Title: July 2018 – To Delete (a Vertebral Body from analysis), or Not to Delete, That is the Question: (Part Two of Two)

Submitted By: Lawrence G. Jankowski, CBDT
Illinois Bone and Joint Institute, LLC. Morton Grove, Illinois. USA

Patient History:
Both patients A and B have returned for a follow-up bone densitometry studies. Neither patient reaches the +/- 1SD deviation difference in T-scores for the exclusion of individual vertebral levels according to ISCD official positions. (Figures 1 and 2 below)

Patient A
A 59 year old white female, current smoker, with rheumatoid arthritis, surgical menopause at age 40 and left total hip replacement, complains of chronic low back pain radiating down the left leg, recently more severe. Height loss of 0.3 inches by calibrated stadiometer in the past year. She has been on oral prednisone of varying dosages for the past year. Repeat scan to determine the effect of steroid use on bone density, and whether prophylactic osteoporosis treatment, a non-steroidal management of RA, or both should be pursued.

Patient B
A 72 year old white female, with steroid dependent asthma, currently treated with daily steroids vial nebulizer and one hospitalization in past year for severe asthma requiring large oral dose tapering off over 2 months. Diagnosed over 30 years ago with mild scoliosis, but no current complaints of back pain and height which did not change during the interim. Returning for a repeat DXA after two doses of denosumab to assess efficacy in the face of her steroid use. She is also being evaluated for the possible right total knee replacement for end-stage osteoarthritis.


Figure 1: Spine DXA results for patient A


Figure 2 Spine DXA results for patient B.

Questions:

  1. What vertebral levels, if any, were excluded in either of these scans and why?
  2. Are there any situations where you might consider not deleting vertebral levels?
  3. What information not provided would be helpful to support your decision(s).

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