Different approaches to bone densitometry

From 1990 to 2000, several effective new treatments were introduced for the prevention of osteoporotic fractures; these treatments were proven effecti ve in large, international, clinical trials. At the same time, there was ra pid technologic innovation, with the introduction of new radiologic methods for the noninvasive assessment of patients' bone density status. These dev elopments led to the publication of guidelines for the clinical use of bone densitometry that include criteria for the referral of patients for invest igation as well as recommendations for intervention thresholds for the init iation of preventive treatment of osteoporosis. Dual-energy x-ray absorptio metry scanning of the spine and hip remains the technique of choice for bon e densitometry studies, although there is now a wider appreciation of the n eed for smaller, cheaper devices for scanning the peripheral skeleton if th e millions of women most at risk of a fragility fracture are to be identifi ed and treated. This article reviews these developments, concentrating in p articular on the advantages and disadvantages of the different types of equ ipment available for performing bone densitometry investigations, the guide lines for the referral of patients, and the principles for the interpretati on of the scan findings.