EXAMINATION:  BONE DENSITOMETRY OF THE []                                                                                 DATE OF STUDY:  [date] [< > This template to be used only with pediatric patients under age 21]                                                                                 HISTORY:  [ ]-year-old [male/female] with [ ].  [She/He] is being treated with [ ].  Evaluate bone mineral density. The bone mineral density of each site was assessed by dual-energy x-ray absorptiometry.  Findings are reported for each site as: Z-Score (the number of standard deviations above or below the mean of the average bone mineral density for age-and gender-matched subjects) SPINE: [] Z-Score: [ ] [< >  add comments about significant degenerative changes or excluded vertebral bodies if needed]   HIP: Femoral Neck Z-Score: [ ] HIP: Total Hip Z-Score: [ ] For bone mineral density values in gm/sq-cm and plots of trends since prior exams, see separate printout (available with mailed reports and also on clindesk). IMPRESSION: 1.  The bone mineral density of the lumbar spine is [within/below – use a Z-score of -2.0 as the cutoff] the expected range for age.  When compared to the baseline exam of [date] there [has or has not] been a statistically significant [increase/decrease/change] in lumbar spine bone mineral density. Note that there should be an age-related increase in bone mineral density in children as a result of normal bone growth. The rate of increase of bone mineral density in this patient is[similar_to/greater_than/less_than] that of age-matched normal children. 2.  The bone mineral density of the left femoral neck [within/below – use a Z-score of -2.0 as the cutoff] the expected range for age.  When compared to the baseline exam of [date] there [has or has not] been a statistically significant [increase/decrease/change] in femoral neck bone mineral density. Note that there should be an age-related increase in bone mineral density in children as a result of normal bone growth. The rate of increase of bone mineral density in this patient is[similar_to/greater_than/less_than] that of age-matched normal children. 3.  The bone mineral density of the left total hip is [within/below – use a Z-score of -2.0 as the cutoff] the expected range for age.  When compared to the baseline exam of [date] there [has or has not] been a statistically significant [increase/decrease/change] in total hip bone mineral density. Note that there should be an age-related increase in bone mineral density in children as a result of normal bone growth. The rate of increase of bone mineral density in this patient is[similar_to/greater_than/less_than] that of age-matched normal children. [< > 4. If the patient is significantly growth delayed, as measured by percentile height and weight, add that this may affect comparison to normal values above, since the normal values are derived from individuals of standard bone maturation] General comments regarding interpretation of bone mineral density measurements: a) In children, premenopausal women and males under age 50 not at increased risk for fractures only Z-scores, not T-scores are used to indicate risk.  A Z-score above -2.0 is defined as "within the expected range for age" and Z-score at or less than -2.0 is "below the expected range for age".  A Z-score below the expected range for age in a patient with recent fractures and/or chronic corticosteroid treatment is consistent with a diagnosis of osteoporosis. b) In post menopausal women and males over 50, comparison of the measured bone mineral density with the average value in young normal subjects (the "T-score") has been found to be useful in assessing fracture risk.  Fracture risk approximately doubles for each 1.0 standard deviation (SD) in individual's hip or spine bone mineral density is below the average value of young normal subjects.  The World Health Organization (WHO) has defined T-scores of -1.0 to -2.5 as indicative of low bone mass (OSTEOPENIA), and T-scores of -2.5 or lower to be indicative of OSTEOPOROSIS, based on the site of lowest bone density. Note that there will be a change in reporting format and reference databases as patients move from the younger population (group a) to the older population (group b). The National Osteoporosis Foundation (www.nof.org) recommends adequate intake of calcium and vitamin D and regular weight-bearing exercise in all patients.  In Caucasian postmenopausal women, the NOF recommends treatment with pharmacologic therapy if the T score is below -2.0.  Treatment might also be considered if the T-score is between -1.5 and -2.0 in patients who are at higher risk (e.g., personal history of fracture as an adult, history of fragility fracture in a first-degree relative, low body weight (< about 127 lbs), current smoking, or use of oral corticosteroid therapy for more than 3 months).  Guidelines for treatment of osteopenia alone in other racial groups, men, and premenopausal women are not available, but treatment should definitely be considered if the bone density reaches the level of osteoporosis (T-score below -2.5).