Program Information

Pre-Meeting Courses

Tuesday, May 31, 2016

11:00–18:00Quality Bone Densitometry: Performance, Interpretation, and Clinical Application for Clinicians
An Osteoporosis Essentials course of the ISCD and IOF.
Separate Registration Fee Required.
Quality Bone Densitometry: Performance, Interpretation, and Clinical Application for Technologists
An Osteoporosis Essentials course of the ISCD and IOF.
Separate Registration Fee Required.

Wednesday, June 1, 2016

7:15–13:15Quality Bone Densitometry: Performance, Interpretation, and Clinical Application for Clinicians
An Osteoporosis Essentials course of the ISCD and IOF.
Separate Registration Fee Required.
Quality Bone Densitometry: Performance, Interpretation, and Clinical Application for Technologists
An Osteoporosis Essentials course of the ISCD and IOF.
Separate Registration Fee Required.
13:30–17:30Pediatric Bone Densitometry Course Course
Separate registration fee required.
Certified Clinical Densitometrist (CCD) and Certified Bone Densitometry Technologist (CBDT) Certification Exams
Separate registration fee required. No onsite registration available.

2016 Annual Meeting: Quality Matters in Bone Health

The 2016 Program Chairs of the ISCD 22nd Annual Meeting have designed an outstanding slate of internationally renowned speakers addressing the theme of Quality Matters in Bone Health.

Wednesday, June 1, 2016

18:00–18:15Welcome
President: Bill Leslie
Annual Meeting Chairs: Anita Colquhoun & Malachi McKenna
18:15–19:15Annual Meeting Plenary Session I — Close to the bone: Engineering research into the biology of Osteoporosis
Laoise McNamara
1. Biomechanical properties of bone: particularly focusing on the contribution of bone mass and bone quality (collagen and mineral composition, tissue microarchitecture, microdamage) to
bone strength. 2. Biomechanical properties of bone during osteoporosis: changes in collagen and mineral composition, tissue microarchitecture and microdamage that arise during estrogen deficiency and how these contribute to bone fracture. 3. The microenvironment of bone cells: this section will focus on the role of mechanical loading at the cell level for governing bone structure and function. This section will also explore whether changes in tissue composition, in particular mineralisation, during osteoporosis occur as a compensatory response to bone loss. 4. Discuss how stimulation of bone and stem cells might alter the biomechanical properties of bone. This section will provide an understanding of the link between mechanical stimulation of MSCs and bone cells and bone biology and matrix production/maintenance. 5. Outline potential for promoting bone health and strength: latest understanding of the role of physical activity for bone health and fracture prevention, the effect of bisphosphonates on bone composition and quality.
19:15–21:00Exhibit Hall Reception/Auction

