Journal of Clinical Densitometry - Ingentaconnect
Journal of Clinical Densitometry - Ingentaconnect
Journal of Clinical Densitometry - Ingentaconnect
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Volume 7 Number 1 Spring 2004 ISSN: 1094–6950<strong>Journal</strong> <strong>of</strong><strong>Clinical</strong><strong>Densitometry</strong>The Official <strong>Journal</strong> <strong>of</strong>The International Society for<strong>Clinical</strong> <strong>Densitometry</strong>Editor-in-ChiefPaul D. Miller, MDHumana<strong>Journal</strong>s.comSearch, Read, and Download
<strong>Journal</strong> <strong>of</strong> <strong>Clinical</strong> <strong>Densitometry</strong>, vol. 7, no. 1, 13–15, 2004© Copyright 2004 by Humana Press Inc.All rights <strong>of</strong> 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 <strong>Clinical</strong> <strong>Densitometry</strong> Position Development Conference, Cincinnati, OH, July 25–27, 2003AbstractFollowing publication <strong>of</strong> the proceedings from the first Position Development Conference (PDC) <strong>of</strong> theInternational Society for <strong>Clinical</strong> <strong>Densitometry</strong> (ISCD), members <strong>of</strong> the ISCD Scientific Advisory Committee(SAC) addressed additional topics <strong>of</strong> interest in the field <strong>of</strong> 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 <strong>of</strong> osteoporosis in men, premenopausal women, and children; (2) technical standardizationfor dual-energy X-ray absorptiometry (DXA); (3) indications for bone densitometry; (4) reporting<strong>of</strong> bone density results; and (5) nomenclature and decimal places for bone densitometry. This report describesthe methodology used for the development, presentation, and finalization <strong>of</strong> PDC positions. These positionsare discussed in the following papers.Key Words: <strong>Densitometry</strong>; osteoporosis; position statement; dual-energy X-ray absorptiometry.IntroductionThe International Society for <strong>Clinical</strong> <strong>Densitometry</strong>(ISCD) is a multidisciplinary organizationdedicated to enhancing the knowledge <strong>of</strong> bone densitometryamong healthcare pr<strong>of</strong>essionals 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 <strong>of</strong> bone densitometryand the interpretation <strong>of</strong> results. This forms the basisfor much <strong>of</strong> the instructional material taught at ISCDcertification courses. In addition, all pr<strong>of</strong>essionalsperforming bone densitometry are advised toReceived 11/03/03; Revised 11/07/03; Accepted 11/10/03*Address correspondence to Edward Leib, InternationalSociety for <strong>Clinical</strong> <strong>Densitometry</strong>, 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 <strong>of</strong> all ISCD positions is publishedin this issue <strong>of</strong> the <strong>Journal</strong> <strong>of</strong> <strong>Clinical</strong><strong>Densitometry</strong> (2).Following the Denver PDC, the ISCD leadershiprecommended formation <strong>of</strong> a second conference,which was held in Cincinnati, Ohio, July 25–27,2003. In the following articles, rationale for establishingeach <strong>of</strong> the ISCD positions is discussed.MethodsThe ISCD Scientific Advisory Committee (SAC)identified five topics <strong>of</strong> interest in the field <strong>of</strong> bonedensitometry to address at the Cincinnati PDC.1. The diagnosis <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> the subcommittees, each <strong>of</strong> whichwas assigned to one <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong>experts in the field <strong>of</strong> pediatric densitometry wasdeveloping a series <strong>of</strong> recommendations for bonemass measurement in children. The opinions <strong>of</strong> pediatricbone densitometry experts were sought byquestionnaires distributed in 2002 at theInternational Pediatric Bone Health Meeting inSheffield, England, and the 15th International Bone<strong>Densitometry</strong> 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 <strong>of</strong> 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 <strong>of</strong> key controversies surrounding theacquisition, analysis, and interpretation <strong>of</strong> DXAstudies in children and adolescents.The conference