Skeletal Sites for Osteoporosis Diagnosis: The 2005 ISCD Official Positions

Size: px
Start display at page:

Download "Skeletal Sites for Osteoporosis Diagnosis: The 2005 ISCD Official Positions"

Transcription

1 Journal of Clinical Densitometry, vol. 9, no. 1, 15 21, 2006 Ó Copyright 2006 by The International Society for Clinical Densitometry /06/9:15 21/$32.00 DOI: /j.jocd Position Statement Skeletal Sites for Osteoporosis Diagnosis: The 2005 ISCD Official Positions Didier Hans,*,1 Robert W. Downs Jr., 2 François Duboeuf, 3 Susan Greenspan, 4 Lawrence G. Jankowski, 5 Gary M. Kiebzak, 6 and Steven M. Petak 7 1 Geneva University Hospital, Geneva, Switzerland; 2 Virginia Commonwealth University School of Medicine, Richmond, VA; 3 Hopital Edouard Herriot, Lyon, France; 4 University of Pittsburgh, Pittsburgh, PA; 5 Center for Arthritis and Osteoporosis, Morton Grove, IL; 6 St. Luke s Episcopal Hospital, Houston, TX; and 7 Texas Institute for Reproductive Medicine, Houston, TX Abstract The International Society for Clinical Densitometry (ISCD) has developed Official Positions to assist healthcare providers in addressing some of the issues inherent with the use of bone mineral density (BMD) assessed by dualenergy X-ray absorptiometry (DXA) to diagnose osteoporosis, apply World Health Organization (WHO) T-score classifications, and monitor BMD changes over time. Differences exist, however, between the ISCD Official Position statement and that of the International Osteoporosis Foundation with respect to WHO criteria for skeletal sites. Consequently, a subcommittee of the ISCD was directed to address the application of the WHO classifications to specific skeletal sites and regions of interest. In 2005, the ISCD Position Development Conference reviewed the findings and prepared Official Positions, which address whether or not: (1) the lowest T-score of the total proximal femur, femoral neck, trochanter, and spine should continue to be used for diagnosis; (2) the WHO classification may be applied to a single vertebral body T-score; and (3) the ISCD should endorse the use of the National Health and Nutrition Examination Survey database for proximal femur T-score derivation. The resulting ISCD Official Positions, with their corresponding rationales and evidence are provided here, as well as questions that will need to be addressed in the future. Key Words: Bone mineral density; Densitometry; Standards; Dual-energy X-ray absorptiometry; DXA; Imaging; Fracture assessment; Position; Guideline. Introduction Bone mineral density (BMD) assessed by dual-energy X- ray absorptiometry (DXA) is used to diagnose osteoporosis, assess fracture risk, and monitor changes in BMD over time. The World Health Organization (WHO) has proposed a set of operational criteria to define osteoporosis in postmenopausal Caucasian women (1). The BMD value of an *Address correspondence to: Didier Hans, PhD, MBA, Head of R&D, Nuclear Medicine Division, Geneva University Hospital, Rue Micheli-du-Crest, 24, 1211, Geneva 14, Switzerland. individual is expressed in terms of the number of standard deviations from the mean of a healthy young-adult reference population, commonly referred to as the T-score (1). Osteoporosis has been defined by a T-score that is equal to or less than This classification was established based on reference values of BMD measured at the lumbar spine, hip* (also referred to as proximal femur), or forearm. The socio-economical emphasis on hip fractures, however, together with studies showing that BMD measured at the proximal femur has the *Note: The term hip and proximal femur are used interchangeably in this paper. 15

2 16 Hans et al. strongest association with hip fracture (2), have focused some clinical guidelines for the assessment of individual patients on BMD measurements made by DXA at the hip (3 5). Furthermore, the WHO working group did not specify how many skeletal sites to measure, or which region(s) of interest (ROI) within a skeletal site should be used for diagnosis. To help healthcare providers adequately utilize the multiplicity of skeletal sites measurable by DXA, the ISCD has recommended that BMD should be measured for the purpose of diagnosing osteoporosis at two preferred skeletal sites, the hip and lumbar spine. A third site (33% or one-third radius of the non-dominant forearm) should be investigated if technical problems arise at any of these two primary sites (6). The ISCD recommended that osteoporosis be diagnosed on the basis of the lowest T-score for BMD found at the spine, total hip, femoral neck, and trochanter, and the distal one-third of the radius, if measured (6). This position differs from that of the International Osteoporosis Foundation (IOF), which recommended the use of WHO criteria only at the hip, stating that in all situations this skeletal site would predict osteoporotic fractures as well as for any other skeletal sites (3). While divergence exists in handling discordances among skeletal sites, technical improvements in DXA open new perspectives in the interpretation of DXA scans. The improvement in resolution of the DXA scan renders the search for artifacts more reliable, enabling the exclusion of a single vertebra, for example. Awareness of technical differences among manufacturers, coupled with an increase in patient mobility (e.g., moving from one city to another), has resulted in manufacturers recognizing the importance of finding equivalency links in order to convert BMD values measured on one DXA system into a value that is comparable to another. However, even with progress in this area, problems arise. For example, it is common to observe physicians applying the operational WHO definition of osteoporosis to any skeletal region of interest (ROI), or to convert densitometric GE data to Hologic data without careful consideration, although this is not recommended by any medical society. Potential consequences of such approaches include an important change in the prevalence of osteoporosis according to the choice of the skeletal sites chosen, and an obvious misdiagnosis of the patient (7), possibly leading to a decrease in the credibility of the field of bone densitometry (3). It is therefore crucial that along with advances in DXA technology, practitioners be given updated recommendations to ensure correct use of DXA in clinical patient management. The following questions regarding skeletal site selection and reference databases were addressed at the 2005 ISCD Position Development Conference, held in Vancouver, British Columbia, Canada, the results of which are presented here. Should the lowest T-score of the total proximal femur, femoral neck, trochanter, and spine continue to be used for diagnosis? Should the ISCD endorse use of the National Health and Nutrition Examination Survey (NHANES) database for proximal femur T-score derivation? Can the WHO classification be applied to a single vertebral body T-score? Methodology The methods used to develop, and the grading system applied to these ISCD Official Positions is presented in detail in the Executive Summary that accompanies this paper. Briefly, all Positions were graded on quality of evidence (good, fair, poor), strength of the recommendation (A, B, or C, where A is a strong recommendation supported by the evidence, B is a recommendation supported by the evidence, and C is a recommendation supported primarily by expert opinion), and applicability (worldwide or variable limited). I. Central DXA for Diagnosis of Osteoporosis ISCD Official Positions: The WHO international reference standard for osteoporosis diagnosis is a T-score of -2.5 or less at the femoral neck: B The reference standard from which the T-score is calculated is the female, white, age years NHANES III database. Grade: Good-A-1 Osteoporosis may be diagnosed in postmenopausal women and in men age 50 and older if the T-score of the lumbar spine, total hip, or femoral neck is -2.5 or less*: B In certain circumstances the 33% radius (also called 1/3 radius) may be utilized. Grade: Good-A-2 *Note: Other hip regions of interest, including Ward s area and the greater trochanter, should not be used for diagnosis. Application of recommendation may vary according to local requirements. Fracture Risk Assessment A distinction is made between diagnostic classification and the use of BMD for fracture risk assessment. For fracture risk assessment any well-validated technique can be used, including measurements of more than one site, where this has been shown to improve the assessment of risk. Grade: Good-A-1. Rationale In the past, the ISCD Official Position was to use the lowest T-score of the total proximal femur, femoral neck, trochanter, and posterior/anterior spine for the diagnosis of osteoporosis. In light of current data, the ISCD Official Position has been updated.

