Journal of Clinical Densitometry - Ingentaconnect

Volume 7 Number 1 Spring 2004 ISSN: 1094–6950Journal ofClinicalDensitometryThe Official Journal ofThe International Society forClinical DensitometryEditor-in-ChiefPaul D. Miller, MDHumanaJournals.comSearch, Read, and Download

Journal of Clinical Densitometry, vol. 7, no. 1, 13–15, 2004© Copyright 2004 by Humana Press Inc.All rights of any nature whatsoever reserved.1094-6950/04/7:13–15/$25.00Position StatementIntroduction, Methods, and ParticipantsThe Writing Group for the ISCD Position Development ConferenceInternational Society for Clinical Densitometry Position Development Conference, Cincinnati, OH, July 25–27, 2003AbstractFollowing publication of the proceedings from the first Position Development Conference (PDC) of theInternational Society for Clinical Densitometry (ISCD), members of the ISCD Scientific Advisory Committee(SAC) addressed additional topics of interest in the field of bone densitometry. These topics were addressedat a subsequent PDC, which was held in Cincinnati, Ohio, July 25–27, 2003. Five topics were chosen for discussion:(1) the diagnosis of osteoporosis in men, premenopausal women, and children; (2) technical standardizationfor dual-energy X-ray absorptiometry (DXA); (3) indications for bone densitometry; (4) reportingof bone density results; and (5) nomenclature and decimal places for bone densitometry. This report describesthe methodology used for the development, presentation, and finalization of PDC positions. These positionsare discussed in the following papers.Key Words: Densitometry; osteoporosis; position statement; dual-energy X-ray absorptiometry.IntroductionThe International Society for Clinical Densitometry(ISCD) is a multidisciplinary organizationdedicated to enhancing the knowledge of bone densitometryamong healthcare professionals andpatients and to providing education and certificationto clinicians and technologists. In 2001, the organizationheld a Position Development Conference(PDC) in Denver, Colorado to develop standardizedpositions for the performance of bone densitometryand the interpretation of results. This forms the basisfor much of the instructional material taught at ISCDcertification courses. In addition, all professionalsperforming bone densitometry are advised toReceived 11/03/03; Revised 11/07/03; Accepted 11/10/03*Address correspondence to Edward Leib, InternationalSociety for Clinical Densitometry, 342 North Main St., WestHartford, CT 06117-2507. E-mail:Edward.leib@vtmednet.orgadhere to the ISCD positions. The 2001 PDC positionshave been published elsewhere (1), and anupdated summary of all ISCD positions is publishedin this issue of the Journal of ClinicalDensitometry (2).Following the Denver PDC, the ISCD leadershiprecommended formation of a second conference,which was held in Cincinnati, Ohio, July 25–27,2003. In the following articles, rationale for establishingeach of the ISCD positions is discussed.MethodsThe ISCD Scientific Advisory Committee (SAC)identified five topics of interest in the field of bonedensitometry to address at the Cincinnati PDC.1. The diagnosis of osteoporosis in men, premenopausalwomen, and children.2. Technical standardization for dual-energy X-rayabsorptiometry (DXA).3. Indications for bone density testing.13

