Elsevier

Bone

Volume 43, Issue 6, December 2008, Pages 1115-1121
Bone

International Society for Clinical Densitometry 2007 Adult and Pediatric Official Positions

https://doi.org/10.1016/j.bone.2008.08.106Get rights and content

Abstract

The International Society for Clinical Densitometry (ISCD) periodically convenes Position Development Conferences (PDCs) in order to establish standards and guidelines for the assessment of skeletal health. The most recent Adult PDC was held July 20–22, 2007, in Lansdowne, Virginia, USA; the first Pediatric PDC was June 20–21, 2007 in Montreal, Quebec, Canada. PDC topics were selected according to clinical relevancy, perceived need for standardization, and likelihood of achieving agreement. Each topic area was assigned to a task force for a comprehensive review of the scientific literature. The findings of the review and recommendations were presented to adult and pediatric international panels of experts. The panels voted on the appropriateness, necessity, quality of the evidence, strength, and applicability (worldwide or variable according to local requirements) of each recommendation. Those recommendations that were approved by the ISCD Board of Directors become Official Positions. This is a review of the methodology of the PDCs and selected ISCD Official Positions.

Introduction

The International Society for Clinical Densitometry (ISCD) is a professional society composed of clinicians, scientists, and technologists dedicated to enhancing knowledge and improving quality in the assessment of skeletal health. The ISCD strives to accomplish this mission through venues that include educational events, the Journal of Clinical Densitometry, certification in bone densitometry, and the establishment of standards and guidelines (Official Positions). New and updated Official Positions have been developed every two years since 2001 at Position Development Conferences (PDCs). The Official Positions provide a reference standard for quality control, acquisition, analysis, interpretation, and reporting of bone density tests. They have advanced the field of bone densitometry by improving the quality and consistency of bone density testing, and have focused attention on topics in need of further study.

The findings of the 2001, 2003, and 2005 PDCs have been published in the Journal of Clinical Densitometry [1], [2], [3] in association with publications providing supporting evidence, the rationale, and controversies, if any, for each Official Position. In 2007, separate adult and pediatric PDCs were held. The Adult PDC was on July 20–22, 2007, in Lansdowne, Virginia; the Pediatric PDC was June 20–21, 2007, in Montreal, Quebec, Canada. This is a review of the 2007 PDC methodology, key participants (Appendices), selected Official Positions for adults, and the complete Official Positions for children and adolescents. Executive summaries, listings of all participants, and supporting evidence are published in the Journal of Clinical Densitometry [4], [5]. All ISCD Official Positions may be viewed and downloaded online at http://www.iscd.org.

Section snippets

Methodology

Topics for the 2007 PDC were selected according to clinical relevancy, a perceived need for standardization, and the likelihood of the expert panelists achieving agreement. Each topic area was assigned a set of clinical questions. Thereafter, an ISCD task force evaluated the medical evidence using a modification of the Cochrane review method [6]. Literature searches were conducted with electronic databases that included PubMed, EMBASE and MEDLINE. Appropriate articles were selected from the

Official Positions of the ISCD

Listed are selected ISCD Official Positions, with those that are new in bold.

General recommendations for non-central DXA devices: QCT, pQCT, QUS, and pDXA

The following general recommendations for QCT, pQCT, QUS, and pDXA are analogous to those defined for central DXA technologies. Examples of technical differences amongst devices, fracture prediction ability for current manufacturers and equivalence study requirements are provided in the full text documents printed in the Journal of Clinical Densitometry.

  • Bone density measurements from different devices cannot be directly compared.

  • Different devices should be independently validated for fracture

Fracture prediction and definition of osteoporosis

  • 1.

    Fracture prediction should primarily identify children at risk of clinically significant fractures, such as fracture of long bones in the lower extremities, vertebral compression fractures, or two or more long-bone fractures of the upper extremities.

  • 2.

    The diagnosis of osteoporosis in children and adolescents should NOT be made on the basis of densitometric criteria alone.

    • The diagnosis of osteoporosis requires the presence of both a clinically significant fracture history and low bone mass.

    • A

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