Main description:

Despite public perception, osteoporosis remains a widespread, devastating disease, and a very serious and costly public health threat. Early detection and treatment must be a priority for primary health care providers. Dual-energy X-ray absorptiometry (DXA) is the principal x-ray technology used to diagnose osteoporosis in its early, asymptomatic stages, to assess treatment efficacy, and to guide treatment decisions. It remains the gold standard today. A DXA Primer for the Practicing Clinician: A Case-Based Manual for Understanding and Interpreting Bone Densitometry is developed around real cases of patients' DXA measurements. The content is derived from presentations given by the authors at a national society training course and exemplifies not only the complete body of education provided through these lectures but the full range of previously undiscussed nuances as well. This practical, easy-to-read title provides the day to day problems of DXA usage that new users may encounter and that training courses do not have time to provide in detail. The central focus of the book is the presentation of what is normal and what is problematic in the use of DXA, depicting various scenarios with real case histories of patients, their corresponding DXA images and the data that explain the problems. Unique in approach and presentation, this case-based manual will be of immense value to all practitioners -- and students - interested in providing optimal diagnosis and treatment of osteoporosis.

Contents:

Introduction

What prompted the authors to write this text

A brief comment on the Bone & Joint Decade

A brief word on the epidemiology of osteoporosis

Primary disease

Secondary disease

That seen in chronic disease, due to Rx, men, bariatric surgery pts.

Introduction to Densitometry

The gold standard for non-invasive skeletal assessment

Ultimate goal: prevent fractures

Limitations: only a 'snap-shot'; can not reveal what has gone on with the bones up to that point

The many challenges of DXA

Obtaining the images

Interpreting the data

Even radiologists are prone to errors

Specific training is essential

Clinical application to the individual patient

Looking into the future

New technologies

Vision of an 'optimal' noninvasive, accurate, measure of bone quality

Chief Medical Officer aboard the USS Enterprise: Lt Commander Leonard "Bones" McCoy

Hand-held 'tricorder'

3D-QCT

Finite element analysis (FEA)

SECTION I: Fundamental Concepts

1. The History of Non-Invasive Skeletal Assessment

Imaging Techniques

Radiographic absorptiometry

SPA

DPA

QCT

DXA

QUS

PIXI

2. Common Terms and Abbreviations Defined

Accuracy

Apparent bone mineral density

BMD = areal density in g/cm2 in this text

Areal vs. volumetric

Bone accretion

Bone markers

Bone Mineral Density

Coefficient of variation

Database

Distal 3rd Radius

DPA

DXA, Central

DXA, Peripheral

Femoral Neck

Femoral Shaft

FRAX - incl application limited to untreated pts. - should not be completed by Techs; emphasize importance of clinical judgment

Hip, Total

LSC

Lumbar spine (L1 - L4)