R.Kousalya.B.

Sc AHS
Junior Technologist
Westminster Health Care, Chennai
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 INTRODUCTION

Bone densitometry, also called dual-energy x-ray absorptiometry has become the

commonest and accurate method for measuring Bone Mineral Density and in add

ition it can also reliably quantitate the body composition in whole.

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TYPES OF X-RAY

kV – 70, mA - 3

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 ADVANTAGES

It uses very small dose of ionizing radiation

To diagnose Osteoporosis

To assess an individual’s risk for developing fractures

To Analyze Body Composition

It is simple, quick and noninvasive procedure

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 ANATOMICAL REGIONS
Lumbar spine Femur Neck Forearm

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INDICATIONS FOR BMD

Women and men aged 65 and older

For post-menopausal women

Prior fragility fracture

Smoking

High risk medication use

Disease or condition associated with bone loss

Pharmacological therapy(Treatment Effect)

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CONTRA INDICATIONS

Pregnancy

Extreme obese patients

Recent GI Contrast

Severe Degenerative changes

Fracture deformity (Measurement area)

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 PATIENT PREPARATION

No specific preparation is needed

Patient must be changed to hospital gown

All metal objects should be removed

Calcium supplements should be stopped 24hours before the exam

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IMPORTANT FACTORS..!!

Gender Height & Weight

Age Ethnicity

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 EQUIPMENT

Make : GE
Model : Lunar Prodigy

1. Power switch
2. Table pad
3. Scan arm
4. Scan arm control panel

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 T score
Comparison by standard deviation (SD) to a young adult population,
matched for sex and ethnicity

Z score
Compared by SD to similar age, sex, and ethnicity population

If this score is unusually high or low, it may indicate a need for further medical
tests

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≥-1.0 : Normal
-1.0 to -2.5 : Osteopenia
≤-2.5 : Osteoporosis

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BMD (g/cm2)
T-score (YA)
Age

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POSITIONING & POST PROCESSING

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MEASUREMENT & ANALYSIS IS DONE
IN

SPINE FEMUR LEFT FOREARM

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 AP SPINE

CENTERING - Laser Light is centered in the midline 1.5cm below the iliac crest

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 Densitometry : USA (combined NHANES / Lunar)
Region BMD Young adult Age – matched
(g/cm2) T - score Z - Score
L1 1.196 0.5 1.0

L2 1.342 1.2 1.7

L3 1.403 1.7 2.2

L4 1.342 1.2 1.7

L1 –L4 1.325 1.2 1.7

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 DUAL FEMUR

CENTERING - Laser Light is centered over the femur, 2cm below the pubic symphysis

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 Densitometry : USA (combined NHANES / Lunar)
Region BMD Young adult Age – matched
(g/cm2) T - score Z - Score
Neck Left 0.990 -0.3 0.5
Neck Right 1.009 -0.2 0.6
Neck Mean 0.999 -0.3 0.6
Neck difference 0.019 0.1 0.1
Total Left 0.928 -0.6 -0.1
Total Right 0.970 -0.3 0.2
Total Mean 0.949 -0.5 0.1
Total Diff 0.042 0.3 0.3

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 LEFT FOREARM

CENTERING - Laser Light is centered over the wrist, adjacent to ulna.

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 Densitometry : USA (combined NHANES / Lunar)

Region BMD Young adult Age – matched

(g/cm2) T - score Z - Score
Radius UD 0.434 -0.8 -0.8

Radius 33% 0.850 -0.4 -0.4

Radius Total 0.714 0.5 0.5

Both Total 0.711 - -

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 ADDITIONAL VIEWS

•Lateral spine

•LVA (Lateral Vertebral Assessment)

•APVA
•Dual VA (APVA and LVA)

•Orthopedic hip

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 FRACTURE RISK ASSESSMENT TOOL

Fracture Risk Assessment Tool (FRAX) is used as a assessment modality for the pr

ediction of fractures on the basis of clinical risk factors.

