What is a bone mineral density test? Who gets this test done? Why is it needed? How many different types? What do the results mean? Bone Mineral Density HHHOLDORF
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What is a bone mineral density test? Who gets this test done? Why is it needed? How many different types? What do the results mean? HHHOLDORF.
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Slide 1
Slide 2
What is a bone mineral density test? Who gets this test done?
Why is it needed? How many different types? What do the results
mean? HHHOLDORF
Slide 3
A bone mineral density test or BMD measures how much calcium
and other types of minerals are in an area of your bone. It is
usually done to help your health care provider detect osteoporosis
and to predict the risk of bone fractures. What is a bone mineral
density test? Osteoporosis is characterized by progressive loss of
bone density, thinning of bone tissue and increased vulnerability
to fractures. May result from disease, dietary or hormonal
deficiency or advanced age
Slide 4
You should have a BMD test or screening done if you are at
increased risk for osteoporosis You are more likely to get
osteoporosis if you are A man over 70 A woman over 65 Women under
65 and men the ages between 50-70 are at increased risk of
osteoporosis if: A broken bone, caused by normal activities, such
as a fall from standing height or lower Chronic rheumatoid
arthritis, chronic kidney disease, eating disorders Early menopause
Smoking Loss of height due to compression fractures in the back
Strong family history of osteoporosis 3 or more alcoholic beverages
per day on most days Taking corticosteroid medications everyday for
more than 3 months Who gets this test done?
Slide 5
Bone mineral density tests are used to: Diagnose bone loss and
osteoporosis See how well you are responding to osteoporosis
medication Predict the risk of future bone fractures Why is it
needed?
Slide 6
Bone density testing can be done several different ways. Most
common and accurate way uses a dual-energy x-ray absorptiometry
(DEXA) scan. It uses lose-dose x-rays You receive more radiation
with a chest x-ray 2 different types of DEXA scans: Central DEXA.
You lay on a soft table while the scanner passes over your lower
spine and hip. Best to predict bone fractures. Peripheral DEXA.
These are smaller machines which measure the bone density in your
wrist, fingers legs or heel. How many different types?
Slide 7
Normal results: Results are reported as a T-score and Z- score
T-score compares your bone density results to a healthy, generally
30 year old of the same gender Z-score compares your bone density
results to other people your age, race and gender With either
score, a negative number means your bones are thinner. The more
negative a number, the more apt the bones are to fracture. A normal
T-score range is between -1.0 and above. What do the results
mean?
Slide 8
Bone density tests DO NOT diagnose bone fractures. It helps
predict, along with other factors, the risk of a bone fracture in
the future. -1 to -2.5 signifies the beginning of bone loss
(osteopenia) -2.5 or greater indicates osteoporosis Hoffman,
Matthew MD. Living with Osteoporosis WebMD. 3 June, 2013.
http://www.webmd.com/osteoporosis/living-with- osteoporosis-7/tests
Strock, Susan MD. Bone Mineral Density Test Medline Plus. 3 June,
2013. http://www.nlm.nih.gov/medlineplus/ency/article/007197.htm
What do the results mean? Contd
Slide 9
Slide 10
BMD measurement dates back as far as the 1940sIt was measured
using a plain radiograph (x-ray) It was noted that bone lost was
not apparent on an x-ray film until the patient lost approximately
40% bone mass, making it too late to treat
Slide 11
In 1960, a young medical physics professor from the University
of Wisconsin invented bone densitometry. Bone densitometry is the
measurement of bone mineral content utilizing a precise amount of
radiation. Since the radiation doses were in small amount, often
his graduate students would volunteer to be research subjects. He
discovered that lactating mothers had a small change in their bone
mineral, thus making it impetrative for young mothers to supplement
during lactating years.
Slide 12
One of Johns early bone densitometry publications (Invest.
Radio. 3:141; 1968) was listed as its single most cited article on
the 25 th anniversary of Investigative Radiology.
