Bone Mineral Densitometry (BMD)
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Important Information Re: BMD Bookings
May 3, 2010
Recently we have been made aware by the Ministry of Health and Long Term Care that some of our patients do not qualify for OHIP funding for BMD studies. Some of our patients fell outside the regulated time requirements. As a result, these have paid for these studies. To minimize the number of patients paying for this service we have outlined the MOHLTC regulations for clarity.
August 11, 2010
The MOHLTC has changed the guidelines for Low Risk BMDs. The update is shown below.
Low Risk BMD
- Second low risk BMD can be performed 36 months after the baseline.
- Third and subsequent low risk BMD’s can be performed no earlier than 60 months (5 years) after the previous BMD.
High Risk BMD
A high risk BMD can be performed once per year.
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);
2. with osteopenia or osteoporosis on any previous BMD testing;
3. with bone loss in excess of 1% per year as demonstrated by previous BMD testing.
For patients booking a BMD we are required to know the date of their previous and if they are high risk or low risk. We ask our referring physicians to please indicate on the requisition if the patient is high risk or low risk.
If a patient is low risk and books before the specified time frame has passed, the MOHLTC will reject their claim and the patient will be invoiced for the cost of the service. At LXA we do our best to screen the patients. Unfortunately, sometimes a patient has had a previous BMD study somewhere else and we are unaware. To support the patient, we ask our referring physicians to please attach the previous BMD report to the requisition.
For patient safety, patients exceeding the weight limit of 340 lbs. will not be done at London X-Ray Associates.
Bone mineral densitometry measures the amount of minerals and calcium within bones. A decrease in the strength of bone due to decreased mineral content is called osteoporosis. Osteoporosis increases the likelihood of breaking (fracturing) a bone. BMD is done to identify those individuals at increased risk for fractures. Two of the most common places to fracture in those with weak bones are the spine and the hip. Because of this, BMD is most commonly performed at these two sites.
The BMD machine passes a thin carefully controlled beam of x-ray through the body. The more mineral (calcium) present, the fewer x-ray make it through the body to be detected by the machine. A computer attached to the machine is able to calculate the amount of mineral present by determining how much of the x-ray beam has been absorbed.
This examination takes about 15 minutes.
Common Reasons for BMD
Some of the more common reasons why your doctor would order a BMD include:
- Early menopause (<45 years old)
- Use of steroid (cortisone-like) medications taken for long periods of time
- Depo-Provera use
- Family history of osteoporosis
- Previous spine, hip, or wrist fracture
- Poor nutrition
- Thyroid abnormalities
- Previous chemotherapy
- Use of anti-seizure medication
- Low body weight
- Cigarette smoking
Who should not have a BMD?
BMD, and indeed all x-ray examinations, should not be performed on pregnant women except when the information provided by the test is vital to treatment of the patient and there are no suitable alternatives.
BMD should be done at least 24 hours after nuclear medicine scans. Patients who have had a barium swallow, upper GI series, small bowel follow-through, barium enema, or CT scan of the abdomen should wait at least 72 hours before having BMD.
How do I prepare for the test?
Calcium and iron pills should be avoided on the day of the examination. There can be no metal overlying the area of the BMD scanning. Belly button rings should be removed.
Who performs the examination?
An x-ray technologist (someone trained to take x-ray images) who specializes and is accredited in Bone Mineral Densitometry.
What happens during the examination?
It is not necessary for the patients to undress for the examination if they avoid wearing metal buttons, zippers or belt buckles over the lower spine and hips. A gown will be provided if necessary. You will be taken to a room containing a BMD machine and a computer. You will lie on your back on a bed while a mechanical arm passes over your spine and hip regions. The machine does not come close to your body. There is no pain and no needles.
What are the risks of the procedure?
All x-rays involve receiving a controlled amount of radiation. The risk associated with the radiation received during a single x-ray examination is very small. While the exact likelihood is controversial, there is a very small chance of the radiation contributing to the development of a malignancy many years in the future. The risks involved in everyday activities such as driving a car are far higher. Generally, the risk of not doing the x-ray far outweighs the risk of the small amount of radiation involved.
Who interprets the results and how do I get them?
The results are interpreted by one of our radiologists and are sent by fax to the doctor who ordered the BMD.
Arrangements to discuss the results of the BMD can be made with the doctor who ordered the exam.
Are childcare (baby sitting) services available while I have my exam?
No childcare services are available. Please prearrange the following:
Adult supervision in the waiting room must be provided at all times for children while you, the caregiver, are having your exam completed. London X-Ray Associates staff will not be able to provide any childcare needs. We ask that all children be supervised by an adult, other than the patient, while at London X-Ray Associates.