Thursday, June 2, 2016

7:50–8:00President Welcome: Bill Leslie
Annual Meeting Program Chairs: John Carey, Neil Binkley, Susan van der Kamp
8:00–10:00Annual Meeting Plenary Session II — Quality Matters
Joint Session of the International Society for Clinical Densitometry & International Osteoporosis Foundation
Osteoporosis around the Globe
Cyrus Cooper
Discuss the global epidemiology of osteoporotic fracture including; Osteoporosis constitutes a major public health problem through its association with age-related fractures. These fractures typically occur at the hip, spine and distal forearm. It has been estimated from incidence rates derived in North America that the lifetime risk of a hip fracture in Caucasian women is 17.5% with a comparable risk in men of 6%. Age- and sex-adjusted hip fracture rates are generally higher in Caucasian than in Asian and Afro-Caribbean populations. This session will consider the variation in fracture incidence by age, sex, geography and time. It will cover the burden on healthcare resources posed by major osteoporotic fractures, and discuss the potential for population-based and high risk preventive strategies.
Densitometry Around the Globe
John Shepherd
The approaches to quantifying bone density and body composition vary around the world for many reasons including economic considerations and accessibility. In the United States, clinical bone density assessment is predominately central DXA. However peripheral DXA and ultrasound assessment are alive and well in many countries. The role of DXA for body composition assessment also varies widely. In this talk, I will discuss the different types of densitometry around the globe with examples in developed and developing countries including Jamaica, Mauritius, Asia, Eastern Europe and the Middle East. I will discuss the international training efforts of the ISCD and other organizations such as the International Atomic Energy Agency (IAEA). I will also discuss how quality DXA can be performed in resources-limited environments.
Quality Metrics
Mike Lewiecki
DXA Best Practices is a newly developed set of quality standards from the ISCD to provide guidance for DXA supervisors, technologists, interpreters, and clinicians. Adherence to quality standards provides assurance that DXA measurements are correct and meaningful for managing patients with skeletal health concerns.
10:00–10:30Exhibit Hall Break/Poster ViewingOffice Hours
10:30–11:25Annual Meeting Plenary Session III — Decade of FRAX: What have we learned? & Dr. Paul D. Miller ISCD Service Award Presentation
Bill Leslie
FRAX® is a fracture risk assessment system from the World Health Organization (WHO) that was released in March 2008. Guidance from the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) on FRAX® was published in 2011 to highlight strengths and limitations in the use of FRAX® in clinical practice. Since then, there has an explosion in information related to FRAX, with over 600 peer-reviewed publications listed in Pubmed alone. Just as attention to detail is critical in achieving high quality bone densitometry, so too accurate fracture risk assessment with FRAX® requires rigorous attention to risk factor collection. This presentation will review common errors and pitfalls in the use of FRAX®, and recent enhancements to FRAX® that can refine risk assessment in glucocorticoid users, discordant lumbar spine results, when lumbar spine trabecular bone score (TBS) is available, and in type 2 diabetes mellitus.
11:25–12:20Annual Meeting Plenary Session IV — Oral Abstracts & Award Presentation: Best Clinician Abstract & ISCD Clinician of the Year
Multiethnic reference values for trabecular bone score (TBS) in dual-energy absorptiometry (DXA) from NHANES 2005-2008
Bo Fan
Abdominal Aortic Calcification on Bone Density Test Images: Potential Role in Atherosclerotic Cardiovascular Disease Risk Screening
John Schousboe
Enhanced precision of the new Hologic Horizon model compared with the old discovery model is less evident when fewer vertebrae are included in the analysis
Elizabeth McNamara
Comparison of five predictive equations to convert Lunar Prodigy fat mass to iDXA fat mass in adults
Karen Hind
Body shape and fat distribution from whole-body DXA accurately predict metabolic syndrome across sex and ethnicity subgroups
Bennett Ng
Is there an optimal TBS lumbar spine vertebrae combination to predict major Osteoporotic Fracture? The OsteoLaus Cohort Study.
Hamza Mraihi
12:20–14:30Exhibit Hall/Poster Viewing/Lunch Break
12:30–13:30Product Theater - GE Lunar Non-CME event
13:30–14:25Meet the Expert Sessions I and Workshop Sessions I
AFF Update
Malachi McKenna
Complete AFFs need urgent surgical fixation. The surgical intervention of choice is insertion of an intramedullary nail. Some incomplete AFF may heal spontaneously, but a characteristic of AFF is slow healing. Bsiphosphonate therapy should cease. Those with incomplete AFF and pain should probably have prophylactic insertion of a medullary nail. Fracture completion is a major concern because the morbidity is high and the long-term outcome is unclear.
Renal - Challenging Patients
Paul Miller
Case presentations of patients with fractures sand also impaired renal function. The cases illustrate the diagnostic approached for distinguishing between osteoporosis and the group of bone diseases that accompany chronic renal failure
What’s Wrong with this DXA?
Brad Richmond and Larry Jankowski
While DXA is considered a gold standard for the assessment of bone density, its clinical efficacy is heavily dependent upon proper execution and interpretation. Error in performance of the scan itself, and both omissions and commissions of erroneous reporting components can result in inappropriate patient management. In this session we demonstrate a systematic approach for reviewing scans for errors. We present a series of real scans and reports for the most common and not so common technical and reporting errors seen in clinical practice, and when possible, offer a number of solutions to garner clinically relevant information from otherwise untrustworthy results. We also stress the importance of communication between technologist and interpreting physician when encountering atypical patients or unexpected results.
Pediatric DXA - Horizon & Discovery Systems Workshop
Catherine Gordon and Kyla Kent
In this Pediatric workshop a technologist and a clinician will provide an overview of scan acquisition, appropriate analysis and interpretation of bone densitometry measurements, respectively, in children and adolescents as well as present and discuss several case examples. Additionally, the presenters will give an overview of basic concepts, how to achieve the best quality scans and highlights from the most recent ISCD Pediatric Official Positions.
Pediatric DXA — Prodigy & iDXA Systems Workshop
Ciara McDonnell and Sheila Shepherd
In this Pediatric workshop a technologist and a clinician will provide an overview of scan acquisition, appropriate analysis and interpretation of bone densitometry measurements, respectively, in children and adolescents as well as present and discuss several case examples. Additionally, the presenters will give an overview of basic concepts, how to achieve the best quality scans and highlights from the most recent ISCD Pediatric Official Positions.
14:35–15:30Concurrent Sessions I and Workshop Sessions II
Surgery and Osteoporosis Orthopedic Principles
Derek Bennett
  1. Outline the surgeons role in managing peripheral fractures in osteoporotic fractures.
  2. Discuss the implications of brittle bone for surgery.
  3. Outline the role of modern surgical techniques to improve outcome.