3 Skeletal Sites for Osteoporosis Diagnosis 17 Although most studies have treated hip fractures as a homogeneous condition (2,8,9), they can be separated into fractures of the cervical region (femoral neck fractures, intracapsular fractures), and fractures of the trochanteric region (extracapsular). Mautalen et al recommended that these two main types of hip fractures be considered independently in epidemiological or clinical studies. Women with trochanteric fractures have more severe and generalized bone loss, especially in the trabecular component. Cervical fractures seem to be more related to proximal femur morphology (10,11). There is also evidence suggesting that the mechanisms are different, possibly due to the trochanteric region having a greater proportion of trabecular bone than the cervical region (50% vs. 30%, respectively) (12). Uitewaal et al analyzed bone structure in both types of hip fractures and reported significantly lower trabecular bone volume and surface density in patients with trochanteric fractures than in patients with cervical fractures (13). A significant difference in morphology and density between trochanteric and cervical hip fractures has been reported by Duboeuf et al in the EPIDOS prospective study (14). The morphologic difference has been confirmed by Partanen et al who reported that the dimensions of the upper femur and the pelvis measured from radiographs are useful in the evaluation of hip fracture risk and fracture type (15). Michaelson et al suggested that height and hormonal factors affect the risk of the two types of hip fractures, and concluded that each fracture type should be considered independently when planning preventive intervention (16). This is even more important as it has been found that in recent years there appears to be an increase in the incidence of trochanteric hip fractures compared with cervical fractures, (17,18) and that trochanteric fractures have been associated with up to twice the short-term mortality of cervical fractures in the elderly (8). Substantially lower femoral BMD amongst women with trochanteric fractures as compared with cervical fractures has been reported (19 22). Further, some studies have found that only trochanteric BMD is a better predictor of trochanteric fractures as compared with cervical fractures. Others have found no difference in BMD between these fracture types (23 25). Although the evidence concerning BMD for different types of hip fracture is somewhat conflicting, it is generally agreed that BMD of the femoral neck best predicts cervical fractures, whereas the trochanteric site best predicts trochanteric fractures, and that the total hip BMD best reflects the risk of any type of hip fracture. Without considering the type of hip fracture, an in-house analysis performed on the EPIDOS cohort (in-house unpublished data: courtesy of Hans D) showed that the best discrimination between patients with and without hip fractures was achieved by considering the lowest T-score of any hip measurements (i.e., femoral neck, greater trochanter and total hip), followed by the greater trochanter. When discriminating all osteoporotic fracture, Hans D found that all hip sites were similar. In another study comparing T-scores from different hip ROI in differentiating postmenopausal women with and without vertebral fracture, Vokes et al concluded that the best discrimination was achieved with the femoral neck, the greater trochanter, or the lowest of any hip ROI measurement (26). Similarly, an analysis of the Study of Osteoporotic Fractures (SOF) cohort by Lu et al concluded that combining the results of BMD assessments at more than one ROI from a single hip scan significantly increases prediction of hip and/or spine fracture risk, and elevates the relative risk with increasing numbers of low BMD ROI (27). Discussion When extrapolating these data for use in clinical practice, differences in recommendations have arisen concerning the hip ROI to be used (femoral neck, trochanter, or total hip) between the IOF (3) and the ISCD (28). On the technical aspect, one could argue that the lack of complete ROI agreement amongst manufacturers may impact the choice of hip sub-regions in the diagnosis of osteoporosis. Indeed, at this stage, the total hip ROI is one of the most consistent amongst manufacturers; however, this issue has been partially taken into account by the introduction of the NHANES III database (29,30) for the total region. In fact, the question, Should the lowest T-score of the total proximal femur, femoral neck and trochanter continue to be used for diagnosis? could even be extended to, Should the lowest T-score of the proximal femur or spine continue to be used for diagnosis? Recently, Kanis et al stated that the selection of patients on the basis of a minimum value from two or more tests will mostly increase the apparent prevalence of osteoporosis, but not improve fracture prediction (gradient of risk) (31). From a theoretical point of view, there is unlikely to be any benefit from combining information from different types of bone densitometry measurements unless they are completely unrelated (32). These findings are at apparent variance with results from the SOF study, (33) which showed an increase in risk in individuals with low BMD at more than one site. These apparent divergent findings are reconcilable. The identification of individuals who have more than one site with low BMD will identify those at higher risk for osteoporosis than patients with a low BMD at one site: they lie at the tail end of the frequency distribution curve for fracture risks, and will be found with a much lower prevalence than individuals with an abnormality at one site only. Thus, specificity is traded-off on poorer sensitivity, but the prognostication of that individual is enhanced. In contrast, when using cut-off points for diagnostic classification, the trade-offs result in a larger proportion of the population selected. The apparent divergent views on the topic are mostly related to confusion of terms. What is the most relevant approach to diagnose osteoporosis? Is it the gradient of risk or the number of patients selected based on a threshold approach? In fact, these concepts are not in conflict with each other. Indeed, a distinction is made between diagnostic classification and the use of BMD for fracture risk assessment. For fracture risk assessment, any well-validated technique can be used, including measurements of more than one

4 18 Hans et al. skeletal site, which has been shown to improve the assessment of risk. In this case, the lowest T-score of measured skeletal sites would be relevant and could be used. The femoral neck is the emerging international reference standard; however, based on a review of the current medical literature (2), osteoporosis may still be diagnosed if the T-score of the lumbar spine, total hip, or femoral neck is -2.5 or less, although it should be recognized that different patients would be characterized as having osteoporosis (34). The present recommendation removes the trochanter from consideration as a diagnostic site in an effort to help reconcile the ISCD guidelines with those of the IOF, National osteoporosis Foundation (NOF) and WHO, and to aid in the transition to fracture probability as a basis for therapeutic intervention. Additional Questions for Future Research The following suggestions for additional research are listed below, stated in the form of questions, most of which could be investigated with retrospective analyses: From meta-analyses comprised of prospective studies, does using the lowest T-score amongst femoral sites improve the fracture prediction? Which one of the hip sub-regions better responds to current treatment? Due to the heterogeneous nature of their size and placement, is there a difference in rates of response of all sub-regions between manufacturers? II. Should the ISCD Endorse the Use of the NHANES III Database for Proximal Femur T-score Derivation? ISCD Official Position The NHANES III database should be used for T-score derivation at the hip regions. Grade: Poor C-1 Rationale Differences in the measurement of BMD and T-scores amongst manufacturers are multifactorial. While technical diversities and differences in ROI exist, the selection of standardized reference databases for the calculation of T-scores could ameliorate some of the differences (7). Unfortunately, different manufacturers use the same names for the hip ROI, when the actual ROI placements and sizes are different. Until standardized ROIs are created by all manufacturers, the role of standardized BMD (sbmd) remains predominantly that of a research tool used for combining large numbers of patients for clinical trials (33,35). Conversely, significant standardization efforts have already been performed for the lumbar spine. The downside of using this latter site is the lack of a current universal reference database. The NHANES III database is currently the best proximal femur database, with a large number of subjects (36 38). Although based only on measurements with Hologic instruments, subject selection was performed with a minimum of statistical bias, and comparison of different cohorts should be performed according to this point, referring back to the different papers. This database is, however, not only a reference database, but also a common platform from which manufacturers can better apply equations of equivalence (33,35). Discussion It has been suggested that the NHANES III database, obtained in the United States, is not necessarily valid in other countries. Furthermore, if one took a BMD value for the total hip that equalled 22.5 on a Hologic machine and converted it to sbmd, then took a value on a Norland or GE Healthcare machine that also equalled 22.5 and converted it to sbmd, the values would not be equal; therefore the NHANES derivation based on sbmd may not be a valid approach. More specifically, Binkley et al showed that a recent implementation of NHANES hip database by GE Healthcare resulted in large changes in T-scores at the hip, due to errors in its calculation. These errors were mostly related to an incorrect use of the correction formula. When the formula was correctly applied, the discordance in T-scores was reduced (29). Kiebzak et al reported an agreement of more than 90% in patient classification based on T-scores between Hologic (Delphi) and GE Healthcare (Prodigy) based on either total hip using the NHANES III database, or the spine using a non-nhanes III manufacturer-specific database (30). The question about the use of NHANES III for proximal femur T-score derivation could easily be answered if patients and providers were not regularly changing systems. The lack of a uniform database would be of less significance if attempts were made to repeat DXA studies on a device of the same manufacturer and model. However, patient mobility represents an increasing challenge to health care. Consequently, it is not unusual to have a bone measurement performed on a specific DXA device and a follow-up scan on another DXA of a different brand. The importance of having a common platform for comparison on the basis of T-score calculation (in default of having similar ROI) is, therefore, desired. Additional Questions for Future Research A series of questions should be investigated, mostly in retrospective analyses: Should we use a different approach based on the percentage of the young normal mean that would be more appropriate if NHANES cannot be used? Would a standardized set of ROI definitions and anatomic positioning (set internal rotation and abduction angles) between manufacturers improve BMD concordance at the femur?

