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What is a clinical spine fracture and what is a morphometric spine fracture?
Clinical Spine Fracture: a fracture of the spine that causes symptoms
Morphometric spine fracture: a spine fracture that is diagnosed with an x-ray without symptoms
What are the normal, osteopenia, and osteoporosis T-scores by WHO standards?
Normal: better than or equal to -1 T-score
Osteopenia: poorer than -1 but better than -2.5 T-score
Osteoporosis: -2.5 or poorer T-score
What is the difference between anabolic and antiresorptive meds?
Anabolic: stimulates bone growth rather than inhibits bone loss (peoplewith severe bone loss)
Antiresorptive:it ismedication that inhibits bone loss rather than stimulates new bone formation
Name 3 diseases or conditions that can lead to osteoporosis.
AIDS/HIV-Eating disorder- Breast cancer
List at least 2 consequences of osteoporosis.
Pain- loss of height-loss of organ function- depressed-kyphosis
What is kyphosis?
Have a hump back appearance in your back
Name 2 risk factors for osteoporosis.
- Age- Race(Caucasians Asian and latinos)-Gender(more common in
- females)-smoking-family history(genes)- body size- lifestile
What is the difference between an osteoblast and osteoclast?
Osteoblast- forms new bone to replace the old bone that has been removed by osteoclasts (BUILD)
Osteoclasts- initiates reabsorbing or removal of old bone (CHEW)
What are the NOF Guidelines are for having a bone mass measurement?
1- postmenopausal women under age 65 with one or more risk factors other than being postmenopausal
2- all women age 65 and over. Consideration of other risk factor are not necessary
3- Postmenopausal women who presently have fractures
4- women in whom knowledgeof their BMD would influence their decision to begin treatment for osteoporosis
5- women who have been on hormone replacement therapy for long periods of time
What are the main CPT codes for Axial and Appendicular DXA scans?
Axial- 77080 (PA spine, lateral spine, proximal femur, total body)
Appendicular-77081 (forearm, heel, phalange
What does osteoporosis mean?
- “a skeletal disorder characterized by compromised bone strength
- predisposing to an increased risk of fracture”
What are some non-prescription interventions for osteoporosis?
Calcium- Vitamin D
Name 3 medications or type
of medications that can affect bone density.
14. How do the oral
bisphosphonates need to be taken? (be specific as far as how long
fasting, what liquids to be taken with and how long you have to wait to
eat/drink after taking them)
it requires you to have not food or drink for 60 minutes after taking thepill on an empty stomach takingthe medication with only water and must remain upright for at least 60 mintuesafter taking it.For #14 abouthow to take the oral bisphosphonates, that was great about only takingthem with water and for BONIVA (ibandronate) it is 60 minutes of nofood or drink after taking it besides remaining upright for that long. Isee on my Actonel and Fosamax slide along with my audio I did notmention that Fosamax and Actonel only need 30 minutes of nofood or drink and remaining upright rather than 60 minutes for Boniva. (Actonelis coming out with one that you can take with food, but not yet).
it requires you to have not food or drink for 60 minutes after taking the
- pill on an empty stomach taking
- the medication with only water and must remain upright for at least 60 mintues
- after taking it.
For #14 about
- how to take the oral bisphosphonates, that was great about only taking
- them with water and for BONIVA (ibandronate) it is 60 minutes of no
- food or drink after taking it besides remaining upright for that long. I
- see on my Actonel and Fosamax slide along with my audio I did not
- mention that Fosamax and Actonel only need 30 minutes of no
- food or drink and remaining upright rather than 60 minutes for Boniva. (Actonel
- is coming out with one that you can take with food, but not yet).
which ones are bisphosphonates/SERMS/Estrogen
bisphosphonates- alendronate (fosamax) risedronate (actonel, ibandronate (boniva) zoledronic acid (reclast)
SERMS- raloxifene (Evista)
Estrogen- premarin, prempro,
How much bone density is lost before you can actually see it on a plain radiograph?
What skeletal region is the Singh Index used to rate?
Trabecular pattern of the proximal femur
What is Calcar Femorale Thickness?
A band of cortical bone immediately above the lesser trochanter
Also normal is greater than 5 mm and anything less than 5 mm is usually at high risk for fracture
4. What isotope did DPA units use to emit
energy to get two photoelectric peaks?
