Audit of Access to DEXA Scanning and Quality of DEXA Reporting in Patients at Risk of Osteoporosis
Keywords:
Clinical Audit, DEXA Scan, Osteoporosis, Dual-energy X-ray absorptiometry, DEXA, Bone mineral density, FRAXAbstract
Objective: To evaluate adherence to osteoporosis screening recommendations by assessing dual- energy X-ray absorptiometry (DEXA) referral practices and the quality of DEXA reporting among patients attending a specialized endocrine outpatient clinic.
Methodology: A retrospective clinical audit was conducted in a specialized diabetes, endocrine, and weight management outpatient clinic between November 1 and December 31, 2025. Medical records of patients attending the clinic during the audit period were reviewed. Patients meeting the National Institute for Health and Care Excellence (NICE) guideline NG56 criteria for DEXA referral were identified. Data were collected regarding referral practices, DEXA completion rates, and quality of DEXA report documentation. Compliance with predefined audit standards was assessed using descriptive statistics.
Results: A total of 227 patients were reviewed, of whom 56 (24.7%) met NICE criteria for DEXA referral. Only 28 (50.0%) eligible patients were advised to undergo DEXA scanning, which was substantially below the target standard of ≥90%. Among those advised, 17 (60.7%) completed the scan, failing to meet the predefined target of ≥80%. Assessment of completed DEXA reports demonstrated poor documentation quality. DEXA indication was documented in none of the reports (0%), formal interpretation in 4 (23.5%), FRAX assessment in 8 (47.1%), management plans in 14 (82.4%), and referring clinician details in 15 (88.2%). Among completed scans, 11.8% were normal, 64.7% showed osteopenia, and 23.5% demonstrated osteoporosis.
Conclusion: Significant deficiencies were identified in both DEXA referral practices and DEXA report documentation. Implementation of standardized referral pathways, reporting templates, and clinician education initiatives may improve adherence to osteoporosis assessment guidelines and facilitate timely identification and management of patients at risk of fragility fractures.