Current Concepts in Minimally Invasive Spinal Surgery for Osteoporosis
John McCabe
  1. Outline the role of orthopedics in managing vertebral fractures.
  2. Discuss MISS.
  3. Outline the steps that are needed to identify and treat these fractures.
Pediatric Bone Disorders
Catherine Gordon
This session will provide an overview of diagnostic and treatment options available for clinicians caring for children and adolescents. The 2013 Pediatric PDC recommendations will be reviewed, and case examples provided as to how they might be incorporated in a pediatric clinical practice. The session will represent a combination of lecture and the presentation of pediatric cases.
Basic DXA — Horizon & Discovery Systems Workshop
Susan van der Kamp and Malachi McKenna
In this basic workshop co-presented by a technologist and a clinician, the participants will obtain practical knowledge about acquiring, analysing and interpreting DXA images. The presenters will show the basic features available in the software that will help ensure the best quality scans and will demonstrate these features through a series of non-challenging cases.
Basic DXA — Prodigy & iDXA Systems Workshop
Anita Colquhoun and John Carey
In this basic workshop co-presented by a technologist and a clinician, the participants will obtain practical knowledge about acquiring, analysing and interpreting DXA images. The presenters will show the basic features available in the software that will help ensure the best quality scans and will demonstrate these features through a series of non-challenging cases.
15:30–16:00Exhibit Hall Break/Poster ViewingOffice Hours
16:00–16:55Concurrent Sessions II and Workshop Sessions III
Quality FLS: Capture the Fracture & Other Programs
Cyrus Cooper
This will be an update on Fracture Prevention Central, the FLS program of the US National Bone Health Alliance, and an introduction to Bone Health ECHO (Extension for Community Healthcare Outcomes), a telementoring strategy to educate healthcare professionals in underserved areas to provide advanced levels of osteoporosis care.
T-Scores & Z-Scores
John Carey
Bone Mineral Density results are often expressed as “T-scores” or “Z-scores” and these numbers are widely recommended in national and international guidelines for diagnosing and managing osteoporosis. Thus it is critical to clearly understand how T-scores and Z-scores are generated in order to make best use of these results in practice. Unfortunately guidelines differ in their recommendations for which T-score or Z-score should be used, which can result in different values which can have important ramifications. During this session Prof Carey will discuss the meaning of the t score and z score from a statistics perspective, and how they differ from DXA T-scores and Z-scores. He will also discuss how these numbers are generated, the factors which can influence them and what they mean. He will finish by addressing when and how they can and should be used in clinical practice, and how I.S.C.D. and DXA manufacturers have worked and collaborated in an attempt to standardise these values for everyone.
Body Composition — Horizon & Discovery Systems Workshop
Sarah Morgan and Kyla Kent
In this DXA body composition workshop co-presented by a technologist and a clinician, the principles of patient position, acquisition analysis and interpretation of total body scans will be discussed and demonstrated through a series of cases. Additionally, the presenters will discuss potential approaches to common challenges with whole body DXA, how to achieve the best quality scans and the ISCD Body Composition consensus recommendations.
Body Composition — Prodigy & iDXA Systems Workshop
Neil Binkley and Diane Krueger
In this DXA body composition workshop co-presented by a technologist and a clinician, the principles of patient position, acquisition analysis and interpretation of total body scans will be discussed and demonstrated through a series of cases. Additionally, the presenters will discuss potential approaches to common challenges with whole body DXA, how to achieve the best quality scans and the ISCD Body Composition consensus recommendations.
17:00–17:55Concurrent Sessions III
Aortic Calcification
John Schousboe
1. Discuss the prevalence and importance of vascular calcification.
2. Discuss the relationship between BMD and vascular calcification
3. Review ways to measure aortic calcification using densitometry
4. Discuss quality reporting for clinicians with respect to aortic calcification
Abdominal aortic calcification (AAC) is commonly visible on densitometric lateral spine images, and is a risk factor for incident cardiovascular disease events. AAC also may be a risk factor for hip fracture, even after adjustment for other clinical risk factors. During this session, the prevalence of AAC and its association with important outcomes will be described, ways to measure AAC described in detail, and recommendations for how to report AAC in bone density reports discussed.
20:00–23:30Trad on the Prom
Separate Registration Required.