5 Skeletal Sites for Osteoporosis Diagnosis 19 III. Can the WHO Classification Be Applied to a Single Vertebral Body T-score? ISCD Official Position BMD based diagnostic classifications should not be made using a single vertebra. If only one evaluable vertebra remains after excluding other vertebrae, diagnosis should be based on a different valid skeletal site. Grade: Fair-C-1. Anatomically abnormal vertebrae may be excluded from analysis if: B They are clearly abnormal and non-assessable within the resolution of the system; or B There is more than a 1.0 T-score difference between the vertebra in question and adjacent vertebrae. When vertebrae are excluded, the BMD of the remaining vertebrae is used to derive the T-score. Grade: Fair-C-1. Rationale In premenopausal women, where hip fracture risk is low, spinal BMD predicts the risk of any fracture as well as, or better than, hip BMD (2,3). However, in later life, spine BMD measurements are often confounded by osteoarthrosis (39), whereas the hip is much less affected by these changes (40 42). The latest guidelines published by the ISCD clearly state that when measuring the lumbar spine by DXA one should use all evaluable vertebrae (L1-L4), and only exclude vertebral bodies (VB) that are affected by local structural change or artefacts. In the worst case scenario, it is acceptable to diagnose osteoporosis based on a minimum of two vertebrae (6). In an attempt to challenge this position statement, Hansen et al (43) studied the impact of picking the lowest vertebral body T-score in the diagnosis of lumbar osteoporosis in men, using high resolution technology. They concluded that in classifying men with prior fractures as being osteoporotic, the lowest lumbar T-score demonstrated similar sensitivity and specificity to that of the lowest hip or wrist T-score, whereas the average L1-L4 and ISCD-determined T-scores performed with less sensitivity but better specificity. The study, however, was cross-sectional, limited to men, and employed a Lunar Expert, a discontinued model with exceptionally high image resolution that more readily identifies vertebral bodies worthy of exclusion (44). This position has also been challenged by two other studies which have recommended using the single vertebra with the lowest T-score (29,45). Conversely, Vokes et al reported no added advantage in using the lowest vertebra in spine fracture discrimination, compared with the total (46). Discussion One should also be cautious not to introduce bias by a systematic selection of the single lowest-density vertebral body, with the assumption that the BMD of all other vertebral bodies is over-estimated due to artefacts. Indeed, it may well be that the lowest vertebral body BMD is the consequence of a metastasis or other structural problems that reduce the apparent BMD. In such a case, the specific vertebra with low apparent BMD should be excluded. The exclusion of anatomically abnormal, non-assessable vertebrae would therefore be reasonable as long as the resolution is sufficient, or if more than one SD is observed between individual vertebral bodies (47). Since the ISCD recommendations are to be used by clinical densitometry facilities that may not be involved in the overall management of individual patients, it will be important to have guidelines that apply generally. Because use of the lowest vertebral body (VB) for diagnosis of osteoporosis may require additional studies, such as plain X- ray to ensure that a single VB is in fact normal, the ISCD is reluctant to recommend the use of the lowest VB as a standard practice for the diagnosis of osteoporosis. Assuming that an assessable vertebra could be identified, the ISCD 2001 Position Development Conference suggested that it should not be used, as the measured area would be too small. Indeed, the precision error is usually inversely correlated to the measured area, meaning the smaller the area measured, the larger the precision error will likely be. One can argue that small areas are used at other skeletal sites such as the femoral neck, so why not at the spine? (48) While this point is well taken and in theory is indeed possible, the consequences of using less precision, compared to what we expect at the spine, will likely be multiple: Reducing the measured area will impact the least significant change (LSC) for single vertebral bodies (49). Jankowski et al (50) showed a strong correlation (R ) between the root mean square (RMS)-standard deviation (SD) and the measured area of the spine in more than 100 patients (average age 71 years): the smallest measured area corresponded to the highest RMS error. Subsequently, the RMS coefficient of variation measured at one single vertebra can equal twice the precision of the total L1-L4 (see Figure 1). It would be necessary to increase the 22.5 T-score threshold by the LSC amount prior to diagnosing osteoporosis, and raise the normal threshold by a similar amount if we wish to be consistent with the total lumbar spine diagnosis. This would be very confusing to the referring physician to have spinal data indicative of osteopenia, even with a single VB T-score of 20.7, or In-house data analysis based on more than 1,800 women (unpublished data: courtesy of Duboeuf F) shows that the error of diagnosis based on one single vertebra versus the total spine could lead to a misclassification of up to 5%. On this same analysis (subset of 900 patients) substantial variations in sensitivity and specificity amongst vertebrae versus total BMD were observed. The sensitivity ranged from 73% for L4 to 82% for L1 and L1-L4, while the corresponding specificity ranged from 62% to 57%. Choosing the minimum T-score between L1 and L4 did not

6 20 Hans et al. 1 VB VB 2 VB VB L1-L4 L1-L3 L2-L4 L1,L3-L4 L1-L2,L4 L1-L2 L1,L3 L3-L4 L2-L3 L2,L4 L1,L4 Possible combination of vertebrae L1 L3 L2 L4 Fig. 1. Precision as a function of the vertebrae level as well as different possible combinations of vertebrael. improve the outcome, although a slight decrease of specificity was reported (approximately 2%). These findings were confirmed by Vokes et al (46). This misclassification also depends on the value of the SD, the normative database used, and the brand of the densitometer, as well as the patient s sex (51,52). Subsequently, the prediction of osteoporotic fractures based on the total L1-L4 will differ depending on the single VB used. Sensitivity will increase using the lowest T-score of each of the lumbar vertebral bodies rather than the average value of the lumbar spine, but at the expense of reduced specificity (43). The monitoring time interval (MTI) would change, meaning that practitioners would need to adjust the time for the next DXA examination according to the number of included vertebrae. Given these data, we can sense that without considering applying the WHO definition or its concept to a single vertebra, the decision to use a single specific vertebra should be handled with caution. An important general point is that one will invariably find an abnormal result the more sites one looks at. Additional questions for future research Do prospective fracture data suggest that the lowest VB has a different RR/SD than the total? Does the vertebral body with the lowest T-score fracture first? Does L1 increase in BMD faster on current therapies than L4? Can any of the medications currently available increase BMD in the spine by more than the LSC of a single vertebral body? Summary The ISCD Official Positions provided here address issues with respect to the application of the WHO classifications to specific skeletal sites and regions of interest. While they are made in consideration of best available evidence, they raise several questions that require further research. As knowledge in the field of bone densitometry expands, the Official Positions can be periodically re-evaluated. References 1. Kanis JA, Melton LJI, Christiansen C, Johnston CC, Khaltaev N The diagnosis of osteoporosis. J Bone Miner Res 9(8): Marshall D, Johnell O, Wedel H Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures [see comments]. BMJ (Clinical Research Ed) 312(7041): Kanis JA, Gluer CC An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11(3): Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5): Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, Johnell O An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 12(7): Lewiecki EM, Kendler DL, Kiebzak GM, et al Special report on the official positions of the International Society for Clinical Densitometry. Osteoporos Int 15(10): Faulkner KG, von Stetten E, Miller P Discordance in patient classification using T-scores. J Clin Densitom 2(3): Greenspan SL, Myers ER, Maitland LA, Kido TH, Krasnow MB, Hayes WC Trochanteric bone mineral density is associated with type of hip fracture in the elderly. J Bone Miner Res 9(12): Kelsey JL, Hoffman S Risk factors for hip fracture. [editorial]. N Engl J Med 316(7): Mautalen CA, Vega EM Different characteristics of cervical and trochanteric hip fractures. Osteoporos Int 3(Suppl 1): Mautalen CA, Vega EM, Einhorn TA Are the etiologies of cervical and trochanteric hip fractures different? Bone 18(3 Suppl):133S 137S. 12. Riggs BL, Wahner HW, Seeman E, et al Changes in bone mineral density of the proximal femur and spine with aging: differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest 70: Uitewaal PJ, Lips P, Netelenbos JC An analysis of bone structure in patients with hip fracture. Bone Miner 3(1): Duboeuf F, Hans D, Schott AM, et al Different morphometric and densitometric parameters predict cervical and