14 Position Development Statement Board Panel4. Reporting of bone density results.5. Nomenclature and decimal places for bone densitometry.Three SAC members and the ISCD presidentserved as conference cochairs, and they, in turn,selected chairs of the subcommittees, each of whichwas assigned to one of the topics.An initial literature search was performed followinga method modified from that used by theCochrane reviews (3). Searches for each topic(except indications for bone density testing) wereconducted using MEDLINE, PubMed, and EMBASEdatabases. The subcommittee chairs and membersselected appropriate articles from those identified bythese searches. Each question was further refined,and a recommended position statement answeringthe question was developed by the members of eachsubcommittee. A literature search was not performedfor indications for bone density testing. The indicationsfrom the initial PDC were discussed by theSAC, modified, and presented to the panel.Concurrent with these activities, a group ofexperts in the field of pediatric densitometry wasdeveloping a series of recommendations for bonemass measurement in children. The opinions of pediatricbone densitometry experts were sought byquestionnaires distributed in 2002 at theInternational Pediatric Bone Health Meeting inSheffield, England, and the 15th International BoneDensitometry Workshop in Monterey, California.Expert opinions were also solicited at a generalforum held in September 2002 in San Antonio,Texas, in conjunction with the annual meeting of theAmerican Society for Bone and Mineral Research.Attendees included radiologists, pediatricians, andother bone experts from the United Kingdom,Poland, Australia, and the United States, as well assome industry representatives. The meeting focusedon a discussion of key controversies surrounding theacquisition, analysis, and interpretation of DXAstudies in children and adolescents.The conference cochairs selected 13 internationalexperts in the field of bone densitometry to serve aspanelists for the conference. It was their role toreview the SAC presentations and make final recommendationsto the ISCD Board of Directors. A ninememberaffirmative vote by the panel was requiredfor the passage of any recommendation.The PDC meeting was organized such that on thefirst afternoon, subcommittee chairs presented thefive topics to the panelists. Preliminary suggestionswere given and changes were made to the presentations.On the second day, two sessions were heldbefore an open meeting of ISCD members, representativesof bone densitometer manufacturers, andothers. Open commentary to the panel was sought.On the third day, the panel, in closed session, determinedthe final wording of the recommendations.Throughout the entire conference, all proceedingswere audio-recorded and a professional writer waspresent to take notes of the discussions to ensureaccuracy.With input from the subcommittee chairs, theconference cochairs finalized the wording of the recommendationswithout change in content. These recommendationswere then presented to the ISCDBoard of Directors for approval according to ISCDpolicy. The recommendations approved by a majorityvote of the board are presented in the followingpapers as official ISCD positions.ParticipantsExpert Panel MembersJohn P. Bilezikian, MD, College of Physiciansand Surgeons, Columbia University, New York, NY;Nancy Fagan, RT (BD), CDT, ArizonaRheumatology Center, Phoenix, AZ; Ghada El-HajjFuleihan, MD, American University of Beirut,Beirut, Lebanon; Didier B. Hans, PhD, GenevaUniversity Hospital, Geneva, Switzerland; ConradC. Johnston, Jr., MD, Indiana University School ofMedicine, Indianapolis, IN; Gary M. Kiebzak, PhD,St. Luke’s Episcopal Hospital, Houston, TX;Andrew J. Laster, MD, Arthritis and OsteoporosisConsultants of the Carolinas, Charlotte, NC;Michael R. McClung, MD, Oregon OsteoporosisCenter, Portland, OR; Paul D. Miller, MD, ColoradoCenter for Bone Research, Lakewood, CO; RichardL. Prince, MD, University of Western Australia,Nedlands, Australia; John A. Shepherd, PhD,University of California at San Francisco, SanFrancisco, CA; Richard D. Wasnich, MD, HawaiiOsteoporosis Center, Honolulu, HI; Nelson B. Watts,MD, University of Cincinnati Bone Health andOsteoporosis Center, Cincinnati, OH.Journal of Clinical Densitometry Volume 7, 2004

