BlueCross BlueShield of Tennessee Medical Policy Manual

Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition

DESCRIPTION

Using low-dose x-rays of two different energy levels, whole body dual x-ray absorptiometry (DXA) measures lean tissue mass and total and regional body fat, as well as bone density. DXA also has the ability to determine body composition in defined regions such as the arms, legs, and trunk. Measurements of body composition have been used to study how lean body mass and body fat change during health and disease. This has provided a research tool to study the metabolic effects of aging, obesity and various wasting conditions such as occurs with acquired immune deficiency syndrome (AIDS) or post-bariatric surgery.

Dual x-ray absorptiometry (DXA) has emerged as a new reference standard for body composition studies, replacing underwater weighing. While DXA scans have become a valued research tool, it is unclear how information regarding body composition could be used in the active medical management of the patient to improve health outcomes.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

None of the published studies used DXA findings to make patient management decisions or addressed how serial body composition assessment might improve health outcomes; therefore this use of the technology remains investigational.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (9:2017). Whole body dual x-ray absorptiometry to determine body composition (6.01.40). Retrieved December 4, 2017 from BlueWeb. (12 articles and/or guidelines reviewed)

Imboden, M., Welch, W., Swartz, A., Montoye, A., Finch, H., Harber, M., et al. (2017, April) Reference standards for body fat measures using GE dual energy x-ray absorptiometry in caucasian adults. PLOS One, 12(4), e0175110. (Level 4 evidence)

Rothney, M., Xia, Y., Wacker, W., Martin, F., Beaumont, M., Rezzi, S., et. al. (2013, January) Precision of a new tool to measure visceral adipose tissue (VAT) using dual-energy x-ray absorptiometry (DXA). Obesity. 21, Vol. 21, No. 1; E124-E126. (Level 4 evidence)

Swainson, M.,  Batterham, A., Tsakirides, C., Rutherford, Z., and Hind, K.(2017, May) Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLOS One, 12(5), e0177175. (Level 3 evidence)

U. S. Food and Drug Administration. (2007, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071570. Retrieved January 9, 2012 fromhttp://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  8/14/2010

MOST RECENT REVIEW DATE:  1/25/2018

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