THE BEGINNING

June I, 1992, the Wyndham Hamilton Hotel, Itasca, Illinois, USA: A small group of physicians, under the leadership of Paul Miller, MD, gathered to discuss problems associated with the practice of densitometry in the United States. They represented the medical disciplines of Endocrinology, Internal Medicine, Nephrology and Rheumatology.

THE PROBLEMS

The very fact that this group was multi-disciplinary was a problem in itself. Physicians operating densitometry practices represent a number of different medical specialties, with none of their particular medical associations able to specifically address issues surrounding densitometry practice. Furthermore, customer surveys revealed only a minority of densitometrists were concerned with basic research in metabolic bone disease, and were not members of bone societies.

The largest problems identified by this group were the huge disparities between epidemiological estimates of the population with existing osteoporosis, and those at risk of developing osteoporosis, compared to the small number of patients who were actually diagnosed by bone measurement. Even if every densitoter in the USA were fully utilized, the gap between those diagnosed and those having osteoporosis would still remain a major health problem. The group realized that only a small minority of machines were being used to capacity. The question was, why?

QUALITATIVE REASONS

One would have thought that with the very successful public education programs sponsored by organizations such as the United States ' National Osteoporosis Foundation patients would have flocked to their physicians to be diagnosed. Somewhere, the group concluded, there were stumbling blocks between public awareness and diagnosis.

They agreed some of these stumbling blocks could be that few treatment options are available to the primary physician. Those that are available are difficult to administer, which adds to the problem of patient compliance. Since there are relatively few densitometry centers, patients sometimes have to travel long distances for a bone densitometry examination. There is no national directory of densitometry centers available to primary care physicians as a reference document. Physicians are unsure what examination to order. Some centers assume patient management and do not send patients back to the referring physician. The result of all these stumbling blocks is a dwindling volume of referrals.

TECHNICAL REASONS

On the technical side, densitometry reporting can be so complex to the non-specialist that densitometry becomes as worthless as an osteoporosis management tool. Couple this with the relatively high cost of densitometry scans, which in private practice are not Medicare reimbursed by health insurers; then, despite the efforts to address the silent and devastating consequences of osteoporosis, very little increase in patient volume will be realized until these problems are solved.

WHY THE SOCIETY FOR CLINICAL DENSITOMETRY?

It was evident among the group that there was a critical need for a common organization, which would be devoted to providing quality standards to serve the needs of clinicians, technicians and patients. What type of quality standards would such a society address?

Here are some examples: Although there is almost a saturation of meetings on osteoporosis, there is still a need to update, simplify, and clarify information on densitometry for the general audience within the contents of those meetings.

Good practice management techniques need to be gathered and broadly disseminated, for instance: The most successful densitometry practices are those who have developed outreach programs for physicians and community groups in their areas. These speaking engagements by both the physicians and technicians result in dramatic increases in referrals. These successful physicians, however, are careful not to take over patient management. They complete a thorough diagnostic work-up in addition to a bone scan, recommend treatment options, and then patients to the referring physician for continued management.

There was discussion that should the Society for Clinical Densitometry prove to be viable, then at some future date training and certification for technicians could be considered.

REPRESENTATION AND STANDARDS

The group that met in Itasca were not representative of the specialists involved in densitometry. Since that meeting, a gynecologist and radiologist have been added to the Steering Committee, but orthopedic and family physician representatives still need to be co-opted. Steering Committee Members have no commercial or consulting interests with equipment manufacturers, and the equipment they operate forms a cross-section of all approved technology. SCD will not be elitist to only those who already own equipment. Membership will be open to all physicians and technicians interested in the subject of densitometry.

WILL SCD BECOME VIABLE?

Following the Itasca meeting, a questionnaire was devised and sent to 380 densitometrists in the United States. Thirty-four percent returned their answers.

The results were: Somewhat likely to extremely likely to join SCD 60% Overall rating of "good to excellent" for SCD 64% Improve community education about osteoporosis 68% Reduce patient costs through increased volume 47% Facilitate reimbursement 65% Lead to antagonism with other societies 44% Satisfaction with other societies to meet densitometry needs 40% With these results, there is a good probability that with perseverance, the SOCIETY FOR CLINICAL DENSITOMETRY will grow and contribute significantly to the growth of osteoporosis diagnosis.

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