Introduction, Methods, and Participants 15Conference CochairsEdward S. Leib, MD, University of VermontCollege of Medicine, Burlington, VT; Neil C.Binkley, MD, University of Wisconsin-Madison,Madison, WI; Ronald C. Hamdy, MD, EastTennessee State University, Johnson City, TN; E.Michael Lewiecki, MD, New Mexico ClinicalResearch & Osteoporosis Center, Albuquerque, NM.SAC Chairs and Writing GroupsThe Diagnosis of Osteoporosis in Men,Premenopausal Women, and ChildrenDavid L. Kendler, MD (chair), University ofBritish Columbia, Vancouver, BC, Canada; JanBruder, MD, University of Texas, San Antonio, TX;Gary W. Edelson, MD, Associated Endocrinologists,West Bloomfield, MI; Ignac Fogelman, BSc, MD,Guy’s Hospital, London, United Kingdom; GhadaEl-Hajj Fuleihan, MD, American University ofBeirut, Beirut, Lebanon; Didier B. Hans, PhD,Geneva University Hospital, Geneva, Switzerland;Aliya Khan, MD, McMaster University, Hamilton,ON, Canada; Brian C. Lentle, MD, University ofBritish Columbia, Saanichton, BC, Canada.Pediatric DXA Guidelines ProjectLaura Bachrach, MD (chair), Stanford UniversitySchool of Medicine, Stanford, CA; Ellen B. Fung,PhD, RD, Children’s Hospital and Research Center,Oakland, CA; Aenor J. Sawyer, MD, pediatric orthopedicsurgeon, private practice, Oakland, CA.Technical Standardization for DXAGary M. Kiebzak, PhD (chair), St. Luke’sEpiscopal Hospital, Houston, TX; Peg Schmeer, BS,CDT (cochair), Northwest Bone DensitometryConsultants, Renton, WA; Mary M. Checovich, MS,CDT, University of Wisconsin Hospital & Clinic,Madison, WI; Satvinder Singh Dhaliwal, MSc, CDT,Curtin University, Perth, Australia; Nancy Fagan,RT (BD), CDT, Arizona Rheumatology Center,Phoenix, AZ; Harry K. Genant, MD, PhD,University of California at San Francisco, SanFrancisco, CA; Larry G. Jankowski, CDT, IllinoisBone and Joint Institute, Morton Grove, IL;Bradford J. Richmond, MD, Cleveland ClinicFoundation, Cleveland, OH; Elliot N. Schwartz,MD, Foundation for Osteoporosis Research andEducation, Oakland, CA.Indications for DXANeil C. Binkley, MD, University of Wisconsin-Madison, Madison, WI, and the SAC membership.DXA Reporting and Vertebral FractureAssessmentOscar S. Gluck, MD (chair), Arizona RheumatologyCenter, Phoenix, AZ; Michael J. Maricic,MD (cochair), Southern Arizona VA Health CareSystem, Tucson, AZ; Susan L. Greenspan, MD,University of Pittsburgh Medical Center, Pittsburgh,PA; Michael Kleerekoper, MD, Wayne StateUniversity, Detroit, MI; Sergio Ragi Eis, MD,Ortopedia-Doencas Osteometabolicas, Praia DoCanto, Brazil; Donna M. Landis, RN, CDT, OsteoporosisD & M Center, Laurel, MD.Nomenclature and Decimal Placesin Bone DensitometryRobert W. Downs, Jr., MD (chair), VirginiaCommonwealth University, Richmond, VA;Anthony B. Hodsman, MD, St. Joseph’s HealthCentre, London, ON, Canada; Akira Itabashi, MD,Saitama Medical School, Moroyama, Japan; John A.Shepherd, PhD, University of California at SanFrancisco, San Francisco, CA; Rogene Tesar, PhD,CDT, Endocrinology Thyroid & OsteoporosisCenter, Austin, TX.StaffDeborah Augustus; M. Suzanne C. Berry; JenniferGentry; Kelly Reith, MS; Martin Rotblatt, CAE.SponsorsThe Alliance for Better Bone Health (Procter &Gamble Pharmaceuticals and Aventis Pharmaceuticals);Eli Lilly & Company; GE Medical SystemsLUNAR; Hologic, Inc.; Merck Human Health.References1. Lenchik L, Leib ES, Hamdy RC, Binkley NC, Miller PD,and Watts NB. 2002 Executive summary InternationalSociety for Clinical Densitometry position developmentconference Denver, Colorado July 20–22, 2001. J ClinDensitom. 5 Suppl:S1–S3.2. Leib S, Lewiecki M, Binkley N, and Handy RC. 2004Official Positions of the International Society for ClinicalDensitometry 7: 1–6.3. Cochrane Reviews Handbook 4.1.5. Oxford: UpdateSoftware; 2002.Journal of Clinical Densitometry Volume 7, 2004