Friday, June 3, 2016

7:45–8:40Meet the Expert Sessions II
DXA for High BMD
Malachi McKenna
Unlike using DXA for the diagnosis of osteoporosis, high BMD is defined on the basis on the Z-score not the T-score. By definition, 2.5% of individuals have Z-score ≥+2.0. In clinical practice, the frequency is higher. In a consecutive sample in our unit (n=2534), we noted that Z-score was ≥+2.0 in 4.5% of total hip BMD and 6.4% of lumbar BMD. The most comprehensive survey of high BMD in DXA units has been performed in the UK(1). In that survey of 13 UK centres (n=335,115), having defined high BMD as Z-score >+4.0, they noted a prevalence of 0.4%. The commonest cause was degenerative disease (49%), but they also identified a group of high BMD (35%) without any an obvious cause. They studied this cohort in more detail. In a cohort of these cases (n=258), they described a phenotype of difficulty with floating, mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (1). In a subsequent report of the cohort with unexplained high BMD, they identified gain-of-function mutations in lipoprotein receptor-related protein 5 (LRP5) in 3%; thus, they concluded that the remainder are caused by unknown monogenic causes or by polygenic inheritance (2). There many sclerosing bone disorders that cause high BMD (3). High BMD may be a consequence of cortical thickening (which is termed hyperostosis) or of cancellous thickening (which is termed osteosclerosis). One of the commonest examples is Paget’s disease of bone, which is apt to affect bone at sites of BMD assessment, namely lumbar vertebrae and proximal femur. Skeletal metastases, particularly from prostate cancer, multiple myeloma, or even myelofibrosis could be identified by DXA. DXA may have a role in monitoring change in BMD in conditions like autosomal dominant osteosclerosis and X-linked hypophosphatemia. In the presentation, a number of case studies will be shown highlighting the role of DXA in these disorders.
Sarcopenia and Fracture Risk Reduction?
Neil Binkley
A growing literature has recognized that osteoporotic fracture is not just related to skeletal fragility, but low muscle mass (sarcopenia), functional limitation and other age-related comorbidities. This session will cover how body composition, sarcopenia and functional limitations contribute to fracture risk and the future of fracture prevention.
Quality Technologists
Susan van der Kamp
1.Describe the features of quality technologist. Suitable qualification, Quality control/assurance daily, attention to detail, good communication skills, interest in learning new skills. 2. Outline the steps taken to maintain quality service. Reading difficult cases on ISCD site, re-certification, challenging cases review, new issues in DXA reporting, undertaking precision study, attending relevant conferences on bone and continuing education. 3. Explore new ways to enhance the quality of the service provided More than just a scan..... Patient assessment, ht with stadiometer, (known height at age 30 years) weight, each patient completes a questionnaire (basic information plus risk factor assessment) and technologist address questionnaire issues such as, meds (? taking them), supplements, calcium and vitamin D intake (questionnaire), exercise, basic strength, mobility, stairs, balance questions. Falls questionnaire. Fracture risk can then be assessed and recommendations reported with DXA. Liaison with mdt groups to promote bone health by monthly lectures for staff and general public, hold a World Osteoporosis Day every October 20th. Bimonthly workshops with other DXA units.
8:45–8:50Award Presentation: Sydney Bonnick ISCD Award for Excellence in Densitometry
8:50–13:00Annual Meeting Plenary Session V — Quality Matters in Additional Modalities
8:50–9:45PDC 2015 Intro
John Shepherd
The ISCD has had position development conferences (PDC) periodically for more than 10 years. The result is a comprehensive set of positions that can be used as a guide in standardizing the use, analysis, and reporting of DXA. In this talk, I will define how position development conferences are initiated and executed. The process starts by members suggesting key controversies and dilemmas that are impacting their clinical practices, and end with new positions being voted on by the ISCD leadership. Lastly, I will discuss the need for the next PDC and what might be covered. Please come to the talk with your ideas, clinical dilemmas, and be ready to contribute to the discussion.
9:45–10:40Non-BMD DXA and Hip Geometry
Bill Leslie
  1. Briefly outline the process of ISCD PDC.
  2. Review non-BMD DXA measures available at time of scanning.
  3. Review 2015 ISCD PDC Consensus statements on non-BMD DXA measures.
10:40–11:10Exhibit Hall Break/Poster ViewingOffice Hours
11:10–12:05CT and FEA
Klaus Engelke
The session will start with a review of the current ISCD official positions on QCT and FEA. What is the
impact of QCT and FEA on diagnosis, fracture prediction and treatment monitoring? What are the benefits of QCT and FEA compared to DXA? The recent introduction of so-called opportunistic screening (OS), which promises a much broader identification of subjects at high fracture risk, will significantly increase the use of QCT and FEA analyses. The different OS techniques and their clinical implications will be discussed in detail. The session will end with an outlook of further technical advances of QCT and FEA.
12:05–13:00Putting the new ISCD Official Positions in to Practice
John Shepherd and John Schousboe
Bold and new positions were created at the 2015 Position Development Conference. All of the positions have the potential to modify how you perform your clinical duties surrounding DXA. The new positions include the use of Trabecular Bone Score (TBS), Hip Axis Length (HAL), Opportunistic bone density screening with computed tomography (CT) and finite element analysis algorithms for CT and DXA to name a few. We will define the technologies and literature studied in the 2015 PDC, survey the positions and provide clinical examples of their practical use.
13:00–15:00Exhibit Hall/Poster Viewing/Lunch Break
13:00–14:00Product Theater - Hologic Non-CME event
14:00–14:55Meet the Expert Sessions III
