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Neil Binkley

Publications and source records attributed to Neil Binkley.

31 records · Page 2Linked to original sources
PubMed2004

Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence.

UNLABELLED: In attempt to improve diagnostic agreement between manufacturers, a recent software update incorporated NHANES III data in GE Lunar densitometers. As a result, the femur neck and trochanter T-scores were lowered, and osteoporosis prevalence was increased. Use of a recalculated young-normal SD for the GE Lunar-adjusted NHANES III database improved diagnostic agreement and is recommended. INTRODUCTION: Use of manufacturer-specific normative databases for T-score derivation leads to discordance in T-score values and differences in diagnostic classification. To address this issue, the International Committee for Standards in Bone Measurement (ICSBM) recommended the NHANES III database for femur T-score derivation. Acquired on Hologic (Hol) instruments, this database requires conversion equations for application to other DXA systems. NHANES III total femur (TF) conversions for GE Lunar (GE) have previously been available, and femoral neck (FN) and trochanter (TR) equations were reported recently. Per the ICSBM recommendation, GE Lunar incorporated these values into their female database. This should produce T-score and diagnostic agreement between Hol and GE instruments; however, this has not been evaluated. MATERIALS AND METHODS: We compared GE femur scans in 115 postmenopausal women using software before and after the NHANES III software update. Subsequently, T-scores derived from femur scans obtained on GE and Hol densitometers were compared in a different group of 89 postmenopausal women. RESULTS: The NHANES III software update had no effect on measured BMD (g/cm2) at any femur region. However, because of changes in values used for T-score calculation (increase in the mean young-normal BMD at the FN and TR and a reduction in SD at the TR), the T-scores were lower (mean, 0.48 and 0.68, respectively) at the FN and TR using post-NHANES III software. Consequently, this update increased femur osteoporosis prevalence in these 115 women from 7.8% to 18.3%. Comparison of GE with Hol total proximal femur T-scores revealed a minimal difference (<0.1) and equal diagnoses of osteoporosis. FN and TR differences were larger, with mean GE T-scores lower than Hol (p < 0.001) by 0.17 and 0.50, respectively, thereby introducing osteoporosis diagnostic disagreement (13 [GE] versus 9 [Hol]). Our evaluation suggested that this disparity resulted from direct application of published NHANES III SDs at the FN and TR. As such, we applied the conversion formulae to the NHANES III published Hologic data and found the FN and TR SDs were greater than assumed by GE. Using our recalculated SD to derive T-scores reduced the mean GE/Hol T-score difference to 0.03 at the FN and 0.32 at the TR and resolved osteoporosis diagnostic disagreement. CONCLUSION: The GE NHANES III software update leads to lower FN and TR T-scores than obtained with Hol or prior GE software. Recalculation of the young-normal SD reduces this difference and is recommended. Clinicians are advised to avoid using the TR for diagnosis or, at a minimum, use caution when making treatment decisions based solely on T-score at this site.

Absorptiometry, Photon↗
PubMed2004

Evaluation and measurement of bone mass.

Patients taking antiepileptic drugs (AEDs) have an increased risk for osteoporosis and osteoporotic fractures. Bone mineral density (BMD) is the best predictor of fracture risk. Measurement of BMD allows the identification of patients at risk before they suffer a fracture. The current "gold standard" for the measurement of BMD and diagnosis of osteopenia and osteoporosis is dual-energy X-ray absorptiometry. Clinicians should be familiar with the ways in which bone mass measurements are reported and should understand how to use BMD measurements in making treatment decisions and monitoring treatment. They should also be aware of current controversies, including the role of peripheral versus central BMD measurements and the use of different reference databases for different patient groups. Laboratory assessment to identify secondary causes of osteoporosis, such as low vitamin D status in patients taking AEDs, is useful, but the role of markers of bone turnover in clinical practice has not been well defined.

Absorptiometry, Photon↗
PubMed2004

Official positions of the International Society for Clinical Densitometry.

The International Society for Clinical Densitometry (ISCD) has convened two Position Development Conferences at which a panel of experts agreed on recommendations for performance and clinical applications of bone density testing. These recommendation were reviewed by the ISCD Board of Directors, and those approved by the board are now official positions of the ISCD. These include (1) indications for bone density testing, (2) reference databases for T-scores, (3) standards for performing central dual-energy X-ray absorptiometry (DXA) for diagnosis, (4) interpretation of peripheral bone density results, (5) diagnosis of osteoporosis in postmenopausal women, (6) diagnosis of osteoporosis in men, (7) diagnosis in premenopausal women, (8) diagnosis in children, (9) indications and interpretation for serial bone mass measurement, (10) technical standards for phantom scanning and calibration, (11) technical standards for cross-calibration of DXAsystems, and (12) standards for reporting of bone density results including correct nomenclature and preferred number of decimal digits.

Absorptiometry, Photon↗
PubMed2004

Use of the lowest vertebral body T-score to diagnose lumbar osteoporosis in men: is "cherry picking" appropriate?

