How do I know which type of test should be ordered

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Tests for osteoporosis are either done to screen an individual to detect the presence of bone loss or done to monitor the progress of previously diagnosed bone loss. You may recall from Question 24 that the only tests used to diagnose osteoporosis are those that test the bone density of your spine or hip. Tests that are performed on peripheral limbs (hands, forearms, wrists, lower leg, and feet) are primarily used for screening. However, if you are obese, peripheral bone mineral density testing at the forearm is often used for diagnosis because most DXA machines are inaccurate for and cannot accommodate individuals who weigh more than 250 pounds.

Peripheral limbs

The outer areas of the body, including hands, forearms, wrists, lower leg, and feet.

Peripheral bone mineral density testing

Bone mineral density tests of the non-central bones, usually heel, wrist, forearm, or fingers.

The test that your clinician orders for you may be determined by many factors. Some of them are the availability of test sites and machines; your private insurance coverage or Medicare; and your individual medical situation, which includes your medical history, your risk factors for bone loss, whether you already have bone loss, and if you can travel to the specific testing site.

If you attend a health fair where you are screened for bone loss using a portable machine, there is not likely to be a choice of tests. And if the portable testing shows bone loss, your clinician may advise you to get a test of your spine or hip (DXA or QCT) to confirm a diagnosis of osteoporosis.

If you are reluctant to have a QCT due to the radiation or the expense, you should ask if there is an alternative test that could be done.

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