Long-Term Bisphosphonate Therapy
Ghada El-Hajj Fuleihan and Neil Binkley
Objective of the Presentation: “Summarize the report of the ASBMR Task Force on "Managing
Osteoporosis in Patients on Long-Term Bisphosphonate Treatment"
Evidence from randomized placebo-controlled trials supports the efficacy of bisphosphonates (BPs) in decreasing the risk of vertebral fractures. The magnitude of risk reduction varies between 40-70% for vertebral fractures, 20-50% for hip fractures, and 15-40% for non-vertebral fractures, depending on the drug and patient risk profile. These drugs therefore have represented first line osteoporosis therapy for the last two decades. They are approved by the FDA and EMA for the treatment of postmenopausal, glucocorticoid-induced, and male osteoporosis. While the duration of pivotal trials varied between 3-4 years, the optimal duration of therapy is unknown. The ASBMR has convened an international Task Force to provide guidance on BP therapy duration with a risk benefit perspective.
Two trials provided evidence for long-term BP use, based on two large trials. The FLEX trial showed post-menopausal women who received alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. The Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, women should be reassessed. Women at high risk should be advised continued therapy for up to 10 years (oral) or 6 years (intravenous), with periodic risk-benefit evaluation. Women at high risk include those with a low hip T-score, a high fracture risk score, a previous major osteoporotic fracture, or fracture on therapy. For women at lower risk, a drug holiday of 2-3 years can be considered, with periodic reassessment. The risk of atypical femoral fracture (AFF) but not osteonecrosis of the jaw (ONJ), clearly, increases with BP therapy duration, but these rare events are outweighed by vertebral fracture risk reduction in high risk patients. Indeed, AFF are uncommon, occurring in less than 0.2% of patients on 8-10 years of BP therapy; current estimates of the incidence of ONJ range from approximately 1/10,000 to 1/100,000 patient treatment-years.
The above suggested approach may be applicable to men and patients with GIOP, with some modifications. The recommendations are based in limited evidence, in mostly Caucasian postmenopausal women, and only for vertebral fracture reduction. The clinician should tailor therapy according to each patient's medical profile, co-morbidities, preferences, benefit/risk ratio, using an evidence base when available, or expert opinion in its absence.
Pediatric Bone Disorders
Ciara McDonnell and Susan van der Kamp
This session will review common paediatric conditions where the approach, diagnosis and/or
management pathway is influenced by knowledge of bone density and bone turnover markers. This is a heterogeneous group of patients who can present at a various ages and stages of puberty. A diagnostic approach will be taken to address the common presentations seen in paediatric clinical practice which will cover primary osteoporosis [osteogenesis imperfecta, juvenile osteoporosis] secondary osteoporosis due to chronic disease [Duchenne muscular dystrophy, cerebral palsy] and osteoporosis occurring due to adverse effects of treatment [steroid induced osteoporosis, chronic epilepsy]. The session will utilise a series of case based examples to illustrate the pathway from presentation to treatment. Finally, the session will conclude with an overview of the current drugs used in management of bone conditions [Calcium, Vitamin D, Bisphosphonates, PTH] as well as novel therapeutic options currently in trial [Denusomab, Anti-sclerostin Ab] and situations where a targeted approach will benefit the patient.
QA-QC/P-3 (Precision, Phantoms, Positioning)
JoAnn Caudill and Larry Jankowski
Quality assurance is more than just daily testing of machine performance. It involves understanding the types of errors, and the statistical concepts used to measure both machine and technologist performance. It includes standardization of positioning and technologist precision assessments. In this session, we will define statistical concepts, types of quality control phantoms and how often to perform them. We will demonstrate how to conduct a precision assessment and incorporate those measurements into practice. Special emphasis on the effects of technologist’s positioning on facility precision will be discussed.
15:00–15:55Annual Meeting Plenary Session VI — Dysmobility Syndrome: Is this the Future of Fracture Risk Reduction
Neil Binkley
A growing literature has recognized that osteoporotic fracture is not just related to skeletal fragility, but low muscle mass (sarcopenia), functional limitation and other age-related comorbidities. This session will cover how body composition, sarcopenia and functional limitations contribute to fracture risk and the future of fracture prevention.
15:55–16:25Exhibit Hall Break/Poster ViewingOffice Hours
16:35–17:15Annual Meeting Plenary Session VII — Global Panel — Cases
Coordinator: John Carey, Susan van der Kamp, Malachi McKenna
Panel: Diane Krueger, Anita Colquhoun, Brad Richmond, Bruno Camargos, JK Lee, Ghada El-Hajj Fuleihan
Review examples and approaches to interpretation and use of bone densitometry. A couple of simple cases, and a few not so simple cases.
17:15–18:10Annual Meeting Plenary Session VIII - Oral Abstracts
Trends in the pharmacological management of osteoporosis in Ireland from 2009 to 2014 with a focus on bisphosphonate containing products
Bernie McGowan
Replacing a Hologic Discovery-A with a Hologic Horizon-A: Cross-calibration, inter-machine and intra-machine precision
Lawrence Jankowski
Novel bilateral analysis of ap lumbar spine bone density in elite cricket fast bowlers
Karen Hind
Persistent Post transplant Hyperparathyroidism is independently associated with loss of mineral bone density by quantitative CT
Ahad Abdalla
Increased Trabecular Bone Score in Kidney Transplant Recipients
Edward Leib
Evaluating Trabecular Bone Score (TBS) and MRI-Derived Bound and Pore Water Concentrations of Cortical Bone in Osteoporotic Patients
Mary Kate Manhard
21:00–24:00Night out in Galway; ROISIN DUBH
On your own