It uses an algorithm developed by the World Health Organization(WHO), it

automatically incorporates the results from a femoral bone mineral density

(BMD) test, while also considering risk factors.

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CLINICAL INPUT FOR FRAX
ESTIMATION

Age & Gender

Height & weight

Previous fracture

Parent history of hip fracture

Smoking

Excessive consumption of Alcohol

Glucocorticoid therapy

Secondary Osteoporosis

Femoral Neck BMD

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FRAX* 10-year Probability of Fracture

Major osteoporotic fracture 6.2%

Hip fracture 1.2%
Population India
Risk factors Family hist. (Parent hip fracture)

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Body Composition Analysis

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 BODY COMPOSITION ANALYSIS

•It is used to describe the percentage of Fat mass, bone mass and lean mass

Total body weight

Fat

Bone

LEAN MASS BODY

•Muscle
•Organ
•Blood
•water

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INDICATIONS FOR BODY COMPOSITION

Patients with metabolic syndromes

Assessment of underweight or anorexic individuals

Monitoring exercise programmes

Weight categorization for Athletes

Obese patient’s assessment prior to bariatric surgery

Muscle wasting conditions - cancer, HIV etc.

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 WHOLE BODY ANALYSIS

CENTERING - Laser Light is centered 3cm above the head

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 DONE TO ESTIMATE..!

• Body Mass Index (BMI)

• Estimated visceral adipose tissue

• Region wise composition

• Relative Skeletal Muscle Index (RSMI)

• Resting Metabolic Rate (RMR)

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 BODY MASS INDEX (BMI)

13 18.3 25 30 35

Underweight Normal Overweight Obese

32 46 62 86
74

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 VISCERAL ADIPOSE TISSUE

• In humans main fat storage areas are Android and the Gynoid region (

Abdomen, Hips and Thighs)

• It is s a specific type of fat that is associated with several types of metabolic

diseases such as obesity, hypertension and Diabetic

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 REGION WISE COMPOSITION

Composition (Enhanced Analysis)

Region Tissue) centile Total mass Region Tissue Fat Lean BMC Fat free
(%fat) (kg) (%fat) (g) (g) (g) (g) (g)

Trunk 26.0 - 32.2 25.5 31,518 8,210 23,307 727 24,034

Trunk Right 26.6 - 16.3 26.0 15,943 4,240 11,703 370 12,073
Trunk Left 25.5 - 15.9 24.9 15,574 3,970 11,604 357 11,961
Android 26.0 - 4.6 25.7 4,531 1,177 3,354 41 3,395
Gynoid 29.1 - 10.7 28.4 10,434 3,039 7,395 264 7,659
Total 26.4 37 66.3 25.4 63,764 16,825 46,939 2,529 49,468
Total Right 26.7 - 33.2 25.4 31,910 8,535 23,375 1,272 24,647
Total Left 26.0 - 33.1 25.7 31,854 8,290 23,564 1,257 24,821

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 RESTING METABOLIC RATE (RMR)

•The resting metabolic rate (RMR) is the number of calories the body requires
at rest

•It represents the minimum amount of energy needed to maintain body tempe
rature, heartbeat and respiratory rate

RMR = (10 x Weight in kg) + (6.25 x Height in cm) – (4.92 x Age) + 5

(For Female – 161)

The Mifflin-St Jeor Equation

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RELATIVE SKELETAL MUSCLE INDEX
(RSMI)
• It represents the relative amount of muscle in the arms and legs

RSMI = [Lean mass of arms (kg)) + Lean mass of legs(kg)/Height (m)]2

Baumgartner RN

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 CONCLUSION

Bone Mineral Density(BMD) with Body Fat Composition can play a vital role in complementing

the clinicians to treat metabolic syndromes and to prevent the incidence of fractures in susce

ptible individuals.

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My sincere thanks:-) to all doctors, RS
O and Techs of Westminster healthca
re

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