Name two problems with the DPA system.
*source decay loss of accuracy and precision
*unable to separate cortical bone from trabecular
Which modality produces no radiation to perform bone density studies?
QUS-quantitative ultra sound
What does the Radiologic Osteoporosis score combine?
- Quantitative morphometry of 3 skeletal sites
- -shaftof femur
- -index of biconcavity of lumbar spine
A score of 168 or less indicatedosteoporosis
What is radiogrammetry?
The actual measurement of dimensions of bones using x-ray
Explain the major difference between SPA and DPA.
SPA- single energy beam
DPA- 2 separate isotopes for distinct photoelectric peaks
11. Explain the major difference between DXA and SXA.
- DXA-eliminated the radioactive source and replaced it win and x-ray tube
- SXA Don’t have the SXA slide anymore, but main difference is SINGLE Energy Absorptiometry vx. DUAL Energy Absoprtiometry
What is 'Ward's Triangle'?
An area on the proximal femur DXA scan that is formed by the intersection of 3 trabecular bundles. The region of lowest density in theprox femur that the computer software determines and is actually seen as asquare on the DXA scan. Not to beused as an indicator of osteo.
What two systems are used in DXA to produce the 2 distinct photoelectric peaks?
- K-edge filters
- Pulsed power/voltage switch
Explain what a 'fan' beam and a 'pencil' beam are.
Pencil- narrow collimated beam-slow scanning – point by poing
Fan- bround collimation-faster – line by line
What areas of the skeleton can pDXA machines scan?
Name two disadvantages of QCT.
- Can only measure spine
- High radiation dose
- Not accurate >60 fat
SOS and BUA stand for what? What modality uses this?
- SOS-speed of sound
- BUA-broad band ultra sound attenuation
What are the Stiffness Index and Quantitative Ultrasound Index?
Stiffness index= mathematic comboof BUA and SOS that MFG report results
Quantitative ultrasound Index=estimated BMD
Which lumbar vertebrae typically has the lowest BMD?
L1 and they keep getting lower besides at L3 L4 it gets slightly higher
Describe what L1-L3 look like in alphabet letters. What does L4 resemble? What does L5 look like?
L1-L3 U or Y L4 H or X L5 I on its side
How many lumbar vertebrae are in 84% of the women’s population?
Do fractures increase or decrease bone density?
-Increased BMD (bone mineral density)
Explain what osteophytes are and what they do to the bone density of the spine?
- Bone spurs-boney projections that form along joints often seen in arthrytus
- IncreasedBMD (14%)
Which lumbar vertebrae can you sometimes see the transverse processes on when doing a
bone density scan?
When labeling vertebrae do you start at the bottom or top?
Explain what Ward's
Triangle is and what another name for it is.
- Area that is formed by an intersection of 3 trabecular bundles
- Another name is Ward’s Area
Explain the significance of having the proximal femur rotated properly.
- Will cause an increase in BMD if not done right
- If the femur is not rotatedenough the lesser trochanter will appear large
- and pointed If the femur is rotated too much internally the lesser troch will not be seen at all
- 15-20 degrees optimum rotation
Which forearm do you scan if a person is left handed and has no history of fractures or artifacts.
If a patient has scoliosis which hip would be a better one to scan?
Side of there convexity – side it curves to
Which area of the forearm has the least amount of trabecular bone?
33% radius or ulna
Will facet sclerosis increase or decrease bone density?
Increased BMD significantly
Name 3 things that will affect hip density.
- Artifacts (surgery metal,
- something in pockets, etc)
Name 3 things that will affect spine density.
vertebralfracture, osteophytes, calcification, facets sclerosis, contrast, gallstones
what are the materials in the K-edge filter?
- Ge Med Lunar= cerium
- Norland= Samarium
what are 2 systems in the DXA scanners that are used to separate bone and tissue?
K-edge filters and pulsed power voltage switches
What are 4 Characteristics of Bones
- Axial and appendicular
- weight bearing and non weight bearing
- central and peripheral
- predominately cortical or predominately trabecular
what are parts of the spine?
body, pedicle, superior and inferior articulating process, lamina, transverse processes, spinous processes