7 Skeletal Sites for Osteoporosis Diagnosis 21 trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res 12(11): Partanen J, Jamsa T, Jalovaara P Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J Bone Miner Res 16(8): Michaelsson K, Weiderpass E, Farahmand BY, et al. Swedish Hip Fracture Study Group Differences in risk factor patterns between cervical and trochanteric hip fractures. Osteoporos Int 10(6): Nydegger V, Rizzoli R, Rapin CH, Vasey H, Bonjour JP Epidemiology of fractures of the proximal femur in Geneva: incidence, clinical and social aspects. Osteoporos Int 2(1): Nagant de Deuxchaisnes C, Devogelaer JP Increase in the incidence of hip fractures and of the ratio of trochanteric to cervical hip fractures in Belgium. Calcif Tissue Int 42(3): Nakamura N, Kyou T, Takaoka K, Ohzono K, Ono K Bone mineral density in the proximal femur and hip fracture type in the elderly. J Bone Miner Res 7(7): Vega E, Mautalen C, Gomez H, Garrido A, Melo L, Sahores AO Bone mineral density in patients with cervical and trochanteric fractures of the proximal femur. Osteoporos Int 1(2): Schott AM, Cormier C, Hans D, et al How hip and wholebody bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int 8(3): Nevitt MC, Johnell O, Black DM, Ensrud K, Genant HK, Cummings SR, Study of Osteoporotic Fractures Research Group Bone mineral density predicts non-spine fractures in very elderly women. Osteoporos Int 4(6): Chevalley T, Rizzoli R, Nydegger V, et al Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur. Osteoporos Int 1(3): Bohr H, Schaadt O Bone mineral content of femoral bone and the lumbar spine measured in women with fracture of the femoral neck by dual photon absorptiometry. Clin Orthop Relat Res 179: Dretakis EK, Papakitsou E, Kontakis GM, Dretakis K, Psarakis S, Steriopoulos KA Bone mineral density, body mass index, and hip axis length in postmenopausal Cretan women with cervical and trochanteric fractures. Calcif Tissue Int 64(3): Vokes T, Lovett J, Gillen D, Favus M T-scores from different regions in subjects with and without vertebral fractures. J Clin Densitom 7: Lu Y, Genant HK, Shepherd J, Zhao S, Mathur A, Fuerst TP, Cummings SR Classification of osteoporosis based on bone mineral densities. J Bone Miner Res 16(5): Abbott T, Barlas S, Brenneman S, Miller P Minimal spine BMD predicts fracture better than total spine BMD. J Clin Densitom 5(Suppl):S Binkley N, Kiebzak GM, Lewiecki EM, et al Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res 20(2): Kiebzak GM, Lewiecki EM, Miller P Good Diagnostic Agreement Using T-score Between Dephi and Prodigy. J Clin Densitom 7: Kanis JA, Seeman E, Johnell O, Rizzoli R, Delmas PD The perspective of the International Osteoporosis Foundation on the Official Position of the International Society for Clinical Densitometry. J Clin Densitom 8(2): Blake GM, Patel R, Knapp KM, Fogelman I Does the combination of two BMD measurements improve fracture discrimination? J Bone Miner Res 18(11): Lu Y, Fuerst T, Hui S, Genant HK Standardization of bone mineral density at femoral neck, trochanter and Ward s triangle. Osteoporos Int 12(6): Johnell O, Kanis J, Oden A, et al A 2005 predictive value of bone mineral density for hip and other fractures. J Bone Miner Res Online 20(7): Hui SL, Gao S, Zhou XH, et al Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res 12(9): Looker AC, Johnston CC Jr., Wahner HW, et al Prevalence of low femoral bone density in older US women from NHANES III. J Bone Miner Res 10(5): Looker AC, Orwoll ES, Johnston CC Jr., et al Prevalence of low femoral bone density in older US adults from NHANES III. J Bone Miner Res 12(11): Looker AC, Wahner HW, Dunn WL, et al Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5): Franck H, Munz M, Scherrer M Evaluation of dual-energy X-ray absorptiometry bone mineral measurementdcomparison of a single-beam and fan-beam design: the effect of osteophytic calcification on spine bone mineral density. Calcif Tissue Int 56(3): Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ 307(6897): Jones G, Nguyen T, Sambrook PN, Lord SR, Kelly PJ, Eisman JA Osteoarthritis, bone density, postural stability, and osteoporotic fractures: a population based study. J Rheumatol 22(5): Greenspan SL, Maitland-Ramsey L, Myers E Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tissue Int 58(6): Hansen KE, Vallarta-Ast N, Krueger D, Gangnon R, Drezner MK, Binkley N Use of the lowest vertebral body T-score to diagnose lumbar osteoporosis in men: is cherry picking appropriate? J Clin Densitom 7(4): Ryan PJ, Evans P, Blake GM, Fogeman I The effect of vertebral collapse on spinal bone mineral density measurements in osteoporosis. Bone Miner 18(3): Sahota O, Pearson D, Cawte SW, San P, Hosking DJ Site-specific variation in the classification of osteoporosis, and the diagnostic reclassification using the lowest individual lumbar vertebra T-score compared with the L1-L4 mean, in early postmenopausal women. Osteoporos Int 11(10): Vokes TJ, Gillen DL, Lovett J, Favus MJ Comparison of T-scores from different skeletal sites in differentiating postmenopausal women with and without prevalent vertebral fractures. J Clin Densitom 8(2): Hansen KE, Binkley N, Christian R, Vallarta-Ast N, Krueger D, Drezner MK, Blank RD Interobserver reproducibility of criteria for vertebral body exclusion. J Bone Miner Res 20(3): Schneider D, Bettencourt R, Barrett-Connor E Should one or more vertebral levels be used for fracture risk assessment. J Bone Miner Res 17(Suppl 1):S Blake GM, Jagathesan T, Herd RJ, Fogelman I Dual X-ray absorptiometry of the lumbar spine: the precision of paired anteroposterior/lateral studies. Br J Radiol 67(799): Jankowski L, O Brien-Schmack E, Broy S What is the Magnitude of Precision Error at the PA Spine by Central DXA When Discontiguous Vertebal Bodies are Selected. J Clin Densitom 6: Smith J, Prestwood C, Dauser D, Kleppinger A, Kenny A Discordance in spine bone density of elderly men and women. J Clin Densitom 7(2): McMahon K, Kalnins S, Freund J, Pocock N Discordance in lumbar spine T-scores and nonstandardization of standard deviations. J Clin Densitom 6(1):1 6.

Effect of Precision Error on T-scores and the Diagnostic Classification of Bone Status

Effect of Precision Error on T-scores and the Diagnostic Classification of Bone Status Journal of Clinical Densitometry, vol. 10, no. 3, 239e243, 2007 Ó Copyright 2007 by The International Society for Clinical Densitometry 1094-6950/07/10:239e243/$32.00 DOI: 10.1016/j.jocd.2007.03.002 Original

More information

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi Clinical Utility of Bone Densitometry Diagnosis (DXA)

More information

Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA

Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA ORIGINAL ARTICLE Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA Leila Amiri 1, Azita Kheiltash 2, Shafieh Movassaghi 1, Maryam Moghaddassi 1, and Leila Seddigh 2 1 Rheumatology

More information

An audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines

An audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines Osteoporos Int (2006) 17: 1111 1115 DOI 10.1007/s00198-006-0101-6 SHORT COMMUNICATION An audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines R. Baddoura. H. Awada. J. Okais.

