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

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathways

Child Who May Benefit from a DXA Bone Scan

No or Low Risk
for Bone Disease

Moderate Risk
for Bone Disease

Diagnosed with or High Risk
for Bone Disease

Vitamin D deficiency
Obesity
Mild Malnutrition

Diseases associated with:
- Immobilization
- Malabsorption
- Inflammation
- Gonadal hormone imbalance
- High-Risk Medications

DXA scan not indicated

Consider DXA scan

Recommendations by Body System

Obtain DXA scan

DXA Scan Interpretation
Find results in EHR within DXA Encounter

DXA Scan Sites
Age	Standard Scan Sites	Alternative Scan Sites
1-2 yrs	Lumbar	Forearm
≥ 3-4 yrs	Lumbar Whole body	Forearm
≥ 5-17 yrs	Lumbar Whole body	Hip Forearm Lateral distal femur
≥ 18 yrs	Lumbar Hip	Forearm Whole body

Z-score > -2 to 2
Bone density within expected reference range

Z-score ≤ -2
Low bone mineral density

Absence of primary bone disorder and/or known risk factors for impaired bone health

Presence of primary bone disorder and/or known risk factors for impaired bone health

Absence of primary bone disorder and/or clinically significant fractures

Presence of primary bone disorder and/or clinically significant fractures

Reassess bone mineral density if clinical situation changes

Z-score > -2 does not rule out impaired bone health
Consider referral to Center for Bone Health, for further testing, and/or repeat DXA scan if:
- Prior history of and/or new minimally traumatic long bone or spine fractures
- Condition where recovery
  is not expected
- Ongoing and/or additional exposure to bone toxic medications

Optimize treatment and management of underlying disease
Repeat DXA scan as clinically indicated per guidance by body system or
DXA scan interpretation
Consider referral to
Center for Bone Health

Refer to Center for Bone Health
Treatment and DXA scan monitoring as indicated per specialist recommendations

Posted: September 2018
Revised: October 2024

Authors:
- M. Mascarenhas, MBBS;
- J. Webster, DO;
- D. Barsky, MD;
- F. Jannelli, RN;
- A. Calabria, MD;
- D. Weber, MD;
- A. Puma, MSN;
- BC. Min, PA;
- J. Zook, PharmD

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Outpatient Specialty Care and Primary Care Clinical Pathway for Children Who May Need a Dual Energy X-ray Absorptiometry (DXA) Bone Density Scan

Evidence

Outpatient Specialty Care and Primary Care Clinical Pathway for Children
Who May Need a Dual Energy X-ray Absorptiometry (DXA) Bone Density Scan