Bone Scanning In Clinical Practice

The most frequently requested investigation in any nuclear medicine department remains the technetium-99m (99mTc)-labelled diphosphonate bone scan. Despite rapid advances in all imaging modalities. there has been no serious challenge to the role of bone scanning in the evaluation of the skeleton. The main reason for this is the exquisite sensitivity of the bone scan for lesion detection. combined with clear visualisation of the whole skeleton. In recent years several new diphosphonate agents have become available with claims for superior imaging of the skeleton. Essentially. they all have higher affinity for bone. thus allowing the normal skeleton to be visualised all the more clearly. However. as will be dis cussed. this may occur at some cost to the principal role of bone scanning. lesion detection. The major strength of nuclear medicine is its ability to provide functional and physiological information. With bone scanning this leads to high sensitivity for focal disease if there has been any disturbance of skeletal metabolism. However. in many other clinical situations. and particularly in metabolic bone disease. more generalised alteration in skeletal turnover may occur. and quantitation of diphosphonate uptake by the skeleton can provide valuable clinical information.

Sydney Lou Bonnick, MD, FACP, and Lori Ann Lewis, MRT, CDT, have updated and expanded their highly praised Bone Densitometry for Technologists to reflect the latest standards and developments in the field. Here radiologic technologists, nurse practitioners, physician assistants, and dedicated densitometry technologists can find new guidelines for bone density testing, new therapies for osteoporosis, and new treatment guidelines for osteoporosis, as well as new chapters on pediatric densitometry, body composition assessments, and the use of skeletal morphometry in diagnosis and fracture risk prediction.

Bone densitometry (BD) is an extraordinary clinical tool. It provides a safe, non-invasive window to the skeleton. Through that window, a physician can obtain vital clinical information that enhances diagnosis and improves patient management. Further, much has changed in the last decade to make bone densitometry the especially fascinating field of medicine it is today, incorporating imaging, physics, quantitative analysis, statistics, and computer technology -- all applied in the diagnosis and management of osteoporosis. No text details the state-of-the-art and value of densitometry better than Bone Densitometry in Clinical Practice: Applications and Interpretation, Third Edition. Written by renowned expert Sydney Lou Bonnick, MD, this edition improves remarkably on her highly regarded previous volumes, with a significant update and expansion of material. New chapters reflect densitometry’s growing applications as well as the evolving needs of the densitometrist. New material on radiation safety and assessment for secondary causes of bone fragility is included, and the text also incorporates material from the recent ISCD Position Development Conferences (PDC’s), both the 4th adult and the 1st pediatric. Moreover, an entire appendix devoted to the PDCs has been added, providing solutions to many unanswered questions concerning bone densitometry applications. Comprehensive and invaluable, Bone Densitometry in Clinical Practice: Application and Interpretation, Third Edition offers all primary care physicians and specialists the ideal reference for practicing state-of-the-art bone densitometry and caring for patients with, or at risk for, osteoporosis.

Bone Densitometry in Growing Patients: Guidelines for Clinical Practice, edited by Drs. Sawyer, Bachrach, and Fung, is a milestone book for all health prof- sionals concerned with bone health in growing patients. The book introduces and emphasizes the importance of attending to issues of bone health and development in childhood and adolescence as a way of maintaining such health and decreasing the epidemic of osteoporosis that we are now seeing in older adults. In doing so, the book offers a much-needed first set of standards of bone densitometry in growing patients. Given the numerous reports of serious interpretation errors in densitometry results in children, the development of this body of work is truly important. It is in this context that Bone Densitometry in Growing Patients: Guidelines for Clinical Practice presents the current evidence, including an assessment of the strengths and weaknesses in the data on assessing bone density in childhood and adolescence. In short, the editors and authors have done an outstanding job of or- nizing not only the key topics in this broad clinical discussion, but also, and most importantly, the evidence within these areas.

Despite public perception, osteoporosis remains a widespread, devastating disease, and a very serious and costly public health threat. Early detection and treatment must be a priority for primary health care providers. Dual-energy X-ray absorptiometry (DXA) is the principal x-ray technology used to diagnose osteoporosis in its early, asymptomatic stages, to assess treatment efficacy, and to guide treatment decisions. It remains the gold standard today. A DXA Primer for the Practicing Clinician: A Case-Based Manual for Understanding and Interpreting Bone Densitometry is developed around real cases of patients’ DXA measurements. The content is derived from presentations given by the authors at a national society training course and exemplifies not only the complete body of education provided through these lectures but the full range of previously undiscussed nuances as well. This practical, easy-to-read title provides the day to day problems of DXA usage that new users may encounter and that training courses do not have time to provide in detail. The central focus of the book is the presentation of what is normal and what is problematic in the use of DXA, depicting various scenarios with real case histories of patients, their corresponding DXA images and the data that explain the problems. Unique in approach and presentation, this case-based manual will be of immense value to all practitioners -- and students – interested in providing optimal diagnosis and treatment of osteoporosis.

This invaluable and well-presented text brings together previously fragmented or incompletely elucidated data on the impressive recent advances in orthopedic nuclear medicine. The book begins by acquainting the readers with various anatomic, physiologic, pathologic and technical concepts crucial to understanding orthopedic nuclear medicine and its utilization in clinical practice. Subsequent chapters detail the diagnosis of skeletal infections, trauma, vascular disorders, metabolic and neoplastic bone diseases, soft tissue calcifications and joint disorders. A separate section is devoted to the use of radionuclides in the treatment of bone and joint diseases. A unique feature of this richly illustrated volume is its comprehensive and clinically oriented approach. The book will prove invaluable to all with an interest in diagnostic and therapeutic orthopedics, including radiologists, orthopedists, rheumatologists, pediatricians, other clinicians and nuclear medicine professionals.

Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men. This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger – 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. Brings together more eminent investigators and clinicians to interpret developments in this growing field Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy There is no book on the market that covers osteoporosis in men as comprehensively as this book