More information

Osteoporosis International. Original Article. Bone Mineral Density and Vertebral Fractures in Men

Osteoporosis International. Original Article. Bone Mineral Density and Vertebral Fractures in Men Osteoporos Int (1999) 10:265 270 ß 1999 International Osteoporosis Foundation and National Osteoporosis Foundation Osteoporosis International Original Article Bone Mineral Density and Vertebral Fractures

More information

Relationship between Family History of Osteoporotic Fracture and Femur Geometry

Relationship between Family History of Osteoporotic Fracture and Femur Geometry Iranian J Publ Health, 2007, Iranian A supplementary J Publ Health, issue 2007, on Osteoporosis, A supplementary pp.70-74 issue on Osteoporosis, pp.70-74 Relationship between Family History of Osteoporotic

More information

Bone density and geometry in assessing hip fracture risk in postmenopausal

Bone density and geometry in assessing hip fracture risk in postmenopausal The British Journal of Radiology, 80 (2007), 893 897 Bone density and geometry in assessing hip fracture risk in postmenopausal women S GNUDI, MD, E SITTA, MD and N FIUMI, MD Modulo Dipartimentale di Medicina

More information

ORIGINAL INVESTIGATION. Single-Site vs Multisite Bone Density Measurement for Fracture Prediction

ORIGINAL INVESTIGATION. Single-Site vs Multisite Bone Density Measurement for Fracture Prediction ORIGINAL INVESTIGATION Single-Site vs Multisite Bone Density Measurement for Fracture Prediction William D. Leslie, MD, MSc; Lisa M. Lix, PhD; James F. Tsang, BSc; Patricia A. Caetano, PhD; for the Manitoba

More information

9 Quality Assurance in Bone Densitometry section

9 Quality Assurance in Bone Densitometry section 9 Quality Assurance in Bone Densitometry section Introduction Bone densitometry is frequently used to determine an individual's fracture risk at a particular point in time but may also be used to assess

More information

Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems?

Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems? Osteoporos Int (2010) 21:1227 1236 DOI 10.1007/s00198-009-1062-3 ORIGINAL ARTICLE Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems? B. Fan & Y. Lu

More information

Purpose. Methods and Materials

Purpose. Methods and Materials Prevalence of pitfalls in previous dual energy X-ray absorptiometry (DXA) scans according to technical manuals and International Society for Clinical Densitometry. Poster No.: P-0046 Congress: ESSR 2014

More information

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security

More information

Documentation, Codebook, and Frequencies

Documentation, Codebook, and Frequencies Documentation, Codebook, and Frequencies Dual-Energy X-ray Absorptiometry Femur Bone Measurements Examination Survey Years: 2005 to 2006 SAS Transport File: DXXFEM_D.XPT January 2009 NHANES 2005 2006 Data

More information

Screening points for a peripheral densitometer of the calcaneum for the diagnosis of osteoporosis

Screening points for a peripheral densitometer of the calcaneum for the diagnosis of osteoporosis 23 Ivorra Cortés J, Román-Ivorra JA, Alegre Sancho JJ, Beltrán Catalán E, Chalmeta Verdejo I, Fernández-Llanio Comella N, Muñoz Gil S Servicio de Reumatología - Hospital Universitario Dr. Peset - Valencia

More information

Annotations Part III Vertebral Fracture Initiative. International Osteoporosis Foundation March 2011

Annotations Part III Vertebral Fracture Initiative. International Osteoporosis Foundation March 2011 Annotations Part III Vertebral Fracture Initiative International Osteoporosis Foundation March 2011 Slide 1-3 Topics to be covered: What is vertebral fracture assessment? How does VFA compare to standard

More information

ASJ. How Many High Risk Korean Patients with Osteopenia Could Overlook Treatment Eligibility? Asian Spine Journal. Introduction

ASJ. How Many High Risk Korean Patients with Osteopenia Could Overlook Treatment Eligibility? Asian Spine Journal. Introduction Asian Spine Journal Asian Spine Clinical Journal Study Asian Spine J 2014;8(6):729-734 High http://dx.doi.org/10.4184/asj.2014.8.6.729 risk patients with osteopenia How Many High Risk Korean Patients with

More information

Diagnosis of Vertebral Fractures by Vertebral Fracture Assessment

Diagnosis of Vertebral Fractures by Vertebral Fracture Assessment Journal of Clinical Densitometry, vol. 9, no. 1, 66 71, 2006 Ó Copyright 2006 by The International Society for Clinical Densitometry 1094-6950/06/9:66 71/$32.00 DOI: 10.1016/j.jocd.2005.11.002 Original

More information

ACCURATE IDENTIFICATION of individuals at risk for

ACCURATE IDENTIFICATION of individuals at risk for 0021-972X/07/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 92(1):77 81 Printed in U.S.A. Copyright 2007 by The Endocrine Society doi: 10.1210/jc.2006-1415 Effectiveness of Bone Density Measurement

More information

Quality Control of DXA System and Precision Test of Radio-technologists

Quality Control of DXA System and Precision Test of Radio-technologists J Bone Metab 2014;21:2-7 http://dx.doi.org/10.11005/jbm.2014.21.1.2 pissn 2287-6375 eissn 2287-7029 Review Article Quality Control of DXA System and Precision Test of Radio-technologists Ho-Sung Kim 1,

More information

DXA Best Practices. What is the problem? 9/29/2017. BMD Predicts Fracture Risk. Dual-energy X-ray Absorptiometry: DXA

DXA Best Practices. What is the problem? 9/29/2017. BMD Predicts Fracture Risk. Dual-energy X-ray Absorptiometry: DXA BMD Predicts Fracture Risk Ten Year Fracture Probability (%) 50 40 30 20 10 Age 80 70 60 50 E. Michael Lewiecki, MD Director, New Mexico Clinical Research & Osteoporosis Center Director, Bone TeleHealth

More information

Available online at ScienceDirect. Osteoporosis and Sarcopenia 1 (2015) 109e114. Original article

Available online at  ScienceDirect. Osteoporosis and Sarcopenia 1 (2015) 109e114. Original article HOSTED BY Available online at www.sciencedirect.com ScienceDirect Osteoporosis and Sarcopenia 1 (2015) 109e114 Original article Localized femoral BMD T-scores according to the fracture site of hip and

More information

Clinical Study Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women

Clinical Study Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women International Endocrinology Volume 3, Article ID 895474, 5 pages http://dx.doi.org/.55/3/895474 Clinical Study Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women Na Li, Xin-min

More information

NIH Public Access Author Manuscript Endocr Pract. Author manuscript; available in PMC 2014 May 11.

NIH Public Access Author Manuscript Endocr Pract. Author manuscript; available in PMC 2014 May 11. NIH Public Access Author Manuscript Published in final edited form as: Endocr Pract. 2013 ; 19(5): 780 784. doi:10.4158/ep12416.or. FRAX Prediction Without BMD for Assessment of Osteoporotic Fracture Risk

More information

Dr Tuan V NGUYEN. Mapping Translational Research into Individualised Prognosis of Fracture Risk

Dr Tuan V NGUYEN. Mapping Translational Research into Individualised Prognosis of Fracture Risk Dr Tuan V NGUYEN Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney NSW Mapping Translational Research into Individualised Prognosis of Fracture Risk From the age of 60, one

More information

Interpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm

Interpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis

More information

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Use of DXA / Bone Density in the Care of Your Patients Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Important Websites Resources for Clinicians and Patients www.nof.org www.iofbonehealth.org

More information

The official position of the International Society for Clinical

The official position of the International Society for Clinical Improving Clinical Decisions for Women at Risk of Osteoporosis: Dual-Femur Bone Mineral Density Testing Raymond E. Cole, DO, CCD Context: In bone mineral density (BMD) testing, unilateral hip analysis

More information

Original Article. Ramesh Keerthi Gadam, MD 1 ; Karen Schlauch, PhD 2 ; Kenneth E. Izuora, MD, MBA 1 ABSTRACT

Original Article. Ramesh Keerthi Gadam, MD 1 ; Karen Schlauch, PhD 2 ; Kenneth E. Izuora, MD, MBA 1 ABSTRACT Original Article Ramesh Keerthi Gadam, MD 1 ; Karen Schlauch, PhD 2 ; Kenneth E. Izuora, MD, MBA 1 ABSTRACT Objective: To compare Fracture Risk Assessment Tool (FRAX) calculations with and without bone

More information

Interobserver Reproducibility of Criteria for Vertebral Body Exclusion

Interobserver Reproducibility of Criteria for Vertebral Body Exclusion JOURNAL OF BONE AND MINERAL RESEARCH Volume 20, Number 3, 2005 Published online on November 29, 2004; doi: 10.1359/JBMR.041134 2005 American Society for Bone and Mineral Research Interobserver Reproducibility

More information

Clinical Densitometry

Clinical Densitometry Volume 8 Number 3 Fall 2005 ISSN: 1094 6950 Journal of Clinical Densitometry The Official Journal of The International Society for Clinical Densitometry Editor-in-Chief Paul D. Miller, MD HumanaJournals.com

More information

2013 ISCD Official Positions Adult

2013 ISCD Official Positions Adult 2013 ISCD Official Positions Adult These are the Official Positions of the ISCD as updated in 2013. The Official Positions that are new or revised since 2007 are in bold type. Indications for Bone Mineral

More information

Dual-energy Vertebral Assessment

Dual-energy Vertebral Assessment Dual-energy Vertebral Assessment gehealthcare.com Dual-energy Vertebral Assessment More than 40% of women with normal or osteopenic BMD had a moderate or severe vertebral deformation seen with DVA. Patrick

More information

Prevalence of Osteoporosis p. 262 Consequences of Osteoporosis p. 263 Risk Factors for Osteoporosis p. 264 Attainment of Peak Bone Density p.

