President’s Message


Dear Colleagues,
I am honored to be serving as president of the International Society for Clinical Densitometry for the 2016-2017 term. I have been a part of the ISCD in one way or another since 1999 and involved in quantifying bone density and medical imaging for the past 20 years. I have seen many changes and advancements in our field as well as setbacks.

I have seen the ISCD grow from small beginnings in the mid 1990s to a truly international organization with worldwide reach and influence on skeletal health assessment, including how osteoporosis is diagnosed and monitored. We are truly an intentional society with over 3000 members throughout the world. In all of our efforts, we aim to serve the needs of diverse regions of our membership. There are 5 regional panels for members to participate including Canadian, Iberian-American, European, Middle Eastern and African (EMEA) and Asia-Pacific regions. I remember when there was only one course with two offerings: bone densitometry for clinicians and for technologists. Now the modern form of this course is taught in partnership with the International Osteoporosis Foundation (IOF) worldwide. Over 6,000 are certified in quality DXA practices. In addition to the core courses, there are now specialty courses in vertebral fracture assessment, body composition, and pediatric densitometry.

ISCD has kept up with the ever changing landscape of how osteoporosis is diagnosed and managed. From T-scores to FRAX, the ISCD has held six position development conferences to guide all physicians and technologists on standards of practice and quality densitometry. In these past twenty years, we have gone from one drug therapy to over a dozen that effectively reduce fracture risk. And for all of this time and with the orchestrated efforts of thousands in academics, clinical practice, and pharmaceutical companies, hip fracture rates have been on the decline. That is until recently.

For the first time in 20 years, hip fracture rates in older women have stopped declining.1 Why is this happening? In simple terms, the patients that would benefit from treatment are either not being identified or are deciding not to use these treatments based on factors including the fear of rare side effects.

One factor that is definitely impacting the ability for individuals to determine if they are at high risk is the declining reimbursement rates for DXA visits in the United States. With dropping rates, physicians who are offering bone density assessment in their offices have closed or stopped providing the test. Over 5,000 physicians in the US that offered DXA in 2008 do not offer DXA now because they lose money with every patient they scan. DXA testing in older women was on the rise through 2008. By 2014, there were 24% fewer DXA exams in the US than would have been expected, had that growth in testing continued!

With dropping reimbursement rates, quality of care goes down. Clinicians and technologists are less likely to be trained in quality practices when they cannot get paid for their services. With decreased access, and a drop in the emphasis on quality, patients suffer by not being identified as being at high risk of fracture early before the fracture occurs.

To add insult to injury, in July, the Centers for Medicare and Medicaid Services proposed a 37% cut to DXA offered in the hospital out-patient department from $100 in 2015 to $62 in 2016. This will further restrict access to DXA testing.

The ISCD continues to be at the forefront of this issue, of how devastating inadequate reimbursement is for patient care, by speaking directly with Congress about the facts of osteoporosis care.

What can you do? First, join us as a member of the ISCD and keep up to date on the new advances in our field. Second, get and maintain your accredited certification. Certification speaks volumes to your patients that you care about quality and follow the most up to date standards of care. Third, get involved. Please click on this link to sign up for our advocacy efforts. What better way to spend your valuable time than insuring access to quality care by teaching, advocating, and contributing case information.

If we have not met, I hope you introduce yourself and tell me of your practice, research, technical insights, and whatever else you like. The perfect opportunity to do this would be the 2017 ISCD Annual Meeting, to be held in conjunction with the National Osteoporosis Foundation.

I close saying that there is much to be done to get hip fracture rates on the decline again. As others have said before, I ask, “if not us, if not you, if not I, then who? If not now, when?”

Best wishes for 2016-2017.

John Shepherd, PhD, CCD
President of the ISCD (

1 Direct Research LLC, Medicare PSPS Master Files and Medicare 5 Percent Sample LDS SAF, analysis by Peter M. Steven, PhD.

Last modified: January 9, 2017