DEXA Scanning Recommendations for Endocrine Disorders and Osteoporosis Risk

Primary Indications for DEXA Scanning

The American College of Radiology recommends DEXA scanning for patients with Hashimoto's thyroiditis who have additional risk factors for osteoporosis, particularly if they are receiving long-term glucocorticoid therapy, as thyroid disorders are considered endocrine conditions that can adversely affect bone mineral density. 1
Patients with Hashimoto's thyroiditis who are receiving (or expected to receive) glucocorticoid therapy for >3 months should undergo DEXA scanning. 1, 2
DEXA scanning is indicated for patients with Hashimoto's who have an endocrine disorder known to adversely affect BMD (including hyperthyroidism, which may occur during periods of hashitoxicosis). 1
The American Academy of Family Physicians recommends DEXA scanning for postmenopausal women with Hashimoto's aged 65 years and older (standard recommendation for all women in this age group). 3
Postmenopausal women with Hashimoto's younger than 65 years who have additional risk factors for fracture should undergo DEXA scanning. 3

Additional risk factors that should prompt DEXA testing include: history of fragility fracture, body weight less than 127 lb (58 kg), and parental history of hip fracture. 3
The American College of Radiology recommends DEXA testing for patients with prolonged immobilization or malabsorption/malnutrition (which may occur with autoimmune comorbidities). 1
Follow-up DEXA scans should be performed every 1-2 years for patients on glucocorticoid therapy, and every 2 years for monitoring BMD changes in untreated patients with risk factors. 1
Z-scores (not T-scores) should be reported for premenopausal women and men under 50 with Hashimoto's, as they represent gender- and age-matched controls for evaluation of secondary osteoporosis. Z-scores of -2.0 or less are considered to be below the expected age range. 1

DXA lumbar spine and hip(s) is the primary recommended modality (rated 9/9 for appropriateness). 4
For patients with advanced degenerative changes of the spine, QCT lumbar spine and hip may be more appropriate. 6

The American Academy of Family Physicians recommends the following daily dietary allowances for calcium and vitamin D:
- Ages 19-50: 1,000 mg calcium, 600 IU vitamin D
- Ages 51-70: 1,200 mg calcium, 600 IU vitamin D
- Ages 71+: 1,200 mg calcium, 800 IU vitamin D 3
Lifestyle modifications including weight-bearing exercise, smoking cessation, and reducing alcohol intake are recommended for prevention. 3
Treatment is recommended for T-score of -2.5 or less. For T-scores between -1.0 and -2.5, FRAX can assist in making treatment decisions. 3
Treatment should also be considered in patients who have had a low-trauma fracture, even if DEXA does not indicate osteoporosis. 3