Saturday, June 4, 2016

7:30–8:25Meet the Expert Sessions IV
Renal - Challenging Patients
Paul Miller
Case presentations of patients with fractures sand also impaired renal function. The cases illustrate the diagnostic approached for distinguishing between osteoporosis and the group of bone diseases that accompany chronic renal failure
AFF Update
Malachi McKenna
Atypical femur fractures (AFF) are a type of stress fracture. Unlike fragility fractures, which are prevented by bisphosphonate (BP) therapy, the occurrence of AFF is associated strongly with AFF. It is this association that led the American Society of Bone and Mineral Research (ASBMR) to establish a Task Force that has delivered two report (1, 2). That the association between AFF and BP therapy increases with the duration raises concerns about long-term BP therapy. This led to the initiation of another Task Force by the ASBMR entitled: Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment (3). The two reports on AFF covered the case definition, which is particularly pertinent to clinical practice. This definition has been universally welcomed and accepted; it will be discussed during the session with case examples. In addition, the Task Force collated all the published cases in the literature in an effort to identify concomitant risk factors. This is also apposite for clinical practice as clinicians try to recognize those patients who are the highest risk. Although BP therapy is the single most important risk factors, there are other risk factors; indeed, AFFs occur in the absence of BP therapy (as will be demonstrated in the presentation). The Task Force report on “Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment” attempted to address the benefit:harm ratio of long-term BP by exploring evidence in the registration trials for BP that had extensions up to 10 years. In doing so, it advocated long-termfor patients deemed to be at high-risk of fragility fracture. Should clinicians opt for long-term therapy, then they need to adopt a strategy for detecting AFF when the AFF is in the incomplete stage. Usually, there is prodrome of pain and tenderness along the outer shaft of the femur. DXA machines have a novel role in the early detection by using the single-energy feature of the machine in order to view the outer aspect of the femur; such a study could be performed at the same time as a BMD assessment with DXA. This option will be discussed with case examples.
Complete AFFs need urgent surgical fixation. The surgical intervention of choice is insertion of an intramedullary nail. Some incomplete AFF may heal spontaneously, but a characteristic of AFF is slow healing. Bsiphosphonate therapy should cease. Those with incomplete AFF and pain should probably have prophylactic insertion of a medullary nail. Fracture completion is a major concern because the morbidity is high and the long-term outcome is unclear.
What’s Wrong with this DXA?
Brad Richmond and Larry Jankowski
While DXA is considered a gold standard for the assessment of bone density, its clinical efficacy is heavily dependent upon proper execution and interpretation. Error in performance of the scan itself, and both omissions and commissions of erroneous reporting components can result in inappropriate patient management. In this session we demonstrate a systematic approach for reviewing scans for errors. We present a series of real scans and reports for the most common and not so common technical and reporting errors seen in clinical practice, and when possible, offer a number of solutions to garner clinically relevant information from otherwise untrustworthy results. We also stress the importance of communication between technologist and interpreting physician when encountering atypical patients or unexpected results.
8:30–9:25Concurrent Sessions IV and Workshop Sessions IV
2015 Top Publications in Bone Health for Clinicians
Paul Miller
Top Papers-A selection by P Miller of what I consider to be the top 10+/- clinical bone papers of 2015 and why?
2015 Top Publications in Bone Health for Technologists
Diane Krueger
This session will highlight new papers published in 2015 related to the use of DXA in clinical and research settings. Specific topics may include precision, trabecular bone score and use of whole body DXA.
Advanced DXA — Horizon & Discovery Systems Workshop
Larry Jankowski and Sarah Morgan
In this advanced workshop, a technologist and a clinician will explore the advanced acquisition and analysis features available within the software, including customization of system configuration settings, reference databases and other advanced features to help ensure the best quality scans. They will demonstrate the applicability of the features through a series of challenging cases.
