Biomedical subjects

Writing Group for the ISCD Position Development Conference

Publications and source records attributed to Writing Group for the ISCD Position Development Conference.

6 recordsLinked to original sources

PubMed2004

Position statement: introduction, methods, and participants. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference.

Following publication of the proceedings from the first Position Development Conference (PDC) of the International Society for Clinical Densitometry (ISCD), members of the ISCD Scientific Advisory Committee (SAC) addressed additional topics of interest in the field of bone densitometry. These topics were addressed at a subsequent PDC, which was held in Cincinnati, Ohio, July 25-27, 2003. Five topics were chosen for discussion: (1) the diagnosis of osteoporosis in men, premenopausal women, and children; (2) technical standardization for dual-energy X-ray absorptiometry (DXA); (3) indications for bone densitometry; (4) reporting of bone density results; and (5) nomenclature and decimal places for bone densitometry. This report describes the methodology used for the development, presentation, and finalization of PDC positions. These positions are discussed in the following papers.

Absorptiometry, Photon↗

PubMed2004

Diagnosis of osteoporosis in men, premenopausal women, and children.

The World Health Organization (WHO) classification of bone mineral density is based on population studies in postmenopausal women. However, the increased use of bone densitometry has raised questions regarding the applicability of this classification to men, premenopausal women, and children. These questions were addressed at the International Society for Clinical Densitometry 2003 Position Development Conference. T-scores can be used and a diagnosis of osteoporosis made for T-scores of -2.5 or less (male reference database) in men age 65 yr and older and in men from 50 to 64 yr of age if other risk factors for fracture are present. The WHO classification should not be applied to premenopausal women. Men and premenopausal women with secondary causes of low bone density or bone loss may be clinically diagnosed with osteoporosis, taking bone density into consideration. In children and adolescents (males and females less than 20 yr of age), there are no densitometric criteria for diagnosing osteoporosis. If Z-scores are -2.0 or less (using pediatric databases of age-matched controls), then a characterization such as "low bone density for chronologic age" is appropriate. In men under 50 yr of age, premenopausal women, and children, Z-scores, not T-scores, should be used when reporting bone density results.

Absorptiometry, Photon↗

PubMed2004

Technical standardization for dual-energy x-ray absorptiometry.

Clinical applications of dual-energy X-ray absorptiometry (DXA) should be updated periodically to address new technologies and inconsistencies in the use of existing technologies. The 2003 Position Development Conference of the International Society for Clinical Densitometry addressed issues regarding hip and forearm regions of interest (ROIs), vertebral fracture assessment (VFA), quality assurance (QA), precision, and cross-calibration. Data are insufficient to determine whether the mean T-score of both hips can be used for diagnosis. However, the mean bone mineral density of both hips can be used for monitoring. The 33% radius is the preferred forearm ROI for the diagnosis of osteoporosis. Data are insufficient to determine indications and clinical utility of VFA. Minimum standards for a QA program were established. Phantom scanning should be performed at least once per week. Precision assessment should use patients representative of a DXA center's patient population. If a center has more than one technologist, then the average precision may be used. Repeat precision assessment is necessary if a new DXA system is installed or a technologist's skills have changed. Knowledge of precision is critical to DXA interpretation, and approval from an institutional review board should not be required. Practical standardized procedures for cross-calibration of DXA systems should be developed.

Absorptiometry, Photon↗

PubMed2004

Indications and reporting for dual-energy x-ray absorptiometry.

Although dual-energy X-ray absorptiometry (DXA) is widely used to measure bone mineral density (BMD), there are few guidelines regarding indications for testing in populations other than postmenopausal women or for reporting the results from DXA studies. At the 2003 Position Development Conference of the International Society for Clinical Densitometry, positions were developed to formalize indications for bone density testing and the components of a DXA report. Bone density testing is indicated for the following individuals: women 65 yr of age and older, postmenopausal women under age 65 yr with risk factors, men 70 yr of age and older, adults with fragility fracture, adults taking a medication or adults with a disease or condition associated with low bone mass or bone loss, any individual being treated for low bone mass to monitor treatment effect, and any individual in whom evidence of bone loss would affect treatment decisions. The DXA report should include patient identification and demographics, identification of the referring provider, indications for the test, an explanation of the technique, and abnormalities in performing the study. In addition, the report should include BMD values, the T-score and/or Z-score as appropriate, World Health Organization (WHO) classification for diagnosis, risk factors, and recommendations for follow-up.

Absorptiometry, Photon↗

PubMed2004

Nomenclature and decimal places in bone densitometry.

There are inconsistencies in densitometry nomenclature and in the use of decimal places in reporting bone density results. These issues were discussed at the 2003 Position Development Conference (PDC) of the International Society for Clinical Densitometry (ISCD). Regarding nomenclature, there was agreement that DXA is the preferred designation for dual-energy X-ray absorptiometry. T-score (not T score, t score, or tscore) is the preferred designation for the standard deviation variance of bone mineral density (BMD) from the mean BMD of the young adult reference population. Z-score terminology should be consistent with that for T-score. For the reporting of bone densitometry results, BMD should be expressed to three decimal places, bone mineral content and area to two decimal places, T-scores and Z-scores to one decimal place, and percentages (percentage of reference population mean BMD) as integers.

Absorptiometry, Photon↗

PubMed2004

Position statement : executive summary. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference.

The International Society for Clinical Densitometry (ISCD) held a Position Development Conference in July 2003, at which time positions developed and researched by the organization's Scientific Advisory Committee were presented to a panel of international experts in the field of bone density testing. This panel reached agreement on a series of positions that were subsequently approved by the Board of Directors of the ISCD and are now official policy of the ISCD. These positions, which are outlined in this article and discussed in greater detail in subsequent articles in this journal, include (1) affirmation of the use of the World Health Organization classification for the diagnosis of osteoporosis in postmenopausal women; (2) the diagnosis of osteoporosis in men; (3) the diagnosis of osteoporosis in premenopausal women; (4) the diagnosis of osteoporosis in children; (5) technical standards for skeletal regions of interest by dual-energy X-ray absorptiometry (DXA); (6) the use of new technologies, such as vertebral fracture assessment; (7) technical standards for quality assurance, including phantom scanning and calibration; (8) technical standards for the performance of precision assessment at bone density testing centers, and for cross-calibration of DXA devices; (9) indications for bone density testing; (10) appropriate information for a bone density report; and (11) nomenclature and decimal places for bone density reporting.

Absorptiometry, Photon↗