Prevalence of Osteoporosis p. 262 Consequences of Osteoporosis p. 263 Risk Factors for Osteoporosis p. 264 Attainment of Peak Bone Density p. Dedication Preface Acknowledgments Continuing Education An Introduction to Conventions in Densitometry p. 1 Densitometry as a Quantitative Measurement Technique p. 2 Accuracy and Precision p. 2 The Skeleton

More information

Ghada El-Hajj Fuleihan, MD,MPH.

Ghada El-Hajj Fuleihan, MD,MPH. Ghada El-Hajj Fuleihan, MD,MPH. Dr El-Hajj Fuleihan is Professor of Medicine and Founder and Director of the Calcium Metabolism and Osteoporosis Program at the American University of Beirut Medical Center.

More information

OSTEOPOROTIC HIP FRACTURE remains a major public. Prevalence of Low Femoral Bone Density in Older U.S. Adults from NHANES III* ABSTRACT

OSTEOPOROTIC HIP FRACTURE remains a major public. Prevalence of Low Femoral Bone Density in Older U.S. Adults from NHANES III* ABSTRACT JOURNAL OF BONE AND MINERAL RESEARCH Volume 12, Number 11, 1997 Blackwell Science, Inc. 1997 American Society for Bone and Mineral Research Prevalence of Low Femoral Bone Density in Older U.S. Adults from

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research  ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Osteoporosis- Do We Need to Think Beyond Bone Mineral Density? Dr Preeti Soni 1, Dr Shipra

More information

Special report on the official positions of the International Society for Clinical Densitometry

Special report on the official positions of the International Society for Clinical Densitometry Osteoporos Int (2004) 15: 779 784 DOI 10.1007/s00198-004-1677-3 POSITION PAPER Special report on the official positions of the International Society for Clinical Densitometry E.M. Lewiecki Æ D.L. Kendler

More information

DXA scanning to diagnose osteoporosis: Do you know what the results mean?

DXA scanning to diagnose osteoporosis: Do you know what the results mean? REVIEW CME CREDIT BRADFORD RICHMOND, MD Department of Radiology, The Cleveland Clinic; certification instructor, the International Society for Clinical Densitometry DXA scanning to diagnose osteoporosis:

More information

Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India

Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India International Journal of Public Health Science (IJPHS) Vol.3, No.4, December 2014, pp. 276 ~ 280 ISSN: 2252-8806 276 Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India

More information

Morphometric Measurements in Radiographic Image Processing in the Assessment of Post Menopausal Osteoporosis

Morphometric Measurements in Radiographic Image Processing in the Assessment of Post Menopausal Osteoporosis Morphometric Measurements in Radiographic Image Processing in the Assessment of Post Menopausal Osteoporosis Shankar N 1, Dr V Rajmohan 2, Sankar K 3 1,3 Assistant Professor, Department of Biomedical Engineering,

More information

Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures

Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures Bone 40 (2007) 1060 1065 www.elsevier.com/locate/bone Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures Asma Arabi a,, Rafic

More information

Efficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study

Efficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study Rheumatol Int (2006) 26: 427 431 DOI 10.1007/s00296-005-0004-4 ORIGINAL ARTICLE J. D. Ringe Æ H. Faber Æ P. Farahmand Æ A. Dorst Efficacy of risedronate in men with primary and secondary osteoporosis:

More information

Risedronate prevents hip fractures, but who should get therapy?

Risedronate prevents hip fractures, but who should get therapy? INTERPRETING KEY TRIALS CHAD L. DEAL, MD Head, Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic THE HIP TRIAL Risedronate prevents

More information

FIRST UPDATE OF THE LEBANESE GUIDELINES FOR OSTEOPOROSIS ASSESSMENT AND TREATMENT

FIRST UPDATE OF THE LEBANESE GUIDELINES FOR OSTEOPOROSIS ASSESSMENT AND TREATMENT FIRST UPDATE OF THE LEBANESE GUIDELINES FOR OSTEOPOROSIS ASSESSMENT AND TREATMENT Ghada EL-HAJJ FULEIHAN, Rafic BADDOURA, Hassane AWADA, Asma ARABI, Jad OKAIS El-Hajj Fuleihan G, Baddoura R, Awada H, Arabi

More information

Omnisense: At Least As Good As DXA

Omnisense: At Least As Good As DXA Omnisense: At Least As Good As DXA The following document summarizes a series of clinical studies that have been conducted to compare between different qualities of the Sunlight support the claim that

More information

( ) () () () () :.. :. (Bone mineral densiy BMD gr/cm 2 ) Dual-energy x-ray absorptiometry (DXA ) Excell (Femoral neck) (L2-L4) T-score Z-score... ± :. t.. /±/ /±/ ( L2-L4 ) BMD. ± %/. % % Z-score %..

More information

CLINIQCT NO-DOSE CT BONE DENSITOMETRY FOR ROUTINE AND SPECIALIST USE.

CLINIQCT NO-DOSE CT BONE DENSITOMETRY FOR ROUTINE AND SPECIALIST USE. CLINIQCT NO-DOSE CT BONE DENSITOMETRY FOR ROUTINE AND SPECIALIST USE Clinically superior BMD solutions for physicians DXA equivalent hip measurements Dual-use of standard abdominal or pelvic CT studies

More information

University of Groningen. Osteoporosis, identification and treatment in fracture patients de Klerk, Gijsbert

University of Groningen. Osteoporosis, identification and treatment in fracture patients de Klerk, Gijsbert University of Groningen Osteoporosis, identification and treatment in fracture patients de Klerk, Gijsbert IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish

More information

Bone Mineral Densitometry with Dual Energy X-Ray Absorptiometry

Bone Mineral Densitometry with Dual Energy X-Ray Absorptiometry Bone Mineral Densitometry with Dual Energy X-Ray Absorptiometry R Gilles, Laurentius Ziekenhuis Roermond 1. Introduction Osteoporosis is characterised by low bone mass, disruption of the micro-architecture

More information

Validation of the Osteoporosis Self-Assessment Tool in US Male Veterans

Validation of the Osteoporosis Self-Assessment Tool in US Male Veterans Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health, vol. 17, no. 1, 32e37, 2014 Published by Elsevier Inc. on behalf of The International Society for Clinical Densitometry

More information

An audit of osteoporotic patients in an Australian general practice

An audit of osteoporotic patients in an Australian general practice professional Darren Parker An audit of osteoporotic patients in an Australian general practice Background Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to

More information

DECADES OF PUBLISHED STUDIES have confirmed the

DECADES OF PUBLISHED STUDIES have confirmed the JOURNAL OF BONE AND MINERAL RESEARCH Volume 15, Number 2, 2000 2000 American Society for Bone and Mineral Research Perspective Bone Matters: Are Density Increases Necessary to Reduce Fracture Risk? KENNETH

More information

Bone Densitometry Radiation dose: what you need to know

Bone Densitometry Radiation dose: what you need to know Bone Densitometry Radiation dose: what you need to know John Damilakis, PhD Associate Professor and Chairman University of Crete, Iraklion, Crete, GREECE Estimation of bone status using X-rays Assessment

More information

Submission to the National Institute for Clinical Excellence on

Submission to the National Institute for Clinical Excellence on Submission to the National Institute for Clinical Excellence on Strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women with osteoporosis by The Society for Endocrinology

More information

THE INTERNATIONAL SOCIETY for Clinical Densitometry

THE INTERNATIONAL SOCIETY for Clinical Densitometry 0021-972X/04/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 89(8):3651 3655 Printed in U.S.A. Copyright 2004 by The Endocrine Society doi: 10.1210/jc.2004-0124 POSITION STATEMENT Official