In this study, we hypothesized that use of the lowest T-score among four lumbar vertebral bodies would lessen the impact of degenerative arthritis and other artifacts on diagnostic categorization at this site and increase study sensitivity, classifying more men with prior fracture as osteoporotic than the other two methods of lumbar spine analysis. Bone density studies of 533 male veterans measured between January and October 2002 were reviewed to determine diagnostic classification using the L1-L4 average, International Society for Clinical Densitometry (ISCD)-determined, and lowest lumbar vertebral body T-score. We calculated sensitivity and specificity of the three methods of spine analysis, using spine osteoporosis to indicate a positive test and prior fracture as the true indicator of osteoporosis. The lowest lumbar T-score performed with similar sensitivity and specificity to that of the lowest hip or wrist T-score in the ability to classify men with prior fracture as osteoporotic, whereas the average L1-L4 and ISCD-determined T-scores performed with lower sensitivity, but better specificity. In conclusion, this retrospective study suggests that use of the lowest vertebral body T-score among men increases diagnostic sensitivity of lumbar spine bone mass measurement. Prospective studies are needed to determine which of these three methods of lumbar spine analysis best predicts future fragility fracture in men and women.

Absorptiometry, Photon↗
PubMed2003

An overlying fat panniculus affects femur bone mass measurement.

Dual-energy X-ray absorptiometry (DXA) is currently the gold standard technique for osteoporosis diagnosis. However, DXA has limitations, including artifacts, such as degenerative disease or metallic foreign bodies, that may confound bone mineral density (BMD) results. Because fat folds overlying the proximal femur may alter soft-tissue density in a nonuniform manner, this may be a currently unappreciated confounder of proximal femur BMD measurement. This possibility was evaluated in 127 patients (52 women/75 men) referred for routine BMD measurement who were identified as having a fat panniculus overlying their proximal femur scan area. Presence of a fat panniculus within the scan field was confirmed by visual assessment of images obtained utilizing a GE Lunar Expert-XL. Subsequently, these individuals were rescanned while retracting their fat panniculus away from the femur scan area without other repositioning between scans. In 49% of the men, and 56% of the women, either the femoral neck, trochanter, or total femur BMD differed by more than the least significant change at our facility. No pattern was observed to predict whether BMD would increase or decrease upon fat retraction. Subsequently, 30 patients were scanned using the standard and retracted technique twice, with repositioning between scans to establish precision. Retracted and standard precision was similar. In conclusion, an overlying fat panniculus may alter proximal femur BMD measurement, which would be expected to impair the ability to accurately diagnose low bone mass and monitor osteoporosis therapy. When a fat panniculus overlays the proximal femur scan area, its retraction should be part of routine densitometric practice.

Absorptiometry, Photon↗
PubMed2003

Are Wisconsin physicians knowledgeable about male osteoporosis?

It is unknown if recent research defining the relatively frequent occurrence and pathophysiology of male osteoporosis has been conveyed to clinicians. To assess if physicians have incorporated such information, 5646 licensed Wisconsin physicians received a 1-page survey consisting of 14 statements regarding general knowledge, diagnosis, and treatment of osteoporosis in men. Twenty-six percent (1488) responded; 69% (1033) were family physicians or internists, 7% (106) orthopedic surgeons, and 5% (63) endocrinologists or rheumatologists. Of these physicians, 61% to 78% recognized that osteoporosis is not rare in men. Most (68%-97%) agreed that low-trauma fracture or corticosteroid therapy initiation are indications for bone mass measurement. Treating osteoporosis at a T-score of -2.5 was accepted by 79% to 89% of responders. Overall these physicians: (1) recognize osteoporosis as an important disease in men; (2) accept corticosteroid therapy and prior low-trauma fracture as indications for bone mass measurement; and (3) utilize T-scores in treatment decisions. These data suggest that knowledge regarding male osteoporosis has been conveyed to practicing physicians. Evaluation of methods by which physicians will translate this knowledge into action, thereby optimizing patient care, are needed.

Bone Density↗
PubMed2002

Densitometric diagnosis of osteoporosis in men: effect of measurement site and normative database.

Controversy exists regarding which sites to measure, and the appropriate reference database to use, for densitometric diagnosis of osteoporosis in men. While hip and spine bone mineral density (BMD) measurement is routine, spinal osteoarthritis often elevates measured BMD in older men. Additionally, the use of male reference data is standard practice; however, recent reports suggest that a female database may be more appropriate. This study evaluated the effect of sites measured, and normative database utilized, on the densitometric diagnosis of osteoporosis in men. Spine, femur, and ultradistal radial BMD T-scores were determined in 595 male veterans using the GE Lunar male normative database. Subsequently, World Health Organization diagnostic criteria were applied, identifying 282 men with osteoporosis (T-score </= 2.5). The combination of femoral (lowest of neck or total) with the ultradistal radius site was more sensitive (p < 0.0001) for diagnosing osteoporosis than femur plus lumbar spine. When scans from 129 subjects with documented fractures were analyzed using female normative data, fewer (p < 0.0001) met an arbitrary threshold for receiving pharmacologic osteoporosis therapy. In conclusion, BMD measurement at only the spine and hip leads to underdiagnosis of osteoporosis in men. This situation will be exacerbated by utilization of a female normative database; more men with prior fracture may be categorized as not meeting a pharmaceutical intervention threshold.