Slide 13
As we get older we all loss some bone mass Therefore making
them (bones) less dense and porous This can happen to men, but is
more prevalent in women who are65 or older. Our bones become
thinner, and this is called osteopenia It makes the bones lighter
and weaker, and a chance of breaking The bone density scan was
invented to help measure When this occurs, our bones lose calcium
and other important minerals (due to hormonal decline) Osteopenia
leads to osteoporosis The amount of matter in bone, sucked out as
calcium.
Slide 14
John was deeply concerned with excess radiation exposures in
diagnostic radiology. He developed simple test tools and techniques
to measure radiation and to evaluate the quality of x-ray images.
These efforts led to the creation of Radiation Measurements, Inc.
(RMI), a pioneering manufacturer in quality- assurance
measurements, materials, and devices. This also led to product
developments by several companies and to several standard
techniques for radiation measurement and image quality assurance.
The Lunar Radiation was developed by GE in the late 90s and was an
extension of what John Cameron developed some 30 years prior John
died on 16 March 2005 at age 82 in Gainesville, Florida, where he
lived during the winter months and served as a Visiting Professor
in the Department of Radiation Oncology at the University of
Florida.
Slide 15
Case Study Patient History A 60-year-old Caucasian female is in
for an annual checkup. The patient experienced menopause in her
early 50s and has been in good health. Other than hormone therapy
(HT) the patient is on no other medications. The patient has no
history of fractures, stands at 57. 112 lbs. and rarely exercises.
Smokes cigarettes and is a regular coffee drinker. Although no
personal injuries, her sister has past experience of a hip
fracture.
Slide 16
Risk Factors Although the patient has no history of fractures,
she does have characteristics that put her at higher risk of
fractures significantly seen in Caucasian women. Risk factors which
may increase fractures: Increased fractures as an adult Family
history of fractures Low body weight (Less that 130 lbs.)
Smoking
Slide 17
Patient Evaluation After annual checkup, no abnormalities were
found. No signs of loss of height were noted Patients vitamin D and
calcium levels remained consistent with past examinations Although
there were no abnormalities during checkup, BMD testing was
recommended due to normal risk factors with age.
Slide 18
BMD Test Results BMD tests reveled a left hip T-score of -1.5,
which is considered a fairly low score and prompted consideration
of what could be causing a low score and bone-loss. All other test
results were said to be normal, including normal serum thyrotropin,
serum 35-hydroxyviatmin D, and cortisol levels. With a low T-score
for the hip, the patient is considered to have low BMD, also known
as osteopenia, which increases the patients risk for future
fractures.
Slide 19
Recommended Preventative Strategies and Treatment for
Osteopenia Patient is highly encouraged to quit smoking women
smokers are typically thinner and undergo menopause at an early
age, there is a higher risk facture for fractures Calcium
supplements are recommended to ensure intake of daily calcium
requirements about 500 mg at a time Weight-bearing exercise is
highly recommended to build muscle mass and tone for protection.
Although swimming is not weight-bearing, many patients chose
swimming to improve strength without high impact risk. Fall
prevention- Studies have proved that over 90% of hip and wrist
fractures are results of a fall, so taking measures to reduce the
risk of falls in your home and work are recommended especially for
elderly
Slide 20
Hormone Therapy Controlled studies have demonstrated that
hormone therapy has decreased vertebral fractures by at least
one/third Hormone therapy has decreased overall fractures by 24-
30% Although hormone therapy is effective, it is not recommended as
the sole treatment or used for disease prevention there can be risk
factors such as stroke, cognitive impairment, and deep vein
thrombosis Increased risk of breast cancer can also be seen in
HT
Slide 21
Patient Summary With risk factors included in HT, the patient
discontinued use. Discontinue raises the patients risk up to 4% in
the first year for increased BMD Patient is recommended calcium and
vitamin D supplements, and adequate daily exercise to increase body
mass.