Next time you get a bone densitometry report, take a few minutes to visit this website. I can almost guarantee your understanding of this investigation will improve.
This is a PowerPoint slide show that you can download to use later. You don’t need to watch it all and, to help you along, this web address starts you at slide eight, where it gets interesting. You can stop at slide 35 where it tells you what a DEXA scan measures, and why the selected areas (hip, spine, and sometimes forearm) are used for measurements.
There is a clear explanation of what a T-score and a Z-score are, and how they are calculated, and it also tells you why the T-score is the more important of the two. A diagnostic classification is given, followed by the all-important diagnostic caveats, such as why a T score of –2.5 does not always mean osteoporosis, and that a low T-score does not identify the cause. Highly recommended.
Why go there: to be able to understand T-scores at last.
Downside: takes up to 15 minutes to absorb properly.
Information from: International Society for Clinical Densitometry.
Apart from the fact that the Website of the Week (see right) slide show takes rather a long time to go through, my other criticism is that the excellent explanation is not accompanied by clinical images. But if you follow it up with a look at this website, your understanding will be further enhanced.
Here is the practical side of the exercise, with pictures of the machines used, and examples of DEXA scan images of the lumbar spine and left proximal femur.
These are followed by a results summary and a reinforcement of what you will have learnt about interpretation of the data from the slide show.
It’s only a couple of screens, so won’t take more than a few minutes.
Why go there: clinch your understanding of DEXA.
Information from: Royal National Hospital for Rheumatic Diseases.
I am not going to apologise for my enthusiasm for the quick reference guidelines from SIGN. This double-sided A4 print-out takes you through the key points of management, and there is an excellent flow chart.
This was published in 2003, so does not take account of the latest NICE recommendations on secondary prevention. But you can check on these with a quick visit to www.nice.org.uk/page.aspx?o=TA087quickrefguide
Why go there: neat summary.
Downside: not 100 per cent up-to-date.
Information from: Scottish Intercollegiate Guidelines Network.
I do not often enthuse about or recommend articles that are too long or complex, knowing how busy GPs are and their need to assimilate key facts as concisely as possible. But I have made this article an exception, with just over six pages of detailed information.
I urge you to read it, because it is so interesting and relevant to what is often a neglected area.
The headline of the article urges doctors to consider secondary disease first when encountering a man with osteoporosis, but there is also a lot of other helpful advice that is well written and presented.
There are graphs comparing male and female osteoporosis, tables of possible causes, and recommendations for investigations and treatment. The final messages are as important as they are simple — calcium, vitamin D and exercise should be part of any treatment plan, and prevention is better than cure.
Why go there: worth the effort.
Information from: Cleveland Clinic, Ohio.
I liked this charity website immediately — it does not mince its words. The first thing you read is a headline that ignores government spin and states ‘Women under 75 to be denied drugs to prevent broken bones’. With this, and a picture of Theo Walcott on the front page, I was hooked.
But it is your patients that this site is aimed at, and the answer to the question ‘What is osteoporosis?’ is dealt with intelligently, briefly and with some useful illustrations. I particularly liked the section on bone health, with plenty of useful advice about exercise, a health lifestyle and diet.
I appreciate any patient-orientated site that finds room for offering help to professionals, and this one does this well. If you go to ‘Support for professionals’ you can find out about Read codes, DXA scan thresholds, osteoporosis facts and figures, and much more. There is a booklet Living with Osteoporosis, but you have to pay £3 each, which seems a bit steep.
Why go there: best for patients.
Information from: National Osteoporosis Society.
- Dr Barnard is a former GP in Fareham, Hampshire