Absorptiometry, Photon↗
PubMed2002

Osteoporosis in men.

Osteoporosis is often considered a disease of women. However, the lifetime risk of osteoporotic fracture in men is as high as 1 in 4. Furthermore, approximately 30% of hip fractures occur in males. Additionally, morbidity and mortality following osteoporotic fractures appears to be greater in men than women. Thus, it is appropriate that increased attention be paid to this problem in men. Recently, indications for bone mass measurement in men have been published. They include prior low trauma fracture, hypogonadism, and corticosteroid treatment, among others. Additionally, a consensus recommendation that osteoporosis be diagnosed at a T-score of -2.5 or below will soon be published. In men presenting with low bone mass or osteoporotic fractures, secondary causes of bone loss will be found in up to two thirds. The most common secondary causes are corticosteroid use, alcohol abuse, hypogonadism, and idiopathic hypercalciuria. Thus, laboratory evaluation is indicated in osteoporotic men. Finally pharmacologic agents to treat osteoporosis have recently been approved in men. This review highlights current understanding of epidemiology, pathophysiology, diagnosis, and treatment of osteoporosis in men.

Humans↗
PubMed1998

Increase in Lead Concentration in the Drinking Water of an Animal Care Facility.

We report here the unexpected detection, and subsequent correction, of a problem that resulted in an increase in lead concentration in the drinking water of an animal research facility. At the initiation of a study, analysis of a water sample obtained from the drinking spout of an animal cage revealed a lead concentration nearly twice the Environmental Protection Agency's maximum acceptable concentration. Because the municipal water supply routinely had been tested and found to be free of lead, it was assumed that this contamination was within the animal care facility. It was hypothesized that the brass fitting connecting the drinking spout to a polyvinyl chloride (PVC) pipe was the source of contamination. Water samples were obtained hourly from 0700 to 1600 hours before and after replacement of the brass fitting with a PVC fitting. After this change, lead concentrations in all samples were within acceptable limits. Although blood lead concentrations were undetectable in 47 rhesus monkeys (Macaca mulatta) housed in the facility, subclinical lead toxicosis could have resulted and potentially complicated studies in which these monkeys were used. We recommend that the water supply of research facilities be monitored periodically.

Journal Article↗
PubMedDate not supplied

Addition of right lateral decubitus positioning improves vertebral visualization with VFA in selected patients.

Densitometric vertebral fracture assessment (VFA) allows detection of clinically unappreciated vertebral fracture. However, vertebral visualization using VFA can be suboptimal. In such individuals, alternative spine positioning may enhance visualization. Consistent with this, we observed that reversal of positioning (right lateral decubitus rather than standard left lateral decubitus, subsequently referred to as "reverse" positioning) improved visualization in patients with suboptimal vertebral visualization. This report describes 33 such individuals (i.e., 30 men and 3 women); their mean age and their lowest T-score (L1-L4 spine, proximal femur or 0.3 radius) was 69.9 yr and 2.2, respectively. All images were acquired using a GE Healthcare Lunar Prodigy densitometer (GE Healthcare, Madison, WI). Reverse VFA increased the number of visualized vertebrae in 82% of these patients (27 of 33; p<0.0001). Specifically, only 62% of vertebrae from T4-L5 were visualized using the standard left lateral position. Addition of either full or partial reverse VFA increased (p<0.0001) the number of visualized vertebrae to 83% (384 of 462). In this cohort, reverse positioning allowed detection of 4 additional vertebral fractures, including two in patients without previously identified fractures. We conclude that in selected patients with suboptimal vertebral visualization on VFA, addition of reverse positioning improves visualization and may enhance vertebral fracture detection.

Absorptiometry, Photon↗
PubMedDate not supplied

DXA quality matters.

The proliferation of devices to measure bone mineral density (BMD), with large numbers of technologists operating these instruments and numerous physicians interpreting/reporting the results, raises concern regarding the quality of the studies. High quality BMD measurement and reporting is essential, since referring healthcare providers rely on these reports to make patient care decisions that include additional medical evaluation (laboratory or imaging tests), drug therapy (starting, stopping, or changing), and possibly referral to an osteoporosis specialist. Incorrect BMD acquisition or reporting may generate unnecessary medical expenses and result in therapeutic decisions that could be harmful to patients. Contrary to the common misperception that BMD measurement and interpretation is a simple procedure requiring no special expertise, densitometer maintenance/operation, data acquisition, and interpretation/reporting of the results are skills that must be acquired and maintained. We recommend that technologists and clinicians involved with performing or interpreting BMD tests be educated and trained in bone densitometry and that they update their skills regularly. We also suggest that they provide demonstration of proficiency in bone densitometry in order to assure patients, referring healthcare providers, and payers of medical services that these skills have been acquired and maintained.

Absorptiometry, Photon↗