Advanced DXA — Prodigy & iDXA Systems Workshop
JoAnn Caudill and Bruno Camargos
In this advanced workshop, a technologist and a clinician will explore the advanced acquisition and analysis features available within the software, including customization of system configuration settings, reference databases and other advanced features to help ensure the best quality scans. They will demonstrate the applicability of the features through a series of challenging cases.
9:25–9:35Break
9:35–10:30Annual Meeting Plenary Session IX — Calcium & Vitamin D
Ghada El-Hajj Fuleihan
1. Calcium and vitamin D metabolism are closely linked. Vitamin D enhances calcium absorption and in turn calcium modulates the vitamin D pathway, through its effect on the one α-hydroxylase enzyme. Both calcium and phosphate are needed for bone mineralization. However, while calcium deficiency in adults causes osteoporosis (from secondary hyperparathyroidism), vitamin D deficiency, or a combination of milder deficits in vitamin D with calcium deficiency cause rickets in children and osteomalacia in adults. The Institute of Medicine has set RDA for both nutrients, that vary by age, based on anticipated differences in needs for mineralization, during the various phases of skeletal maturation. 2. The beneficial effect of vitamin D on healing rickets in children, and reducing fractures and falls, only when co-administered with calcium, in the elderly, are well established. A Cochrane systematic review of 8 clinical trials with 10,380 subjects showed high quality evidence for fracture reduction, including hip fractures, RR=0.84[0.74-0.96], and non-vertebral fractures, RR=0.86 [0.76-0.96] . However, neither calcium, nor vitamin D, taken separately, had been shown to be beneficial to musculoskeletal health. Furthermore, the evidence for a beneficial effect of vitamin D effect on non-skeletal outcomes, including cancer, auto-immune, and cardiovascular diseases is lacking. A recent review identified 15 on-going trials investigating the effect of high dose vitamin D replacement on cardiovascular, and renal outcomes, and on survival in chronic lymphocytic leukemia. 3. There has been a trend for advocating intake for both calcium and vitamin D that are in excess of recommended intakes. However, several recent trials failed to show an added beneficial effect of high dose vitamin D, compared to lower doses, on skeletal outcomes, and in some instances it may be harmful. These include trials with the primary outcome of functional decline and falls, upper respiratory tract infections, clearance of sputum from mycobacterium tuberculosis, etc. There are growing concerns regarding harms of calcium supplementation, such as an increased risk of kidney stones, and potential contribution of this nutrient given as supplement to cardiovascular risk. The IOM recently updated their recommendation on dietary nutrient intake, by age and gender. The IOM recommended daily intake of calcium is 1000-1200 mg in adults and elderly, with an upper level intake of 2,000 mg, and for 25-OH vitamin D of 600-800 IU/day, with an upper level of 4000IU/day.
10:30–11:25Annual Meeting Plenary Session X — Update on Medical Treatment for Osteoporosis
Cyrus Cooper
Retardation of bone loss and prevention of fracture comprise the hallmarks of the medical treatment of osteoporosis. Recent advances in our understanding of bone turnover, and of the molecular control of bone formation and resorption, have led to emergence of a number of antiresorptive and formation stimulating therapies. Among the former, bisphosphonates (alendronate, risedronate, ibandronate) and denosumab, are all widely used and have joined the more long-standing aspects of treatment including calcium, vitamin D, hormone replacement therapy and selective oestrogen receptor modulation. The most widely available formation stimulating regimen currently available is teriparatide. This session will address the available evidence pertaining to use of these agents in the short and long-term for the treatment of osteoporosis; as well as considering the newer agents under development (sclerostin antibody, odanacatib and abaloparatide).
11:25–11:35Break
11:35–12:30Annual Meeting Plenary Session X — Economics of DXA — Why Should We Pay For Quality
John Schousboe
1. Review the economic impact of fragility fractures.
2. Review studies on the health economics of bone densitometry.
3. Discuss whether quality densitometry is worth paying for?

