title: Recommendations for bone mineral density reporting in Canada.
abstract: OBJECTIVE
  To propose a set of recommendations for optimal bone mineral density (BMD) reporting in postmenopausal women and older men and to provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture.
  
  
  METHODS
  The current methods of BMD reporting were reviewed. In this document, we propose that an individual's 10-year absolute fracture risk, rather than BMD alone, be used for fracture risk categorization. Consequently, age, sex, BMD, fragility fracture history, and glucocorticoid use are the basis for the approach outlined in this document.
  
  
  RESULTS
  An optimal BMD report as proposed in this document will provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture. A BMD report format, a checklist, and a patient questionnaire are meant to further encourage its use.
  
  
  METHODS
  All recommendations were developed using a consensus from clinicians and experts in the field of BMD testing and a standard method for the evaluation and citation of the supporting evidence.
  
  
  METHODS
  These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of the Osteoporosis Society of Canada and the Canadian Association of Radiologists. BENEFITS, HARM, AND COSTS: Optimal BMD reports help the practitioner to assess an individual's risk for osteoporotic fracture and to decide whether medical therapy is warranted.
  
  
  CONCLUSIONS
  The BMD report should include: patient identifiers. Dual-energy X-ray absorptiometry (DXA) scanner identifier. BMD results expressed in absolute values (g/cm2; 3 decimal places) and T-score (1 decimal place) for lumbar spine; proximal femur (total hip, femoral neck, and trochanter); and an alternate site (forearm BMD preferred: 1/3 radius, 33% radius or proximal radius) if either hip or spine is not valid. A statement about any limitations due to artifacts, if present. The fracture risk category (low, moderate, or high) as determined by using Tables 3 and 4 and by including major clinical factors that modify absolute fracture risk probability (with an indication of the corresponding absolute 10-year fracture risk of <10%, 10-20%, or >20%). A statement as to whether the change is statistically significant or not for serial measurements. The BMD centre's least significant change for each skeletal site (in g/cm2) should be included.
  
  
  RESULTS
  Recommendations were based on consensus opinion. Since these are the first Canadian recommendations integrating clinical risk factors in a quantitative fracture risk assessment, it is anticipated that these "Recommendations for BMD Reporting in Canada" will be a work in progress and will be updated periodically to accommodate advances in this field.
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB. kerrygs@telusplanet.net
authors.forename: Kerry
authors.initials: K
authors.lastname: Siminoski
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Heather
authors.initials: H
authors.lastname: Frame
authors.forename: Anthony
authors.initials: A
authors.lastname: Hodsman
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Aliya
authors.initials: A
authors.lastname: Khan
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lentle
authors.forename: Jacques
authors.initials: J
authors.lastname: Lévesque
authors.forename: David J
authors.initials: DJ
authors.lastname: Lyons
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarulli
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
mesh_terms: D015502:Absorptiometry, Photon / Q000592:standards*; D000368:Aged; D015519:Bone Density; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging; D018570:Risk Assessment