Bone Abstracts

Background: Demand for timely DXA scanning is rising as services balance capacity for both osteoporosis care and oncology patients receiving endocrine therapies with the need to access anabolic bone therapy. Our aim was to estimate the clinical value of a local DXA guideline to reduce early repeat scans and the potential to increase capacity.

Methods: We conducted a retrospective multisite audit across five National Health Service (NHS) bone densitometry services. Repeat intervals were categorised as early, on-time, or late relative to local guidance based on NOGG 2020 guidance: A documented fracture on treatment in the referral text would permit earlier DXA scanning; otherwise, 5 years for oral bisphosphonates, 3 years for zoledronate, 10 years for denosumab, 2 years for teriparatide, and 3 years for patients receiving no active therapy. Patients receiving denosumab without a major fracture are not recommended to have a DXA. Bone protection therapy that was not otherwise specified was assigned a minimum interval of 5 years. For those adults on aromatase inhibitor or androgen deprivation therapy, the 2020 ESMO guidance was followed.

Results: Across the five NHS sites, 591 DXA scans were collected: 354 (59.9%) were first scans and 235 (39.8%) were repeat scans. Of repeat scans with paired data, 52.2% (121/232) were classified as early, representing one in five of all scans performed. Non-cancer repeats were predominantly early (68.8%), accounting for 505 patient-years of scanner capacity, whereas CTIBL repeats were more frequently on-time (63.8%) or late (32.8%). Of these early scans, only 2 included an incident fracture in the indication.

Conclusion: Adopting more stringent repeat-scan criteria has the potential to significantly improve DXA scan capacity, and further research is needed to assess clinical value by examining changes in BMD relative to the reported least significant change.