for my turn. But I haven’t heard of anything since. And perhaps I ought to chase it up. I haven’t. I’ve had other things to deal with, like my ankle. But I did, as I say, get in touch with [MP]. He did take it on board but wanted more information. However, as you’re probably aware, [MP] had his own problems, it had national coverage, and it sort of went by the wayside. And also I lost impetus because I had this accident and I had to focus on me and getting myself better.

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Several women who at the time of their fracture were not offered a DXA scan felt upset about the lack of preventive medicine because their diagnosis and treatment was delayed, sometimes for years (see Being diagnosed with osteoporosis).
Several close relatives of the people we talked to requested a DXA scan themselves to find out if they had osteoporosis. For most of these people, their GP arranged this. Diana’s and Sheila’s daughters, have also been diagnosed with the condition. But Laurence feels frustrated that his daughter and also his wife with a maternal history of the condition were denied a scan.

Despite having a maternal history of osteoporosis, Laurences wife was denied a DXA scan on the…

Age at interview 62

Gender Male

Age at diagnosis 54

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Getting back to the wife she went to the doctor and asked him about going on HRT and could she have a scan as well because her mother had osteoporosis and, you know, blah blah blah. He said he’d find out. Anyway he rang up three weeks later and he said, Very sorry, [wife] you cannot have a scan because you’re not old enough. She’s fifty five means in apparently you’ve got to he sixty now before you have a scan unless you break a bone. So if she decides to fall down and break her neck or break a bone they’d have her in tomorrow to give her a scan. But because she hasn’t, then no she can’t, not until she’s sixty I suppose. it’s just their way of saving money isn’t it?

Yeah she’s concerned that she’ll get is as well, you see. I think they’re all me family are concerned yeah they’re they might end up with it, yeah. They are getting to that stage, yeah.

Well yeah, they have and then they get told, I mean me daughter especially and they say, You’re too young. You know. I mean surely if I’ve got it, my mother had it, mother-law had it surely that they would check the wife see if she’s got it even though she’s only fifty five and perhaps check the daughter as well, perhaps check me sons. If, it’s so hereditary you know, I mean [sighs] I don’t know.

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The results of the DXA scan are usually sent to the GP with whom people can discuss the results. Accurate interpretation of results depends on repeat scans being performed on the same machine, especially if they are being used to monitor a treatment or bone loss. For a few people comparisons couldn’t be made because their tests had been done on different scanners. To get around this problem Jenny paid for her subsequent scans to be done on the original machine after her GP clinic started arranging DXA scans at another hospital. Having her scans done there would have made it impossible to compare previous scan results with newer ones.

In some parts of the UK support groups have raised funds to buy or contribute to the cost of a DXA scanner to ensure that one is available locally ensuring that patients’ scan results can be compared accurately.

Anns local support group raised money to donate a DXA scanner and computer to their hospital, so…

Age at interview 69

Gender Female

Age at diagnosis 62

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I’ve had quite a few. The initial one was at [hospital] then it turned it transpired that the machine they use at [hospital] as far as the results were concerned, wasn’t compatible with the machine they use at [hospital] and [hospital] so there was nothing to compare.

So the comparison didn’t really begin properly until I had scans at [hospital].But now I have regular ones at [hospital] and I can keep a proper record, you know, I keep it in my diary, the results of each DXA scan.

Because when I said initially there was a three year waiting list. The waiting list now is non-existent because the [city] and District Support Group with fund raising events paid for the DXA scan that’s currently in use at [hospital]. And the computer which prints out the results in a format that GPs can understand so you know, but yes as a nurse, yes I have a personal interest.

What do you mean in a form the GP can understand?

Well, when the results were available initially. The GPs didn’t realise that the plus or minus of the As, the Zs the T scores and the Z scores they couldn’t interpret it and the patient was told, Yes, you have osteoporosis Or, No, you don’t have osteoporosis With no idea of the levels, you know, the spine and the hips. No idea whatsoever of how severe this osteoporosis had become. Well, now there is absolutely no excuse for Gps not knowing how to interpret the results, you know. There’s no excuse now because, as I said, we bought the computer for these results to be made available.