Dual energy X-ray absorptiometry (DXA) has been a cornerstone of the diagnosis of osteoporosis and fracture risk assessment since its introduction into clinical practice over 25 years ago. In spite of this, the use of bone densitometry has been questioned by many health care professionals in the wider health and health care community. In this session we will review the health care costs of fractures, the economics of bone densitometry in detail, leading to a critical discussion of the incremental value of quality DXA, beyond clinical risk factors, for identifying individuals at high risk of fracture and identifying candidates for pharmacologic facture prevention therapies.
12:45–13:45Closing Session & ISCD Business Meeting
Lunch Provided

Post-Meeting Courses

Saturday, June 4, 2016

14:00–19:00DXA Body Composition Analysis Course
Separate registration fee required.
14:00–18:00Vertebral Fracture Recognition Course
Separate registration fee required.

CME Information:

EACCME Accreditation Statement

The International Society for Clinical Densitometry (ISCD) is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), www.uems.net.

The ISCD 2016 Annual Meeting: Quality Matters in Bone Health is designated for a maximum of 16 hours of European external CME credits. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.

Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convert EACCME credit to AMA credit can be found at www.ama-assn.org/go/internationalcme.

Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada.«

EACCME credits

Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. The EACCME credit system is based on 1 ECMEC per hour with a maximum of 3 ECMECs for half a day and 6 ECMECs for a full-day event.

ACCME Accreditation Statement

The International Society for Clinical Densitometry is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

For information about the accreditation of this program, please contact ISCD at +1.860.259.1000 or inquire at education@iscd.org.

AMA PRA Category 1 Credits™
The International Society for Clinical Densitometry designates this live educational activity for a maximum of 23 AMA PRA Category 1 Credits™. Physicians should only claim credits commensurate with the extent for their participation in the activity.

ASRT Category A Credit

Approved by the ASRT for Category A CE Credit.  Individuals seeking ASRT Category A credit will need to scan in and out of each session using their own smart device.  Individuals must remain in each activity a specified amount of time to be eligible to earn credit for that session.

Policy on Commercial Support and Conflict of Interest

The ISCD maintains a policy on the use of commercial support, which ensures that all educational activities sponsored by the ISCD provide in-depth presentations that are fair, balanced, independent, and scientifically rigorous.

ISCD requires faculty, planners, managers and other individuals and their spouse/life  partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by ISCD for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. Individual disclosures are included in meeting material.

Last modified: May 18, 2016