Abstract
Densitometry has primarily been a quantitative measurement technique. The first skeletal images from a densitometer, as seen in Fig. 2-7 in an earlier chapter, were only vaguely reminiscent of the actual bone. The poor image quality had little effect on the ability to quantify the bone density, which was the primary purpose of the various techniques. Imaging, as a potential application of densitometry, has been anticipated for over a decade. Continued improvements in DXA technology combined with modern computer capabilities have resulted in dramatic improvements in imaging and acquisition speed. Truly remarkable images of the spine such as the RVA™ image from a Hologic Discovery1 seen in Fig. 13-1 are possible today. When combined with the very low radiation exposure in comparison to conventional X-ray studies, the use of lateral spine DXA imaging for the diagnosis of vertebral fractures and assessment of aortic calcification has become a clinical reality.
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Notes
- 1.
RVA™ is a trademarked reference for radiographic vertebral assessment from Hologic. Specifications for the Hologic Discovery can be found in Chapter 15.
- 2.
A prevalent fracture is a fracture that is already present at the time the patient is seen. An incident fracture is a fracture that develops at some point in time after the initial evaluation.
- 3.
DVA™ is a trademarked reference to Dual-energy Vertebral Assessment as performed on GE Lunar fan-array DXA devices. Specifications for the GE Lunar Prodigy may be found in Chapter 15.
- 4.
Parallax refers to an apparent displacement of an object due to a change in the observer’s position. In the case of spine radiography, it refers to the angle at which the X-ray beam passes through the vertebral bodies. If the X-ray beam is not parallel to the vertebral endplates, the shape of the vertebrae may be distorted, making morphometric measurements inaccurate.
- 5.
See Chapter 3for a discussion of precision.
- 6.
See Appendix VIII for a listing and discussion of relevant CPT codes.
- 7.
See Chapter 9 and Appendix IV for a discussion of the WHO criteria for the diagnosis of osteoporosis based on the measurement of bone density.
- 8.
See Chapter 2 for a discussion of the potential effect of aortic calcification on BMD measured at the PA lumbar spine.
- 9.
The Rotterdam study is a prospective population-based cohort study of 7983 women and men age ≥55 years in which the incidence and causes of chronic disabling diseases were investigated.
- 10.
The Framingham Heart Study is a prospective epidemiologic cohort study begun in 1948 to identify potential risk factors for coronary heart disease.
- 11.
Coronary heart disease refers to angina, unstable angina, myocardial infarction, and coronary disease death.
- 12.
See Chapter 3 for a discussion of receiver operator characteristic curves.
- 13.
Diagnostic tests with an AU-ROC of 0.70–0.90 when compared to a “gold standard” test are considered to have acceptable predictive accuracy. An AU-ROC > 0.90 is superb.
- 14.
EPIDOS is a multicenter prospective study of 7575 women living at home aged 75–95 years in France. The data in this study are from 320 women from the Lyon and Montpellier centers.
- 15.
The Dubbo Osteoporosis Epidemiology Study is a case-control study involving 1902 men and women who were recruited between 1989 and 1993.
- 16.
The CMSI is a measure of the distribution of the mineral within the cross-section. It is not a measure of bone strength but directly affects the section modulus, which is a measure of strength in bending.
- 17.
The CSA is a measure of the bone mineral content in the cross section. It is directly proportional to the ability of the bone to withstand axial compression.
- 18.
The section modulus is a measure of the strength of the bone in bending. Note that the section modulus is indicated by the abbreviation “Z,” which is unrelated to the z-score used in densitometry.
- 19.
The BR is the ratio of the diameter of the cross section to its cortical thickness. High BRs suggest the possibility of local failure or buckling due to an excessively thinned cortex.
- 20.
This was originally called the Fall Index.
- 21.
This technique is also known as hydrostatic weighing or hydrodensitometry.
- 22.
See Chapter 11 for a discussion of the percent coefficient of variation and the number of subjects and studies needed for a valid precision study.
- 23.
Chemical fat is actually a component of adipose tissue. Fat can be found in other tissues as well. Similarly, adipose tissue also contains protein, minerals, and water. The terms fat and adipose tissue are unfortunately often used interchangeably, even though they are clearly not synonymous.
- 24.
See Chapter 5 for a discussion of the effective dose equivalent (HE).
- 25.
The Tanner and Whitehouse method is often indicated by the abbreviation TW2 to indicate the method proposed in 1983 rather than an earlier method proposed in 1975.
- 26.
This is the same James Mourilyan Tanner as in the Tanner and Whitehouse bone age method.
- 27.
A centile scale reflects values from 0 to 100. The terms centiles and percentiles are often used interchangeably. The location of the value plotted on the scale indicates the percentage of individuals in the population in question, who have a similar or poorer value. For example, if the centile scale reflects a value of 40, 40% of individuals in that population have the same or poorer value for the quantity in question. Conversely, 60% will have a higher value. If the value on the centile scale is 50, an appropriate interpretation is that half of the population will have a better value and half will have a poorer value. A centile value of 5 or less is generally a cause for concern although some circumstances may dictate concern at higher centile values.
- 28.
See Chapter 9 for a discussion of the World Health Organization criteria for the diagnosis of osteoporosis based on the measurement of bone density.
- 29.
Menarche is defined as the age at which the first menstrual period occurs.
- 30.
See Chapter 3 for a discussion of the normal distribution.
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Bonnick, S.L. (2010). New Applications for DXA. In: Bone Densitometry in Clinical Practice. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-499-9_13
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