AbstractOsteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of20%within thefirst year. Dual x-ray absorptiometry(DXA)is the primary diagnostic modality bywhich to screen women>65years of age and men >70 years of age for osteoporosis. In postmenopausal women <65 years of age with additional risk factors for fracture, DXA is recommended. Some patients with bone mineral density above the threshold for treatment may qualify for treatment on the basis of vertebral body fractures detected through a vertebral fracture assessment scan, a lateral spine equivalent generated from a commercial DXA machine. Quantitative CT is useful inpatients with advanced degenerative bony changes in their spines. New technologies such astrabecular bone score represent an emerging role for qualitative assessment of bone in clinical practice. It is critical that both radiologists and referring providers consider osteoporosis in their patients, thereby reducing substantial morbidity, mortality, and cost to the health care system.TheAmerican College ofRadiologyAppropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewedjournalsand the application ofwell-established methodologies(RAND/UCLAAppropriateness Method and Grading ofRecommendations Assessment, Development, and Evaluation or GRADE)to rate the appropriateness ofimaging and treatment procedures for specificclinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Key Words: Appropriateness Criteria, Appropriate Use Criteria, AUC, DXA, fracture, osteoporosis, screeningJ Am Coll Radiol 2017;14:S189-S202. Copyright ◎ 2017 American College of RadiologyACR Appropriateness Criteria®Osteoporosis and Bone Mineral DensityExpert Panel on Musculoskeletal Imaging: Robert J. Ward, MDa, Catherine C. Roberts, MDb,Jenny T. Bencardino, MDc, Erin Arnold, MDd, Steven J. Baccei, MDe, R. Carter Cassidy, MD f,Eric Y. Chang, MD g, Michael G. Fox, MDh, Bennett S. Greenspan, MD, MSi, Soterios Gyftopoulos, MD j, Mary G. Hochman, MDk, Douglas N. Mintz, MDl, Joel S. Newman, MDm, Charles Reitman, MDn,Zehava S. Rosenberg, MDo, NehalA. Shah, MDp, Kirstin M. Small, MDp, Barbara N. Weissman, MDqaPrincipal Author, Tufts Medical Center, Boston, Massachusetts. bPanel Chair, Mayo Clinic, Phoenix, Arizona.cPanel Vice-Chair, New York University School of Medicine, New York, New York.dIllinois Bone and Joint Institute, Morton Grove, Illinois; American College of Rheumatology.eUMass Memorial Medical Center, Worcester, Massachusetts.fUK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Ame...
