Orthopaedics  |  Fragility Fracture Pathway - Refer for DEXA


Fragility Fracture Pathway - Refer for DEXA

A limited number of DHB-funded DEXA bone mineral density (BMD) scans are available for  primary  care clinicians.  Follow up and management is the responsibility of the clinician who orders the scan.

Patient eligibility - ALL SEVEN of the following criteria must be met:

1. The patient is between the ages of 50 and 75 (those aged over 75 who have a fragility fracture meet the criteria for biphosphonate therapy without DEXA scanning)

2. The patient has a recent (within last 4 months) fragility fracture, i.e. a fracture of wrist, humerus, ankle, pelvis, vertebrae or ribs that has been caused by a minimal trauma event usually as a result of a fall from a standing height or less.

3. The patient has not had a DEXA scan in the last 18 months

4. The patient has not had an isolated fracture of the face, hands, feet or clavicle

5. The patient does not have a fracture caused by evident trauma, e.g. motor vehicle accident or fall from ladder

6. The patient is not already on antiresorptive osteoporosis medication

7. The patient has not had been reviewed by the Fracture Prevention Service in the WBOP (i.e. used WBOP hospital services for fracture treatment) AND has not had a hip fracture.

Not all patients will require a DEXA scan but all should be considered for one.

Recent DEXA scan:
 If the patient has had a DEXA scan in the past 18 months to 2 years, please seek expert advice as the margin of error for the measurement often exceeds any actual differences in bone mineral density within this time frame and may not provide useful information.

DEXA scanning procedure: this takes approximately 15 minutes, is not claustrophobic and carries little risk. Other than pregnancy, there are few contraindications. However, the patient must be able to lie flat and flex their hips slightly so please do not refer your patient for a bone scan if they are unable to do this or if they would be within 2 weeks of a hip fracture (contraindicated).

Primary prevention: Patients without fragility fracture will not at present be eligible for DHB- funded DEXA scanning but which can still, of course, have this done privately.

How to refer:

An eReferral is now available via BPAC. Fax a Radiology Request form  annotated with "fragility fracture" and the '7 criteria' mentioned above. These can be copied and pasted with relevant clinical details into the form. Please fax forms to the Radiology department on 07 571 2573 in the WBOP and 07 306 0966 in the EBOP. 

Last updated : Monday, March 05, 2018
Next review date : Tuesday, March 05,2019

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.