The Secondary Care DXA Service (SCDS) provides access to DXA scanning for secondary care clinicians' referrals of patients with agreed risk factors for osteoporosis. The risk factors that merit referral are the same as used for the DADS service for primary care clinicians (see below). The SCDS also permits referral of patients who have diseases or who require treatments that can adversely affect bone mineral density
The Secondary Care DXA Service (SCDS) provides access to secondary care clinicians for referrals of patients with at least one of the following referral criteria:
1) past history of low trauma fractures (outwith RTA & other than resulting from fall from above head height) in men or women age >50 years,
2) use of at least 5mg Prednisolone per day for >3 months – ongoing or starting steroids with that expectation of treatment
3) age >60 and early menopause under age 45 (without HRT),
4) age >60 and acquired kyphosis
5) age >60 and significant self-reported height loss
6) age >60 and first-degree relative with DXA-proven osteoporosis,
7) age >60 and first-degree relative with history of low trauma fracture,
8) age >60 and first-degree relative with acquired kyphosis,
9) use of Depo-provera for more than five years where result of DXA will influence management.
Other appropriate indications for DXA referral (a list that is by no means exhaustive):
Endocrinology: primary or secondary hypogonadism including Turner’s syndrome; Cushing’s syndrome/Cushing’s disease; thyrotoxicosis & primary hyperparathyroidism.
Rheumatology: severe chronic rheumatoid arthritis; vasculitis or polyarthritis requiring long-term steroid therapy.
Gastroenterology: chronic liver disease, liver transplant, malabsorption syndrome such as coeliac disease & severe inflammatory bowel disease requiring prolonged steroid treatment..
Nephrology: renal transplant; long-term steroids for management of glomerulonephritis or other renal diseases or vasculitides.
Respiratory Medicine: cystic fibrosis, asthma requiring high-dose inhaled steroids or frequent or prolonged courses of oral steroids; other pulmonary diseases such as pulmonary fibrosis requiring prolonged steroid therapy. Oncology: treatment with aromatase inhibitor
The SCDS requires completion by the referring clinician of the specific referral form. Patients are appointed for DXA (but this service does not provide consultation with Nurse Specialists nor with a Physician with an interest in osteoporosis). The SCDS process is outlined in this diagram.
A patient-specific report generated through the GISMO database is produced for each patient; this integrates the DXA results with risk factors for osteoporosis & for falls and fractures and includes a patient-specific treatment recommendation. Follow-up DXA scanning where warranted is recommended after an appropriate time interval.