More information

Bone Density Measurement in Women

Bone Density Measurement in Women Bone Density Measurement in Women Revised 2005 Scope This guideline defines the medical necessity of bone mineral density (BMD) measurement using dualenergy x-ray absorptiometry (DXA or DEXA), and applies

More information

STRUCTURED EDUCATION REQUIREMENTS IMPLEMENTATION DATE: JULY 1, 2017

STRUCTURED EDUCATION REQUIREMENTS IMPLEMENTATION DATE: JULY 1, 2017 STRUCTURED EDUCATION REQUIREMENTS Bone Densitometry The purpose of structured education is to provide the opportunity for individuals to develop mastery of discipline-specific knowledge that, when coupled

More information

ORIGINAL INVESTIGATION. Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures

ORIGINAL INVESTIGATION. Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures ORIGINAL INVESTIGATION Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures Ethel S. Siris, MD; Ya-Ting Chen, PhD; Thomas A. Abbott, PhD; Elizabeth Barrett-Connor, MD;

More information

BONE FLUORIDE IN PROXIMAL FEMUR FRACTURES

BONE FLUORIDE IN PROXIMAL FEMUR FRACTURES Fluoride Vol. 34 No. 4 227-235 2001 Research Report 227 BONE FLUORIDE IN PROXIMAL FEMUR FRACTURES A Bohatyrewicz a Szczecin, Poland SUMMARY: Bone fluoride concentration and bone mineral density (BMD) were

More information

Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis

Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis Annals of the Rheumatic Diseases 1994; 53: 117-121 117 Rheumatology, Whipps Cross Hospital, Leytonstone, London, United S Donnelly D V Doyle A Denton I Rolfe Human Metabolism, University of Sheffield Medical

More information

Information Processing of Medical Images for the Detection of Osteoporosis in Hip Region of Interest

Information Processing of Medical Images for the Detection of Osteoporosis in Hip Region of Interest Information Processing of Medical Images for the Detection of Osteoporosis in Hip Region of Interest Venkatesh Mahadevan, Sapthagirivasan V Abstract Quality Healthcare decision making support system (HDMS)

More information

Bone Mineral Density and Its Associated Factors in Naresuan University Staff

Bone Mineral Density and Its Associated Factors in Naresuan University Staff Naresuan University Journal 2005; 13(3): 13-18 13 Bone Mineral Density and Its Associated Factors in Naresuan University Staff Supawitoo Sookpeng *, Patsuree Cheebsumon, Malinee Dhanarun, Thanyavee Pengpan

More information

Fracture Prediction From Bone Mineral Density in Japanese Men and Women ABSTRACT

Fracture Prediction From Bone Mineral Density in Japanese Men and Women ABSTRACT JOURNAL OF BONE AND MINERAL RESEARCH Volume 18, Number 8, 2003 2003 American Society for Bone and Mineral Research Fracture Prediction From Bone Mineral Density in Japanese Men and Women SAEKO FUJIWARA,

More information

Absolute Fracture Risk Assessment Using Lumbar Spine and Femoral Neck Bone Density Measurements: Derivation and Validation of a Hybrid System

Absolute Fracture Risk Assessment Using Lumbar Spine and Femoral Neck Bone Density Measurements: Derivation and Validation of a Hybrid System ORIGINAL ARTICLE JBMR Absolute Fracture Risk Assessment Using Lumbar Spine and Femoral Neck Bone Density Measurements: Derivation and Validation of a Hybrid System William D Leslie 1,2 and Lisa M Lix 3

More information

New Dual-energy X-ray Absorptiometry Machines (idxa) and Vertebral Fracture Assessment

New Dual-energy X-ray Absorptiometry Machines (idxa) and Vertebral Fracture Assessment Case 1 New Dual-energy X-ray Absorptiometry Machines (idxa) and Vertebral Fracture Assessment (VFA) History and Examination Your wealthy friend who is a banker brings his 62-year-old mother to your office

More information

Contribution of Lumbar Spine BMD to Fracture Risk in Individuals With T-Score Discordance

Contribution of Lumbar Spine BMD to Fracture Risk in Individuals With T-Score Discordance ORIGINAL ARTICLE JBMR Contribution of Lumbar Spine BMD to Fracture Risk in Individuals With T-Score Discordance Dunia Alarkawi, 1 Dana Bliuc, 1 Tuan V Nguyen, 1,2 John A Eisman, 1,2,3,4,5 and Jacqueline

More information

Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis

Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis Bone 40 (2007) 1066 1072 www.elsevier.com/locate/bone Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis Rafic Baddoura a,, Asma Arabi c, Souha Haddad-Zebouni

More information

Diagnostische Präzision von DXL im Vergleich zu DXA bei pmp Frauen mit Frakturen

Diagnostische Präzision von DXL im Vergleich zu DXA bei pmp Frauen mit Frakturen Diagnostische Präzision von DXL im Vergleich zu DXA bei pmp Frauen mit Frakturen Christian Muschitz II. Medizinische Abteilung mit Rheumatologie, Osteologie & Gastroenterologie Akademisches Lehrkrankenhaus

More information

Research Article The Slovak Predictive Regression Model of Fall-Related Femoral Neck Fracture Risk

Research Article The Slovak Predictive Regression Model of Fall-Related Femoral Neck Fracture Risk Ashdin Publishing Journal of Forensic Biomechanics Vol. 4 (2013), Article ID 235595, 5 pages doi:10.4303/jfb/235595 ASHDIN publishing Research Article The Slovak Predictive Regression Model of Fall-Related

More information

Cross-reference: MP Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition MP Bone Mineral Density

Cross-reference: MP Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition MP Bone Mineral Density Original Issue Date (Created): April 26, 2011 Most Recent Review Date (Revised): September 24, 2013 Effective Date: November 1, 2013 I. POLICY Screening for vertebral fractures using dual x-ray absorptiometry

More information

Prodigy. from GE Healthcare. Most trusted, reliable and best-selling DXA system with one of the largest installed base in the world. gehealthcare.

Prodigy. from GE Healthcare. Most trusted, reliable and best-selling DXA system with one of the largest installed base in the world. gehealthcare. Prodigy from GE Healthcare Most trusted, reliable and best-selling DXA system with one of the largest installed base in the world gehealthcare.com Prodigy High performance, efficient and reliable DXA system

More information

Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures

Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures DOI 10.1007/s00198-013-2460-0 ORIGINAL ARTICLE Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures H. Johansson & A. Odén & E. V. McCloskey & J. A. Kanis Received:

More information

Bone Densitometry. Total 30 Maximum CE 14. DXA Scanning (10) 7

Bone Densitometry. Total 30 Maximum CE 14. DXA Scanning (10) 7 STRUCTURED SELF ASSESSMENT CONTENT SPECIFICATIONS SSA LAUNCH DATE: JANUARY 1, 2018 Bone Densitometry The purpose of continuing qualifications requirements (CQR) is to assist registered technologists in

More information

Official Positions on FRAX

Official Positions on FRAX 196 96 DEPLIANT 3,5x8,5.indd 1 2010 Official Positions on FRAX 21.03.11 11:45 Interpretation and Use of FRAX in Clinical Practice from the International Society for Clinical Densitometry and International

More information

Concordance of a Self Assessment Tool and Measurement of Bone Mineral Density in Identifying the Risk of Osteoporosis in Elderly Taiwanese Women

Concordance of a Self Assessment Tool and Measurement of Bone Mineral Density in Identifying the Risk of Osteoporosis in Elderly Taiwanese Women TZU CHI MED J September 2008 Vol 20 No 3 available at http://ajws.elsevier.com/tcmj Tzu Chi Medical Journal Original Article Concordance of a Self Assessment Tool and Measurement of Bone Mineral Density

More information

EXAMINATION CONTENT SPECIFICATIONS ARRT BOARD APPROVED: JANUARY 2017 IMPLEMENTATION DATE: JULY 1, 2017

EXAMINATION CONTENT SPECIFICATIONS ARRT BOARD APPROVED: JANUARY 2017 IMPLEMENTATION DATE: JULY 1, 2017 EXAMINATION CONTENT SPECIFICATIONS Bone Densitometry The purpose of the bone densitometry examination is to assess the knowledge and cognitive skills underlying the intelligent performance of the tasks

More information

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with

More information

Lunar Prodigy Advance

Lunar Prodigy Advance GE Medical Systems Lunar Prodigy Advance Direct-Digital Densitometry imagination at work Your practice needs to move fast, yet you want peace of mind. A partnership is a journey - expertise, support and

More information

This is a repository copy of Microarchitecture of bone predicts fractures in older women.

