WELL Health Diagnostic Centres

BMD Measurement Information

AgeCategoryCriteria
< 50 yearsBelow expected range for ageZ-score ≤ -2.0
Within expected range for ageZ-score > -2.0
> 50 yearsSevere (established osteoporosis)T-score ≤ -2.5 with fragility fracture
OsteoporosisT-score ≤ -2.5
Low bone massT-score -1.0 to -2.5
NormalT-score ≥ -1.0

bT-score: number of standard deviations above (+) or below (-) the mean peak density;
Z-score: number of standard deviations above (+) or below (-) the mean density for an individual of that age and sex.

cFracture Risk: (10-year absolute): low (<10%) moderate (10% to 20%), or high (>20%).

Fracture risk predicted for an individual by this system applies only for a finite period of time, and that risk will change with advancing age or with the development of new clinical risk factors. Based on 2010 CAROC system. Papaioannou, A et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-73.

dFor the purpose of second and subsequent testing (MOHLTC Schedule of Benefits, 2010)

“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); or

2. with osteopenia or osteoporosis on any previous BMD testing, or

3. with bone loss in excess of 1% per year as demonstrated by previous BMD testing.

High risk patient is limited to a maximum of one test every 12 months unless the ordering physician obtains written prior authorization from a medical consultant.

“low risk patient” means a patient who is not a high risk patient. Limited to a maximum of one second test not earlier than 36 months following baseline; subsequent test not earlier than 60 months following the second or any subsequent test.

Recommended Timing of Follow-Up BMD Tests

Expected Rate of BMD ChangeClinical ExampleTiming of Follow-Up
Very HighModerate to high dose glucocorticoids, anabolic agent6 to 12 months
HighOsteoporosis drug therapy initiated or changed, low to moderate dose glucocorticoids1 to 3 years
ModerateTherapy with nutritional supplements or lifestyle improvements1 to 3 years
LowStability documented on nutritional supplements or lifestyle improvements and with no change in clinical status; drug therapy shows to be effective3 to 5 years
Very LowNormal results or low fracture risk, and no clinical risks5 to 10 years

In some jurisdictions, the timing of follow-up may be restricted by provincial health insurance plans. In these circumstances, follow-up recommendations need to be applied in the context of local restrictions.

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BMD Equipment Specifics

LocationBrandModelSerial Number
CalgaryGE LunarProdigy iDXA212391MA
Lindsay HospitalGE LunarProdigy Series1RDF+5000018
London FanshaweGE LunarProdigy AdvanceP8/PA+300482
London WharncliffeGE LunarProdigy Advance130476
MiltonGE LunarProdigy Advance17/08/2726
MississaugaGE LunarProdigy AdvancePA+310220
North YorkGE LunarProdigy Series8743/9055845PROD
OshawaGE LunarProdigy SeriesIRDF-85134
PickeringGE LunarProdigy SeriesPA+15023
Port PerryGE LunarProdigy Series63327
SarniaGE LunarProdigy Series63136
Sault Ste. MarieGE LunarProdigy Advance41191GR
ScarboroughGE LunarProdigy SeriesPA+130461
SimcoeGE LunarProdigy SeriesLU43616EN
Sudbury ElmGE LunarProdigy SeriesPA+301850
ThornhillGE LunarProdigy SeriesC00878-BMD-1

Suggested Timelines for Reassessment of BMD and Fracture Risk.

Centres using FRAX2Centres using CAROC*
If initiated pharmacotherapy:3yIf initiated pharmacotherapy3y
If not a candidate for or chose not
to take pharmacotherapy:
If not a candidate for or chose not
to take pharmacotherapy
If 10-y fracture risk <10%5-10yIf 10-y fracture risk <10% (low risk)5-10y
If 10-y fracture risk 10%-15%5yIf 10-y fracture risk=10%-20% (moderate risk)3-5y
If 10-y fracture risk >15%3yIf 10-y fracture risk >20% (high risk)3y

*CAROC-based recommendations are a best fit of the FRAX-based recommendations.

CAR Practice Guideline on Bone Mineral Densitometry Reporting

ParameterPopulationNormative databaseComments
T-scorePostmenopausal women, Men aged 50 y or olderWhite female NHANES III for femoral neck and total hipthis T-score is used for both diagnostic category and fracture risk assessment
White female vendor database for other sitesthough fracture risk is then established (FRAX, CAROC) using sex-specific fracture
Z-scoreUsed clinically only in premenopausal women and men aged less than 50yPopulation specific vendor database for all sitesZ-scores should be population specific where adequate reference data exist³
However, vendor BMD output typically includes the Z-score for all patientsThis should include sex-specific data
It may include ethnicity-specific, using the patient's self-reported ethnicity, if adequate reference data exists³
As per the CAR Practice Guideline on Bone Mineral Densitometry Reporting: 2024 Update, it is now recommended that the T-score used in establishing both the diagnostic category and the fracture risk is based on the female normative database.1,2
  1. Burrell S, et al. CAR Practice Guideline on Bone Mineral Densitometry Reporting: 2024 Update. Canadian Association of Radiologists Journal. 2025;76(3):417–426.
  2. The International Society for Clinical Densitometry. 2023 ISCD Official Positions Adult. 2023.