Expert DXA Scan Interpretation Alerts Referring Physicians to Bone Health Issues

Two pediatric gastroenterologists are ensuring that physicians receive a detailed interpretation of every bone scan ordered through Cincinnati Children’s. Their expertise provides critical information about bone health for children with cancer, cerebral palsy, eosinophilic esophagitis, inflammatory bowel disease, chronic liver disease, neuromuscular diseases and many other conditions.

A. Adjowa Amevor, MD, CNSC, and Sarah Orkin, MD, CCD, have been reviewing dual-energy X-ray absorptiometry (DXA) scans since November 2020, averaging 20 to 30 per week. In addition to checking for technical concerns, such as whether the patient was positioned optimally for the scan, they analyze results in the context of the patient’s clinical presentation.

“Knowledge of the patient’s condition and treatment course is important to consider when giving an interpretation,” says Orkin, who is a certified clinical densitometrist. “Growth failure, pubertal delay, a history of compression fractures, non-ambulatory status and medication use all affect bone health. You have to be aware of the whole picture instead of just reading test results independent of those factors.”

DXA scan results can create awareness about bone mineral density issues that increase the risk for fractures, which can be devastating for children with certain conditions. For those with Duchenne muscular dystrophy (DMD) or cystic fibrosis, for example, a vertebral fracture can affect their ability to breathe, which is of critical importance to their disease process. For patients with DMD, a long bone fracture may result in a life-threatening fat embolism. Even when fractures don’t lead to catastrophic outcomes, they can be painful and negatively affect a child’s quality of life.

Amevor and Orkin both completed an Advanced Nutrition fellowship at Cincinnati Children’s and received DXA interpretation training. Their work with DXAs derives from their clinical interest in maximizing bone health through nutritional interventions.

Scan results may prompt the care team to modify a child’s medication regimen. For example, if the child is on corticosteroids and has developed low bone mineral density, consideration is given to steroid tapering or beginning a steroid-sparing regimen. If that isn’t possible (as in the case of DMD patients, for whom steroids are a mainstay of therapy), Amevor and Orkin may make other recommendations. These can include a referral for nutritional services, endocrinology or physical therapy to optimize the child’s bone health.

“Multiple subspecialties rely on DXA scans to guide clinical care decisions, which is why it’s important for trained physicians to interpret them for the care team,” Orkin says. “Ordering physicians often come back to us with questions or to talk about possible nutrition interventions.”

To learn more, contact Sarah Orkin, MD.