The Value of Bone Density Testing

Synopsis: An article just published in the online version of the British Medical Journal (BMJ 2009;338:b2266) concludes that bone mineral density (BMD) testing by DXA to monitor response to bisphosphonate therapy in older women is unnecessary and potentially misleading. The article was quickly picked up by WebMD Health News and Forbes within 24 hours and … Continue reading

VFA Update 12/05

Andrew Laster, MD, FACR, CCD Public Policy Committee Chair Official Indications The indications for vertebral fracture assessment (VFA) now appear in the Official Positions of the ISCD. These indications originated with the ISCD Position Development Conference (PDC) in Vancouver in July of this year and represent the culmination of a rigorous process involving recommendations from … Continue reading

A Basic Primer On Vertebral Fracture Assessment (VFA)

Andrew Laster, MD, FACR, CCD Public Policy Committee Chair WHAT IS VFA? Vertebral Fracture Assessment (VFA) is a new technology using central DXA that permits imaging of the thoracic and lumbar spine to evaluate for the presence of vertebral fractures. Images can be obtained at the same time as a BMD measurement at lower cost … Continue reading

Region of Interest: ROI Column Wal-Mart: A Case of Advocating for Patients for Appropriate DXA Coverage

John Goldman, MD, CCD OsteoFlash® Editor Dr. Michael R. Saitta, MD, FACR, CCD, an ISCD member and ISCD Certified Clinical Densitometrist (CCD), is a rheumatologist in Fayetteville, Arkansas. Dr. Saitta’s office is near the Arkansas national headquarters of Wal-Mart Stores, Inc. The Wal-Mart Associates Medical Plan is administrated by Blue Advantage Administrators of Arkansas (Blue … Continue reading

New Format for OsteoFlash®

As mentioned in the first newsletter of 2005 the OsteoFlash® continues its reconstruction. It will be used as a toolbox to give ISCD: 1. A quick response to changes affecting the densitometry community 2. To answer some of the many questions ISCD refers to the Regional Representative System regarding: a. Imaging b. Interpretation c. Regulation … Continue reading

New OsteoFlash® Format

OsteoFlash® will have a new primary responsibility beginning with this, the first newsletter of 2005. OsteoFlash® will serve as a means of communication between ISCD regional representatives and the membership. Regional representatives are a free resource for ISCD members, allowing individuals to inquire about public policy and technical issues relevant to bone densitometry. These inquiries … Continue reading

Public Policy Committee Update

Blue Cross and Blue Shield Association and Vertebral Fracture Assessment: Vertebral fracture assessment (VFA) has been recognized by the Centers for Medicare and Medicaid Services (CMS) as a valuable means of identifying individuals with fragility fractures. Reimbursement by CMS for performance of this service has been authorized (OsteoFlash®, November 2004). However, the Blue Cross and … Continue reading

Regional Representative Reports

Northwest Region, USA Q. How often will Medicare pay for DXAs? A. Medicare will reimburse for DXAs once every two years with a few exceptions, as long as the patient meets appropriate criteria for screening DXAs, reviewed in a prior issue of OsteoFlash® (November 2004). A DXA may be repeated one year after initiation of … Continue reading

Vertebral Fracture Assessment (VFA)

Vance J. Bray, MD The 2005 American Medical Association Current Procedural Terminology (CPT®) coding manual includes a new CPT code, 76077, for vertebral fracture assessment (VFA) utilizing DXA technology. VFA is the preferred term for what has been called morphometric x-ray absorptiometry (MXA) in the medical literature. VFA is the same as the proprietary terms … Continue reading

The Skeleton in Primary Hyperparathyroidism

Joseph L. Shaker, MD Endocrine-Diabetes Center St. Luke’s Medical Center, Milwaukee, WI Primary hyperparathyroidism (PHPT) is a common condition with prevalence in the general population of approximately 3 per 1000.1 The incidence peaks in midlife with the female to male ratio about 5:1 after age 55 years.1 The biochemical profile includes hypercalcemia with elevated or … Continue reading

Osteoporosis in Men

Pamela B. Sheets, MD The Polyclinic, Seattle, WA, USA Clinical Characteristics Osteoporosis is under-recognized and under-treated. The problem is compounded in men because of the misconception that osteoporosis is a disease of women. A gender-specific approach to screening, diagnosis, and treatment should reduce the morbidity and mortality of the disease, particularly in men over 70. … Continue reading

Vitamin D Deficiency: The Silent Epidemic of the Elderly

Alfred Denio, MD Prior to the 1930s, rickets, or severe childhood vitamin D deficiency, was epidemic in the United States and Europe, afflicting an estimated 85% of children in industrial cities. In the United States today, milk and infant formula are fortified with vitamin D and frank rickets is now uncommon. Despite these public health … Continue reading

The Women’s Health Initiative in Perspective

John A. Goldman, MD Division of Rheumatology and Immunology Emory University School of Medicine The Woman’s Health Initiative (WHI) was designed in 1991-1992 to define the risks and benefits of interventions to potentially reduce heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women (1, 2, 3). After screening 373,092 women aged 50 … Continue reading

Women’s Health Initiative Commentary

Mary K. Beard, MD, FACOG Department of Obstetrics and Gynecology Adjunct Clinical Professor, University of Utah Dr. Goldman is not alone in raising the various concerns presented in his article. The Women’s Health Initiative (WHI) was designed to answer many of the issues regarding the benefits and risks of hormone therapy (HRT). However, the entry … Continue reading

Osteoporosis Screening Guidelines

Vance J. Bray, MD, FACP, FACR The U.S. Preventive Services Task Force (USPSTF) released guidelines for osteoporosis screening on September 16, 2002. The USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. A list of current reviews and … Continue reading