DXA Unit - Referral Criteria

Medical exposure authorisation criteria – bone density measurement

The operator’s are entitled to authorise requests for dual energy X-ray absorptiometry examinations, as justified, if:

  • the request is for a listed examination;
  • the request is an ‘adequate referral’ (see below);
  • the referrer group and clinical indications meet one or more of the criteria given.
  • If a request does not meet the conditions given above it should be held for review by an IRMER practitioner (Dr Clive Butcher, Consultant Radiologist).

Authorisation is to be indicated by the operator’s signature on the request card.

Examination  Bone densitometry of the spine and/or hip and/or wrist which may be requested as:
• DXA (scan)
• bone densitometry or similar.
If the request is for ‘bone scan’ and the clinical indication does not UNAMBIGUOUSLY identify it as for bone densitometry (eg appropriate reference to osteoporosis) then the request must be clarified with the referring team.
Adequate referral The referral request must:
• contain sufficient information to be able to correctly identify the patient according to the patient ID procedure;
• an indication of the test requested;
• sufficient clinical information to be able to authorise the request as justified;
• the name and signature of the referring doctor (‘pp’ is not acceptable);
• sufficient information to be able to identify an appropriate recipient for the test report.


 Clinical indications:  The patient must have at least one of the criteria listed below
 Referrer   Patient group    Indication

Registered medical practitioners from SFHT

Approved Nurse Specialists (undertaken relevant IRME(R) training)

General Practitioners (GPs)


Out-patients or in-patients, male or female aged 18 and over

GP patients, male or female aged 18 and over

A low trauma fracture 
(according to NICE guidelines)
An x-ray depicting significant osteopenia (plus one risk factor - see Nottinghamshire guidelines)
A history of an eating disorder, ie anorexia nervosa, bulimia
Gastrointestinal problems:
• Coeliac disease
• Inflammatory bowel disease
Endocrine disorders:
• Hyperparathyroidism
• Hyperthyroidism
• Type 1 diabetes 
Abnormal hormonal status:
• Untreated premature menopause < 45
• Untreated hysterectomy <45
• History of prolonged amenorrhoea >12 months
• Testosterone deficiency 
Drug induced risk: 
• Patients receiving Hormone Antagonists for breast cancer
• Patients receiving Hormone Antagonists for prostate cancer
• A history of prolonged corticosteroid use 
    (current or planned) 
    i) 3 months continuous 
   or ii) intermittent (3 courses /year)
• Anticonvulsants
• Depo-Provera >2 years 
Other risk factors:
•  Parental history of hip fracture
•  History of Dr. diagnosed osteoporosis in parent or sibling
• Rheumatoid arthritis
• Chronic liver disease
• Low body mass<19 / Anorexia nervosa
• Vitamin D deficiency
• Osteogenesis imperfecta
• FRAX risk assessment
• Recommended repeat DXA scan

Current clinical lead of the Osteoporosis service is: Dr Salman Hassoun, Locum Consultant Endocrinologist. 

Authorisation criteria prepared by: Dr Clive Butcher  Consultant Radiologist