This is a repository copy of Microarchitecture of bone predicts fractures in older women. This is a repository copy of Microarchitecture of bone predicts fractures in older women. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/130351/ Version: Accepted Version

More information

Dual-Energy X-Ray Absorptiometry in the Diagnosis of Osteoporosis: A Practical Guide

Dual-Energy X-Ray Absorptiometry in the Diagnosis of Osteoporosis: A Practical Guide Nuclear Medicine and Molecular Imaging Pictorial Essay Lorente-Ramos et al. DEX of Osteoporosis Nuclear Medicine and Molecular Imaging Pictorial Essay Rosa Lorente-Ramos 1 Javier zpeitia-rmán raceli Muñoz-Hernández

More information

Bone Mineral and Body Composition Measurements: Cross-Calibration of Pencil-Beam and Fan-Beam Dual- Energy X-Ray Absorptiometers*

Bone Mineral and Body Composition Measurements: Cross-Calibration of Pencil-Beam and Fan-Beam Dual- Energy X-Ray Absorptiometers* JOURNAL OF BONE AND MINERAL RESEARCH Volume 13, Number 10, 1998 Blackwell Science, Inc. 1998 American Society for Bone and Mineral Research Bone Mineral and Body Composition Measurements: Cross-Calibration

More information

DEXA T-score Concordance and Discordance Between hip and Lumbar Spine

DEXA T-score Concordance and Discordance Between hip and Lumbar Spine Abstract DEXA T-score Concordance and Discordance Between hip and Lumbar Spine Jang-Suk Choi, MD, Ki-Chan An, MD, Chang-Seop Lee, MD Jong-Moon Choi, MD, Joo Yong Kim, MD, Dong-Reol Shin, MD* Department

More information

The Bone Densitometry Examination

The Bone Densitometry Examination The Bone Densitometry Examination The purpose of The American Registry of Radiologic Technologist (ARRT ) Bone Densitometry Examination is to assess the knowledge and cognitive skills underlying the intelligent

More information

The DXL Calscan heel densitometer: evaluation and diagnostic thresholds

The DXL Calscan heel densitometer: evaluation and diagnostic thresholds The British Journal of Radiology, 79 (2006), 336 341 The DXL Calscan heel densitometer: evaluation and diagnostic thresholds J A THORPE, MSc, BSc and S A STEEL, MSc, BSc Centre for Metabolic Bone Disease,

More information

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now?

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Steven M. Petak, MD, JD, FACE, FCLM Texas Institute for Reproductive Medicine And Endocrinology, Houston, Texas

More information

PhenX Measure: Body Composition (#020300) PhenX Protocol: Body Composition - Body Composition by Dual-Energy X-Ray Absorptiometry (#020302)

PhenX Measure: Body Composition (#020300) PhenX Protocol: Body Composition - Body Composition by Dual-Energy X-Ray Absorptiometry (#020302) PhenX Measure: Body Composition (#020300) PhenX Protocol: Body Composition - Body Composition by Dual-Energy X-Ray Absorptiometry (#020302) Date of Interview/Examination (MM/DD/YYYY): A downloadable PDF

More information

ReviewArticle. Frequently Asked Questions About Bone Mineral Density Test

ReviewArticle. Frequently Asked Questions About Bone Mineral Density Test ReviewArticle Frequently Asked Questions About Bone Mineral Density Test Jiraporn Sriprapaporn, M.D.*,** *Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol

More information

Prevalence of Osteoporosis in the Korean Population Based on Korea National Health and Nutrition Examination Survey (KNHANES),

Prevalence of Osteoporosis in the Korean Population Based on Korea National Health and Nutrition Examination Survey (KNHANES), Original Article http://dx.doi.org/10.3349/ymj.2014.55.4.1049 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 55(4):1049-1057, 2014 Prevalence of Osteoporosis in the n Population Based on National Health

More information

Predicting the Risk of Fracture at Any Site in the Skeleton: Are All Bone Mineral Density Measurement Sites Equally Effective?

Predicting the Risk of Fracture at Any Site in the Skeleton: Are All Bone Mineral Density Measurement Sites Equally Effective? Calcif Tissue Int (2006) 78:9 17 DOI: 10.1007/s00223-005-0127-3 Predicting the Risk of Fracture at Any Site in the Skeleton: Are All Bone Mineral Density Measurement Sites Equally Effective? G. M. Blake,

More information

A prospective evaluation of bone mineral density measurement in females who have fallen

A prospective evaluation of bone mineral density measurement in females who have fallen Age and Ageing 2003; 32: 497 502 Age and Ageing Vol. 32 No. 5 British Geriatrics Society 2003; all rights reserved A prospective evaluation of bone mineral density measurement in females who have fallen

More information

2013 ISCD Combined Official Positions

2013 ISCD Combined Official Positions 2013 ISCD Combined Oicial Positions Oicial Positions of the International Society for Clinical Densitometry The International Society for Clinical Densitometry (ISCD) is a not-for-profit multidisciplinary

More information

Obesity Increases Precision Errors in Total Body Dual X-ray Absorptiometry Measurements.

Obesity Increases Precision Errors in Total Body Dual X-ray Absorptiometry Measurements. Obesity Increases Precision Errors in Total Body Dual X-ray Absorptiometry Measurements. 1 K.M.Knapp, 1 J.R.Welsman, 1 S.J.Hopkins, 1 A.Shallcross, 2 I.Fogelman and 2 G.M.Blake 1. University of Exeter,

More information

Measurement Uncertainty in Spine Bone Mineral Density by Dual Energy X-ray Absorptiometry

Measurement Uncertainty in Spine Bone Mineral Density by Dual Energy X-ray Absorptiometry J Bone Metab 2017;24:105-109 https://doi.org/10.11005/jbm.2017.24.2.105 pissn 2287-6375 eissn 2287-7029 Original Article Measurement Uncertainty in Spine Bone Mineral Density by Dual Energy X-ray Absorptiometry

More information

The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study

The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study JCY Cheng HL Sher X Guo VWY Hung AYK Cheung Key words: Absorptiometry, Bone density; Densitometry, X-ray; Lumbar vertebrae; Scoliosis "#$%& "# X HKMJ 2001;7:241-5 The Chinese University of Hong Kong, Prince

More information

A response by Servier to the Statement of Reasons provided by NICE

A response by Servier to the Statement of Reasons provided by NICE A response by Servier to the Statement of Reasons provided by NICE Servier gratefully acknowledges the Statement of Reasons document from NICE, and is pleased to provide information to assist NICE in its

More information

Foreword...v Preface...vii Acknowledgments... xi Dedication... xiii Continuing Medical Education... xxv. Chapter 1: Densitometry Techniques...

Foreword...v Preface...vii Acknowledgments... xi Dedication... xiii Continuing Medical Education... xxv. Chapter 1: Densitometry Techniques... CONTENTS Foreword...v Preface...vii Acknowledgments... xi Dedication... xiii Continuing Medical Education... xxv Chapter 1: Densitometry Techniques... 1 Plain Radiography in the Assessment of Bone Density...

More information

Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study

Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study Osteoporos Int (2010) 21:1503 1511 DOI 10.1007/s00198-009-1102-z ORIGINAL ARTICLE Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study L. A. Ahmed & N. Emaus & G. K. Berntsen

More information

Can we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous

Can we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous Can we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous Distal radius fracture in women after menopause is in many cases a first clinical indication for the presence of

More information

DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN

DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN October 2-4, Liverpool, UK EURO SPINE 2013 DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN D. Colangelo, L. A. Nasto, M. Mormando, E.

More information

QCT BMD Imaging vs DEXA BMD Imaging

QCT BMD Imaging vs DEXA BMD Imaging QCT BMD Imaging vs DEXA BMD Imaging by Charles (Chuck) Maack Prostate Cancer Advocate/Activist Disclaimer: Please recognize that I am not a Medical Doctor. I have been an avid student researching and studying

More information