Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health, vol. 18, no. 2, 139e140, 2015 Published by Elsevier Inc. on behalf of The International Society for Clinical Densitometry 1094-6950/18:139e140/$36.00

Letter From the Editor The Declining Use of Bone Densitometry

densitometry to better diagnose and more effectively treat patients with osteoporosis. Similarly the paper by Yates et al from Australia on Fracture Liaison Services should foster collaborative efforts between primary care providers and specialists to offer patients who have sustained fractures the best possible comprehensive treatment allowing them to resume their daily activities in their own environment as soon as possible after the fracture. A manuscript from Canada (McLeod et al) on the discriminatory performance of calcaneal quantitative ultrasound and osteoporosis self-assessment tool to select older women for DXA scans should also be helpful. The lion’s share of this issue is devoted to obesity, body composition and bone mass: from Brazil: the relationship between obesity and fractures in postmenopausal women (Premaor et al), from the United Kingdom: the relationship between body weight, composition and bone strength in elite rugby players (Hind et al), from France: the effect of 3-years soccer practice on bone acquisition in prepubescent boys (Zouch et al); from Australia: the relationships between age, BMC, BMD, body composition and cardiorespiratory fitness in young men (Liberato et al); from South Korea: the quantification of visceral fat using DXA and its reliability (Chung et al); from China the association between the duration of playing video games and bone mineral density in Chinese adolescents (Zhang et al); from Lebanon, a letter to the editor regarding physical performance and trabecular bone score in young women (El Hage); from the USA: the inverse relationship between bone marrow adipose tissue and cortical bone area in children and adolescents (Shen et al) and from the United Kingdom reminding us that obesity increases in precision errors in total body dual X-ray absorptiometry measurements (Knapp et al). This is a truly international collaborative effort! A series of manuscripts should be of special interest to our technologists: from Denmark: the use of relative versus fixed offset distance to define region of interest at the distal radius and tibia in HR-pQCT (Shanbhogue

The use of bone densitometry in the USA in postmenopausal women between the ages of 50 and 64 years has decreased: from 149 per 1,000 person-years in 2009 to 110 per 1,000 person-years in 2012. These findings by Overman et al published in this issue of JCD raise serious concerns about osteoporosis being underdiagnosed and under-treated. It may be argued that bone densitometry is not essential to make a diagnosis of osteoporosis, and that the diagnosis can be established by the presence of fragility fractures or by estimating the risk of sustaining an osteoporotic fracture (1) yet in order to adequately follow up patient’s response to therapy and to motivate patients to continue taking the medication DXA scans are needed. Patients like to see numbers. No one would contemplate treating hypertension, diabetes or hypercholesterolemia without being able to monitor the relevant blood levels. Similarly without bone densitometry treating clinicians have no way of knowing whether the prescribed medication is effective and are not in a position to answer the patient’s basic questions: ‘‘Am I getting better? When can I stop taking this medication?’’ Lack of adequate monitoring discourages patients from continuing with the prescribed medication and recommended lifestyle changes. Given the silent nature of osteoporosis until a fracture occurs, the availability of medications that significantly reduce the risk of osteoporotic fractures, including hip fractures, and the poor prognosis of post osteoporotic fractures, it behooves clinicians to identify and treat the population at risk preferably before a fracture occurs. The USPTF recommends that all women 65 years of age and older and all men 70 years of age and older be screened for osteoporosis and that adults who have sustained fractures or have risk factors for osteoporosis be screened for the disease (2). Several organizations endorsed these recommendations (3,4). So why is DXA utilization decreasing rather than increasing in parallel with the increasing older population? The paper by Overman et al should stimulate clinicians to review their modus operandi and use of bone 139

140 et al) and an accompanying editorial from Stathopoulos in Greece; from the USA: spine TBS precision, a comparison between GE Lunar standard and highresolution densitometers (Kruger et al) with an accompanying editorial (Blank); from Switzerland: the reproducibility of VFA readings from DXA scans (Aubry-Rozier et al); from the United Kingdom: the reproducibility and diagnostic accuracy of KellgrenLawrence Grading for Osteoarthritis using radiographs and DXA images (Gregory et al); from China: the characteristics of distal radius speed of sound data (Tong et al) and from Japan: accuracy of segmental bioelectrical impedance analysis for predicting body composition in pre- and postmenopausal women (Tanaka et al). Finally, from Canada, the second part of the trilogy on bone imaging technologies: one-year change, long-term precision and LSC (Wong et al). The manuscript: ‘‘Appropriate Osteoporosis Treatment by Family Physicians in Response to FRAX vs CAROG Reporting’’ by Beattie et al published in JCD 2014:17:458-465 triggered some correspondence. In this issue we publish a letter to the editor from Hammond et al in Canada and the authors’ response to these concerns.

Letter From the Editor I am sure you’ll agree with me, our Journal of Clinical Densitometry is truly international and vibrant, dedicated to improving the diagnosis and management of patients with bone diseases. I would like to thank our authors and reviewers for their contributions and look forward to our continued collaboration. Happy reading! Ronald C. Hamdy, MD, FRCP, FACP Editor-in-Chief

References 1. Siris ES, Adler R, Bilezekian JP, et al. 2014 The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439e1443. 2. US Preventive Services Task Force. 2011 Screening for osteoporosis: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 154:356e364. 3. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S. 2013 Executive Summary of the 2013 ISCD Position Development Conference on Bone Densitometry. JCD 16(4):455e467. 4. National Osteoporosis Foundation. 2014 Clinician’s guide to prevention and treatment of osteoporosis. Washington: National Osteoporosis Foundation. Available at:

Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health

Volume 18, 2015

The declining use of bone densitometry.

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