BMD — Radiology Now

Age	Category	Criteria
< 50 years	Below expected range for age	Z-score ≤ -2.0
	Within expected range for age	Z-score > -2.0
> 50 years	Severe (established osteoporosis)	T-score ≤ -2.5 with fragility fracture
	Osteoporosis	T-score ≤ -2.5
	Low bone mass	T-score -1.0 to -2.5
	Normal	T-score ≥ -1.0

T-score: number of standard deviations above (+) or below (-) the mean peak density;
Z-score: number of standard deviations above (+) or below (-) the mean density for an individual of that age and sex.

Fracture Risk: (10-year absolute): low (<10%) moderate (10% to 20%), or high (>20%).

Fracture risk predicted for an individual by this system applies only for a finite period of time, and that risk will change with advancing age or with the development of new clinical risk factors. Based on 2010 CAROC system. Papaioannou, A et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-73.

For the purpose of second and subsequent testing (MOHLTC Schedule of Benefits, 2010)

“high risk patient” means a patient:

1. at risk for accelerated bone loss (in the absence of other risk factors, patient age is deemed not to place a patient at high risk for accelerated bone loss); or

2. with osteopenia or osteoporosis on any previous BMD testing, or

3. with bone loss in excess of 1% per year as demonstrated by previous BMD testing.

High risk patient is limited to a maximum of one test every 12 months unless the ordering physician obtains written prior authorization from a medical consultant.

“low risk patient” means a patient who is not a high risk patient. Limited to a maximum of one second test not earlier than 36 months following baseline; subsequent test not earlier than 60 months following the second or any subsequent test.

Recommended Timing of Follow-Up BMD Tests

Expected Rate of BMD Change	Clinical Example	Timing of Follow-Up
Very High	Moderate to high dose glucocorticoids, anabolic agent	6-12 months
High	Osteoporosis drug therapy initiated or changed, low to moderate dose glucocorticoids	1-3 years
Moderate	Therapy with nutritional supplements or lifestyle improvements	1-3 years
Low	Stability documented on nutritional supplements or lifestyle improvements and with no change in clinical status; drug therapy shows to be effective	3-5 years
Very Low	Normal results or low fracture risk, and no clinical risks	5-10 years

In some jurisdictions, the timing of follow-up may be restricted by provincial health insurance plans. In these circumstances, follow-up recommendations need to be applied in the context of local restrictions.

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Expected Rate of BMD Change	Clinical Example	Timing of Follow-Up
Very High	Moderate to high dose glucocorticoids, anabolic agent	6-12 months
High	Osteoporosis drug therapy initiated or changed, low to moderate dose glucocorticoids	1-3 years
Moderate	Therapy with nutritional supplements or lifestyle improvements	1-3 years
Low	Stability documented on nutritional supplements or lifestyle improvements and with no change in clinical status; drug therapy shows to be effective	3-5 years
Very Low	Normal results or low fracture risk, and no clinical risks	5-10 years

BMD Measurement Information

Recommended Timing of Follow-Up BMD Tests