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Margerys support group found out that other specialists in the hospital didnt know they had a…

Age at interview 72

Gender Female

Age at diagnosis 58

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Locally I think possibly our biggest contribution has been helping, we didn’t spearhead the campaign but we did a lot of work and we raised money to get our own DXA scanner at the local hospital which has cut out this long journey for patients having to go over into England for a DXA scan. We have one member who actually had a spinal fracture in the ambulance being taken all that way to be scanned. So those days are over.

Locally we are very, very fortunate to have a lady consultant who is passionate about osteoporosis and we’ve formed, as a result I have to say, of help from our MP who is our Patron, after we got our DXA scanner we discovered that it was not being very frequently used and our MP called a meeting in the hospital and we were appalled to find that of the consultants who attended it from other specialties, some didn’t even know that there was this machine in their hospital to which they could refer patients from perhaps geriatrics or another specialty and so as a result of this, people from each of these related specialties formed an osteoporosis working group on which our group secretary and I served and we met twice a month in order that right across the hospital and within the group information was being shared about osteoporosis treatments and we could hear how the DXA scanner was being used, how many people were being referred.

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Evidence suggests that a bone scan may not be the best way to assess fracture risk in the elderly because degenerative conditions of the spine such as osteoarthritis may occur as part of the ageing process. In turn, this can affect the reading of a DXA scan hence giving a misleading estimate of a person’s bone mass. This happened in Joan’s case.

Changes in Joan’s spine affected the accuracy with which her bone mineral density (BMD) could be…

Age at interview 73

Gender Female

Age at diagnosis 69

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What did the DXA scan say. Increased risk of fracture. No previous scans available for comparison. Results will be elevated simply due to Strontium but to what extent is impossible. Results for the spine scan are compromised because degenerative changes have falsely elevated the BMD (bone mass density) results. The value for the hip may produce a more accurate picture. And it just said that the hip was showing that I was at risk there. I can’t remember that was here.

Treatment recommendations were the calcium and vitamin and it talked about bisphosphonates or Strontium and someone like me has already had a low trauma fracture, a fall from standing height or less. And that they, because I’m post-menopausal no further drastic bone loss expected unless there is a clinical change.

Did these results, did you talk to your doctor about them?

Yes.

Ok what did he or she say?

She said yes you must make sure you continue taking all your medication and because you definitely do not want to break a hip. And I agreed with her, no I do not want to break a hip. So the reason I do take them, the hip score is lower. And so yes I, I’d like to think that I’m doing now all that I possibly can in order to help myself.

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Blood and urine tests: biochemical markers

During bone remodelling substances are produced which can be detected in the blood and urine. These are known as biochemical bone markers. The levels of these markers can be used to measure the rate of bone turnover, giving useful indicators of bone strength and future fracture risks. Blood and urine tests alone cannot diagnose osteoporosis, people also need a DXA scan, but can be used to assess the effectiveness of treatment. Most treatments for osteoporosis work by reducing the rate of bone turnover, so monitoring bone loss with this technique may help with dosage adjustments of medication or help indicate the need to change to another medication if bone turnover is not reduced or back to normal within six months.

Some units use biochemical markers instead of DXA for monitoring treatment, the tests are a bit awkward; the patient has to fast and the sample must be taken at the same time of day each time. A few people told us that the biochemical markers of bone turnover are being used to assess their response to the prescribed medication.

Diana has blood tests now instead of DXA scans.

Age at interview 77

Gender Female

Age at diagnosis 72

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Now did you have another scan after you finished the treatment?

Yes, yes I did. But after that they did tell me that I, to, they don’t advise the deep bone scan now. But they say they can tell from the blood, taking blood now. So they, the deep bone scan isn’t so necessary any more. So every year I go to my GP and have s-, blood taken once a year. And it takes a couple of weeks or so before the results come back. But I go and see her every so often. And she, she did say that the osteoporosis was out of the spine, you know. So that was excellent, you know, as far as I was concerned. I feel very fortunate, you know, to have um done what I’ve done so far.

Who gave you this information?

Yes, that was up at the hospital. Yes, because I did suggest, you know, saying, Well, can I have a deep bone scan But then I was told, Well, the blood will tell us as much as having a deep bone sca.

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Being diagnosed with osteoporosis

Throughout life, the skeleton continually renews itself through a process known as remodelling or bone turnover. In healthy bone, the rate of bone breakdown is...

Who develops osteoporosis?

Throughout life, the skeleton is continually renewing itself through a process known as remodelling or bone turnover. In healthy bone, the rate of bone breakdown...