Statement:  The North Carolina Rheumatology Association recommends that central DEXA studies be performed and appropriately reimbursed by insurance, for these additional conditions: 1) testosterone deficiency; 2) men over the age of 70; 3) men receiving hormonal therapy or manipulation for the treatment of prostate cancer; 4) men with any low trauma fracture (fragility fractures); and 5) men with rheumatoid arthritis and other autoimmune inflammatory diseases.

Discussion:  The NIH Consensus Statement on Osteoporosis Prevention, Diagnosis, and Therapy defines osteoporosis as "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality." Osteoporosis is a silent disease until bones become so weak that fractures occur. Osteoporosis is a major health problem in the United States, affecting approximately 10 million people and 20% of these are men. Approximately 18 million people have osteopenia and 20% of these are men. Thirty percent of all hip and vertebral fractures occur in men. Approximately one in every eight men over the age of 50 will have an osteoporotic fracture in his lifetime. Ultimately, in an extremely elderly population, one in every six men will have a hip fracture.

Osteoporosis in men has become a major health problem as the elderly population expands. In men, bone density declines slowly after 30 years of. age. A number of risk factors increase the chance of developing osteoporosis and fractures in men, including: smoking, excessive alcohol consumption, the use of corticosteroids and certain anti-seizure medications, inadequate intake of calcium and vitamin D, inadequate exercise, a family history of osteoporosis, and a previous history of low trauma fracture (hip, wrist, pelvis, etc.). Illnesses such as hyperthyroidism, hyperparathyroidism, and severe liver and kidney diseases can lead to osteoporosis. In men, the lack of testosterone and the use of some treatments for prostate cancer (e.g., Lupron) can also result in osteoporosis. Additionally, rheumatoid arthritis can increase bone resorption and can lead to metabolic bone disease.

Osteoporosis, in both men and women, is best diagnosed with a central bone density test, called a DEXA. Although both central and peripheral bone density tests can identify patients with osteoporosis or osteopenia, central DEXA studies are recognized as the only way to monitor response to therapy. Moreover, the World Health Organization definitions of disease prevalence using T-score equivalents are based on central, not peripheral, DEXA measurements.

Medicare and other insurance companies generally cover central DEXA studies in men for the following diagnoses: osteopenia (733.90), osteoporosis (733.00 - 733.09), hyperparathyroidism (252.0), vertebral fracture (733.13), or for monitoring of bone density when on chronic corticosteroids (V58.65) or monitoring response to therapy (V67.59).