Bone Densitometry

By Sara Foster

(Bone Mineral Density [BMD] Test, Bone Density Test, Bone Mineral Content, Bone Absorptiometry)

Procedure overview

What is bone densitometry?

Bone densitometry is used to measure the bone mineral content and density. This measurement can indicate decreased bone mass, a condition in which bones are more brittle and more prone to break or fracture easily. Bone densitometry is used primarily to diagnose osteoporosis and to determine fracture risk. The testing procedure measures the bone density of the bones of the spine, pelvis, lower arm, and thigh.

Bone densitometry testing may be done using X-rays, dual-energy X-ray absorptiometry (DEXA or DXA) or by quantitative CT scanning using special software to determine bone density of the hip or spine. These procedures are generally done in a clinic, hospital, or free-standing radiology facility.

However, for mass screening purposes, there are portable types of bone densitometry testing. The portable testing is done using either a DEXA (or DXA) X-ray device or a quantitative ultrasound unit. Both types of portable testing may use the radius (one of the two bones of the lower arm), wrist, fingers, or heel for testing. The portable testing, while useful for general screening, is not as precise as the nonportable methods because only one bone site is tested.

Standard X-rays may detect weakened bones. However, at the point where bone weakness is obvious on standard X-rays, the bone weakness may be too far advanced for treatment to be effective. Bone densitometry testing can determine decreasing bone density and strength at a much earlier stage when treatment of the bone weakness can be beneficial.

Test results

The bone densitometry test determines the bone mineral density (BMD). Your BMD is compared to two norms--healthy young adults (your T-score) and age-matched (your Z-score).

First, your BMD result is compared with the BMD results from healthy 25- to 35-year-old adults of your same sex and ethnicity. The standard deviation (SD) is the difference between your BMD and that of the healthy young adults. This result is your T-score. Positive T-scores indicate the bone is stronger than normal; negative T-scores indicate the bone is weaker than normal.

According to the World Health Organization, osteoporosis is defined based on the following bone density levels:

  • A T-score within 1 SD (+1 or -1) of the young adult mean indicates normal bone density.

  • A T-score of 1 to 2.5 SD below the young adult mean (-1 to -2.5 SD) indicates low bone mass.

  • A T-score of 2.5 SD or more below the young adult mean (more than -2.5 SD) indicates the presence of osteoporosis.

In general, the risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of 1 SD below normal (T-score of -1) has twice the risk for bone fracture as a person with a normal BMD. A person with a T-score of -2 has four times the risk for bone fracture as a person with a normal BMD. When this information is known, people with a high risk for bone fracture can be treated with the goal of preventing future fractures. Severe (established) osteoporosis is defined as having a bone density that is more than 2.5 SD below the young adult mean with one or more past fractures due to osteoporosis.

Secondly, your BMD is compared to an age-matched norm. This is called your Z-score. Z-scores are calculated in the same way, but the comparisons are made to someone of your age, sex, race, height, and weight.

In addition to bone densitometry testing, your doctor may recommend other types of tests, such as blood tests, which may be used to detect the presence of renal (kidney) disease, evaluate the function of the parathyroid gland, evaluate the effects of cortisone therapy, and/or assess the levels of minerals in the body related to bone strength, such as calcium.

Other related procedures that may be used to diagnose bone problems include bone scan and X-rays of the bones. Please see these procedures for more information.

Reasons for the procedure