CHAPTER 12: OSTEOPOROSIS SCREENING AT OUR OFFICE

 

USING ULTRASOUND INSTEAD OF X-RAY RADIATION

 

        Nearly 44 million American Women suffer from osteoporosis, with osteoporotic fractures, costing the U.S. 17 billion dollars a year to treat.  Osteoporosis, or low bone mass, is a major health threat for people aged 50 and older.  Osteoporotic fractures, especially hip fractures, are major causes of morbidity and mortality among the elderly population, and half of hip fracture patients never return to their former state of mobility.  Further, between 12% to 20% of hip fracture patients die within a year of the fracture.

         Osteoporosis is a systemic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue, resulting in an increase in bone fragility and fractures.  Although the only symptoms of osteoporosis are the fractures that appear with the advanced stages of the disease, patients and physicians have an interest in managing this silent disease before fractures occur.  Early diagnosis and treatment along with regular monitoring are crucial to patients' quality of life and life expectancy.  Still, despite the availability of diagnostic methods and treatment options, osteoporosis is massively under-diagnosed.

RADIATION-BASED TECHNOLOGIES

         Dual X-ray Absorptiometry (DXA) exams that measure bone mineral density (BMD) have been used to assess fracture risk since 1987.  Other radiation-based technologies for diagnosis include quantitative computed tomography (QCT) and radiographs, but these are less common than DXA.  Because of their cost, bulk, and the licensing requirement for operating X-ray based devices, these technologies are typically available at larger clinics and specialty providers.  Radiation-based peripheral measurement methods are also available.  These devices include peripheral DXA (pDXA), radiographic absorptiometry (RA), and peripheral quantitative computed tomography (pQCT) devices.

QUANTITATIVE ULTRASOUND (QUS)

         Quantitative Ultrasound devices are radiation free.

          Quantitative ultrasound devices, i.e. Omnisense by Sunlight Medical, evaluate bone by measuring different properties of an ultrasound wave emitted through or along bone.  These systems differ from imaging ultrasound systems in that they analyze quantitative, measurable aspects of the ultrasound wave, such as how fast it travels, rather than an image produced by ultrasound.  QUS devices may measure the bone at one skeletal site or at multiple skeletal sites for added measurement flexibility and fracture discrimination.  QUS devices measure a number of bone characteristics, including bone mineral density, elasticity, cortical thickness, and the microarchitecture of the bone, all of which affect bone strength.

HOW PRECISE IS OMNISENSE?

         Omnisense precision is 0.4% at the radius (wrist), one of the highest precision ratings in the industry.  The lower the number, the higher the precision.  Precision is important because it gives the system the ability to monitor bone changes due to aging, treatment and other disorders.  The Omnisense is an approved FDA technology for osteoporosis screening.

HOW WELL CAN A MEASUREMENT AT THE WRIST PREDICT THE RISK OF FRACTURE OF THE HIP OR SPINE?

         A wealth of data and clinical studies support Omnisenses' fracture prediction abilities by measuring at the radius.  Hip and spine are the traditional sites measured by DXA.  Omnisenses' clinical studies demonstrate that by measuring the radius bone, of the wrist, Omnisenses' fracture prediction ability is equal to that of DXA obtained at the hip and spine.  Further, it is important to know that Omnisense measures a major fracture site - the wrist.  This peripheral site is the earliest to fracture, often preceding hip and spine fractures by as much as 10 to 28 years.

WHAT IS BEING MEASURED WITH OMNISENSE?

         Omnisense measures Speed of Sound (SOS) expressed as meters per second.  SOS is the most appropriate technology to measure bone strength since multiple bone properties - microstructure, elasticity, cortical thickness, bone density - are accounted for in the result.  DXA measurements are based on bone mineral density only, a limited predictor of bone strength and changes, over time.

OTHER FACTORS THAT ARE IMPORTANT IN THE UNDERSTANDING OF OSTEOPOROSIS (PARTIAL LIST):

*    Bone is living tissue

*    The quality or type of food that we eat

*    Whether there are nutritional deficiencies, as bone formation, growth and maintenance is nutrient, vitamin and hormone dependent

*    A persons ability to digest, assimilate, metabolize and utilize food

*    Heavy metals such as aluminum, cadmium and lead as well as environmental chemicals, food additives and some prescriptive medicines can weaken bones

*    Allergies can impair the uptake and utilization of food (malabsorption)

*    Lack of weight bearing exercise (sedentary lifestyle) can weaken bone over time

*    Genetic differences

*    Certain diseases such as diabetes, rheumatoid arthritis and lung disease have an increased osteoporosis risk

*    Chronic and or excessive use of sugar, caffeine, salt, alcohol, colas (high phosphorus content) can weaken bone

         The above discussion points out that bone is a living tissue and undergoes a dynamic process of growth, maintenance and aging and this process is affected by many factors.  A screening test is therefore like a snapshot in time.  Your doctor will discuss with you what frequency of osteoporosis screenings are right for you.  You have been told that there is more than one type of osteoporosis screening and that you freely choose to be screened for osteoporosis using the Quantitative Ultrasound Method (Omnisense).  You are advised that a screening test such as Omnisense can not and does not ever guarantee or imply that a person will or will not develop osteoporosis or fractures even if the osteoporosis screening result was normal.  The purpose of running this osteoporosis screening test is to assist in evaluating your present state of health.  It does not take the place of a clinical examination and evaluation in any way for any medical condition.  You should continue to have regular check ups and continue to follow the instructions of your health care provider(s) for any health condiditon. 

          If you have a family history of osteoporosis and/or had a number of risk factors of osteoporosis, you should also be under the care of a medical specialist such as an internist, orthopedic physician or rheumatologist.  No guarantees or claims are made either expressed or implied, that any treatment provided by our office to help strengthen bones can or will prevent or cure osteoporosis or bone fractures in a person.  Please be advised that there are other diagnostic methods available and used by the medical profession to screen osteoporosis, most commonly, x-ray radiation.