DEXA is an abbreviation for "Dual Energy X-ray Absorptiometry". This is a special x-ray procedure that determines the strength of your bones. Bone strength is assessed by measuring the bone density so a DEXA scanner is sometimes called a "bone densitometer." Other means of assessing bone strength are also available but a DEXA scan is currently the most accurate method and it uses the lowest amount of radiation (a standard chest x-ray exposes you to 10 times more radiation than a typical DEXA scan). The DEXA scanner (LUNAR) at Dubuque Internal Medicine was purchased October 2003 and is a state of the art machine. All of our bone densitometry technologists are certified by the International Society of Clinical Densitometry.

Basically, all you have to do is lie flat on a table while the scanner moves over the top of your body. Generally, the bone density is measured at different sites in the body, usually both hips (or femurs) and the spine (or vertebral column). If you have had both hips surgically replaced or if you have had surgery on your spine, an alternative site may be chosen. Also, if your weight exceeds the table limit
(300 pounds), a forearm scan may be substituted. The actual scanning time is about 10 minutes per site but you should allot 30 minutes for the entire procedure.

Plan to arrive at Dubuque Internal Medicine about 10 minutes prior to your scheduled appointment time. You will need to fill out a history form. In addition, you should note the following information:

• CLOTHING: Wear loose comfortable clothing. No metal buttons, zippers, or snaps. Do not wear a girdle. Do not wear blue jeans.
• DIET/MEDICATION: If you are taking a calcium supplement, do not use it for 48 hours before your exam.
• PAST MEDICAL HISTORY: Remind the technologist if you have had any back or hip surgery.

The current cost of the DEXA is $325. Many insurance companies do NOT pay for SCREENING DEXA. Some insurance companies may pay for the DEXA if you have certain signs and/or symptoms of osteoporosis. The only way to know with certainty is to check with your insurance company BEFORE you schedule this test. We do have some information from the major insurance carriers in this regard but there is no way we could possibly know the individual policies of the hundreds of insurance companies that we deal with. As of the writing of this pamphlet 02/01/02, we can relay the following information:

• SCREENING: Medicare began coverage of screening DEXA on July 1, 1998. A repeat screening is covered once every 24 months. A woman who is past menopause (that is, she is no longer producing estrogen) and is "at risk" for osteoporosis should qualify for a screening DEXA.  A repeat screening DEXA is covered once every 24 months, although your health care provider may decide that you do not need it that often.  Currently, Medicare does not cover SCREENING DEXA in MEN.  Non-screening DEXA will be covered in men if certain conditions are present (see below).
• NON-Screening: Medicare will also pay for a DEXA in specific situations other than screening including:
• Patients who have been noted to have "thin bones" or certain fractures on a conventional bone x-ray.
• Patients who are taking more than 7.5 mg of prednisone per day.
• Patients with an overactive parathyroid gland.
• Patients already taking an FDA approved drug for the treatment of osteoporosis to see how well it is working.

If your DEXA scan shows osteoporosis and you are started on a prescription medication to treat osteoporosis, a DEXA scan performed 1 year after starting treatment will be covered. A repeat screening DEXA is covered once every 24 months.

UNITED HEALTHCARE : If your physician orders this test, it should be covered by UHC.

• SCREENING: Most Blue Cross Blue Shield plans do not cover SCREENING DEXA. However, your individual plan may have added this benefit so it does not hurt to ask your insurance company. Call your customer representative to find out if you have coverage.
• DIAGNOSTIC: If you have certain signs and symptoms of osteoporosis (for example, a compression fracture in your spine), BC/BS will likely pay for a DEXA. However, we do not know for certain if you have coverage so you should still check with your insurance company to determine if your test will be covered
  by insurance.

Ultimately, your physician at Dubuque Internal Medicine ordered a DEXA scan to assist in the prevention, diagnosis and management of osteoporosis. The information provided by the DEXA will give you the data you need to make informed choices related to treatment options for osteoporosis. On the other hand, we think it is important for you to know the cost of this test and the uncertainty of its coverage by most insurance companies so you can decide whether or not you want this test. If you are unable to pay a lump sum, a payment plan can be arranged.

You should not have this test if:

• You are pregnant or think you might be pregnant.
• You had another x-ray within the last week that used contrast media. This would include a barium enema (colon x-ray), an upper GI (stomach x-ray) or certain CT scans.
• You had a nuclear scan in the past week (includes a bone scan, thyroid study, etc.).

We hope this information has been helpful. If you have additional questions about the DEXA scanner or osteoporosis, please ask. If you want to check with your insurance before scheduling this test, call 563-589-4848 when you are ready to schedule.