cochairs selected 13 internationalexperts in the field <strong>of</strong> bone densitometry to serve aspanelists for the conference. It was their role toreview the SAC presentations and make final recommendationsto the ISCD Board <strong>of</strong> Directors. A ninememberaffirmative vote by the panel was requiredfor the passage <strong>of</strong> 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 <strong>of</strong> ISCD members, representatives<strong>of</strong> bone densitometer manufacturers, andothers. Open commentary to the panel was sought.On the third day, the panel, in closed session, determinedthe final wording <strong>of</strong> the recommendations.Throughout the entire conference, all proceedingswere audio-recorded and a pr<strong>of</strong>essional writer waspresent to take notes <strong>of</strong> the discussions to ensureaccuracy.With input from the subcommittee chairs, theconference cochairs finalized the wording <strong>of</strong> the recommendationswithout change in content. These recommendationswere then presented to the ISCDBoard <strong>of</strong> Directors for approval according to ISCDpolicy. The recommendations approved by a majorityvote <strong>of</strong> the board are presented in the followingpapers as <strong>of</strong>ficial ISCD positions.ParticipantsExpert Panel MembersJohn P. Bilezikian, MD, College <strong>of</strong> Physiciansand Surgeons, Columbia University, New York, NY;Nancy Fagan, RT (BD), CDT, ArizonaRheumatology Center, Phoenix, AZ; Ghada El-HajjFuleihan, MD, American University <strong>of</strong> Beirut,Beirut, Lebanon; Didier B. Hans, PhD, GenevaUniversity Hospital, Geneva, Switzerland; ConradC. Johnston, Jr., MD, Indiana University School <strong>of</strong>Medicine, Indianapolis, IN; Gary M. Kiebzak, PhD,St. Luke’s Episcopal Hospital, Houston, TX;Andrew J. Laster, MD, Arthritis and OsteoporosisConsultants <strong>of</strong> 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 <strong>of</strong> Western Australia,Nedlands, Australia; John A. Shepherd, PhD,University <strong>of</strong> California at San Francisco, SanFrancisco, CA; Richard D. Wasnich, MD, HawaiiOsteoporosis Center, Honolulu, HI; Nelson B. Watts,MD, University <strong>of</strong> Cincinnati Bone Health andOsteoporosis Center, Cincinnati, OH.<strong>Journal</strong> <strong>of</strong> <strong>Clinical</strong> <strong>Densitometry</strong> Volume 7, 2004
Introduction, Methods, and Participants 15Conference CochairsEdward S. Leib, MD, University <strong>of</strong> VermontCollege <strong>of</strong> Medicine, Burlington, VT; Neil C.Binkley, MD, University <strong>of</strong> Wisconsin-Madison,Madison, WI; Ronald C. Hamdy, MD, EastTennessee State University, Johnson City, TN; E.Michael Lewiecki, MD, New Mexico <strong>Clinical</strong>Research & Osteoporosis Center, Albuquerque, NM.SAC Chairs and Writing GroupsThe Diagnosis <strong>of</strong> Osteoporosis in Men,Premenopausal Women, and ChildrenDavid L. Kendler, MD (chair), University <strong>of</strong>British Columbia, Vancouver, BC, Canada; JanBruder, MD, University <strong>of</strong> 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 <strong>of</strong>Beirut, Beirut, Lebanon; Didier B. Hans, PhD,Geneva University Hospital, Geneva, Switzerland;Aliya Khan, MD, McMaster University, Hamilton,ON, Canada; Brian C. Lentle, MD, University <strong>of</strong>British Columbia, Saanichton, BC, Canada.Pediatric DXA Guidelines ProjectLaura Bachrach, MD (chair), Stanford UniversitySchool <strong>of</strong> 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 <strong>Densitometry</strong>Consultants, Renton, WA; Mary M. Checovich, MS,CDT, University <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> 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 <strong>Densitometry</strong>Robert 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 <strong>of</strong> 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 <strong>Clinical</strong> <strong>Densitometry</strong> 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 <strong>of</strong> the International Society for <strong>Clinical</strong><strong>Densitometry</strong> 7: 1–6.3. Cochrane Reviews Handbook 4.1.5. Oxford: UpdateS<strong>of</strong>tware; 2002.<strong>Journal</strong> <strong>of</strong> <strong>Clinical</strong> <strong>Densitometry</strong> Volume 7, 2004