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Bone Density Registry review| 200 Questions
All Answered Correctly| Success Guaranteed|
Name the bisphosphonate anti resorptive medications: alendronate (fosamax) risedronate (actonel) ibandronate (boniva) zoledronic acid (reclast name the non bisphosphonate anti resorptive meds estrogen therapy raloxifene (evista denosumabb (prolial) name the anabolic osteoporosis meds teripartide (forteo) should a T-score be used for comparison on children? A T-Score should never be used before age 20When what are the preferred DXA sites for children 3yr old and up? PA L-spine and total body minus the head when is DXA recommened for children? (7)
recurrent fractures bone pain bone deformity osteopenia seen on x-ray cancer survivors females with eating disorders/excessive exercise females after 6+ months without menstrual cycle for pediatric DXA a cancer survivor is recommended to have imaging done at what point? either 2yr after chemo or by the age of 18 which ever comes first the risk of fracture ___ for each SD decline in BMD. a. double b. tripples d. sees very little increase c. decreases doubles (approximatly) what type of bone is measured in a total body scan? cortical why is the forearm typically not used to monitory osteoporosis therapy?
what is a morphometric spinal fracture? a fracture that can be seen on a radiograph but has little to no symptoms Define a clinical spine fracture a spinal fracture that causes symptoms What is the WHOs definition of established osteoporosis? A BMD of 2.5SD or more below the average of a young adult and a history of fracture what is a European Spine Phantom? anthropomorphic phantom, the European Spine Phantom (ESP) contains a spine insert consisting of three vertebrae of increasing bone mineral densities and thicknesses of cortical structures what is an anthropormorphic phantom? replicates skeletal region to detect a shift in BMD values over time What is the recommended follow up time between DXAs for a patient taking steroids? every 6 months What is the recommended follow up time between DXAs for a normal patient? L-spine is recommended once per year Proximal Femur is recommended every 2 years how long does a long term precision study last?
usually 1 year how long does a short term precision study last? 2 - 4 weeks What is the importance of least significant change (LSC)? it determines the minimum interval between follow up measurements before a change in BMC can be seen Which arm should be scanned? non dominate arm name the distal forearm sites: 5 &8 mm 10% ultra distal name the proximal forearm sites 33% or 1/ 50% does previous femur fracture (with out surgery) have any affect on a proximal femur DEXA? yes it will be inaccurate and should not be scanned in cases of scoliosis lower BMD is shown on which hip? the side of convexity (out side curve of the spine)
for better accuracy since L3 may be the only vertebra measured and it is mainly a trabecular measurement which lumbar vertebra in the lateral position is least affected by ribs or pelvis? L is there a way to overcome most spinal artifacts? yes. Lateral Spine DXA What spinal artifacts can inaccurately increase BMD of the spine? osteophytes facet sclerosis (grade 2 or 3 only) aortic calcification vertebral fx Should a vertebra with a previous fracture (new or old) be included in a PA L- spine DXA? no. because it can inaccurately increase the BMD for that vertebra Why do you count the lumbar spine from L5-L1 instead of L1-L5 for a DXA scan? so that you don't accidentally factor in a T-spine vertebra as it will lower total BMC and possibly create a false positive result Why is L5 not to be included in a PA DXA scan? it has too much interference with the pelvis what shape is L5's vertebra?
dog bone/ bow tie What shape is L4 vertebra in? H or X what is unique about L3's shape? it has the largest transverse processes. what shape is L1-L3 vertebra in?
. U or Y what are the 6 parts of an individual vertebra? Body pedicles lamina spinus process transvers process articulating surface What part of the body does a pereferal QCT look at? the forearm. which is best for patients who's bones are still growing what is Dual Energy QCT used for? to eliminate error from marrow fat
what is Dual Photon Absorptiometry (DPA)? works the same as SPA, but uses a radioactive material that produces 2 different KV intensity's. doesn't need a water bath, so it could scan central sites. why were SPA and DPA considered un precise? because of the radioactive decay over time followed by sudden increase in radioactivity when old source was replaced what is Single Photon Absorptiometry (SPA)? uses a single radioactive material that produces 1 level of radiation as a radiation source scanned forearms and heels because it needs a water bath to insure uniformity. describe Radiographic Absorptiometry (RA). 2 x-rays of the left hand are taken on non screen film at 2 different KVp techniques it is then sent to a lab and digitized for computer analysis of the ring and middle finger is good for long term reproducible results what is Radiographic Photodensitometry? was the starter technology for SPA, DPA, and current DXA is a radiograph of the bone alongside a step wedge which is then measured with a
photodensity scanner and compared to known BMD correlations with the step wedge densitys what is the Radiologic Osteoporosis Score? uses radiogrammetry of the femur and the bio-concavity of the L-spine to determine BMD Describe radiogrammetry. radiograph of the hand is measured with fine calipers across the metacarpals. Can be used with digital radiographs and use a computer analysis. Correlates well with BMD. What is the Singh Index? uses an AP hip x-ray to look at the cortical shell thickness and trabecular patterns What is Qualitative Spinalmorphemetry (QSM)? uses a lateral spine x-ray to look at the cortical shell thickness and trabecular patterns. How much bone demineralization has to occur before it can be seen on diagnostic x-rays? at least 40% explain an Age-regression Graph?
how does QUS measure bone? speed of sound (SOS) Broadband Ultrasound Attenuation (BUA) Stiffness index how is BMD calculated for the L-spine? total BMC for each vertebra divided by total area for each vertebra how is BMC quantified for QCT? g/cm how is BMC quantified for DXA? g/cm What ROIs are predominantly cortical bone? femoral neck phalanges portions of the forearm total body define trabecular bone: spongy, has a higher metabolic rate Which DXA ROI have predominantly trabecular bone? L-spine Ward's Area
Calcaneus proximal portions of the forearm name the peripheral sites for DXA: calcaneus tibia metacarpals phalanges forearm do central densotometers measure peripheral sites along with central sites? yes name the central sites for DXA: T-spine L-spine proximal femur name the appendicular sites: extremitys girdles (includes scapula and pelvis) what is the most sensitive weight bearing bone? calcaneous name the weight bearing sites of the skeleton:
healthy nutritional status weight gain return of regular menstrual periods persons with anorexia nervosa have increased bone formation and decreased bone resorption True/False false The recommended level of vitamin D intake for infants, children and adolescents including breastfed infants is ___IU per day 400 the AAP recommendation for upper level calcium intake in children ages 4-8 yr is ___mg 2500 t is believed by bone health experts that 75% of an individual's final bone mass is influenced by ___ genetics the intra-membranous ossification process occurs during the formation of all of the following except: a. flat bones of the skull b. mandible and maxilla
c. ulna and radius d. clavicle c. ulna and radius at birth an infant has as many as ___ separate skeletal bones in the body. 270 osteoporosis in a child is characterized as ___ when there is no identifiable cause idiopathic the drug used for treatment of men with primary or hypogonadal osteoporosis who are at high risk for fracture is: teripartide (forteo) men age 50 and over require mg of calcium daily 1200 reasons to consider bone density testing in men include a fracture after the age of 50 to monitor the effect of treatment on bone loss not receiving treatment for bone loss although treatment is indicated in men the diagnosis of osteoporosis is often not made until a fracture occurs true/false true
The US Surgeon General recommends a minimum of ___ min of moderate intensity physical activity most, if not all, days of the week. 30 diets with an increase of ___-rich foods may reduce the need for calcium to be withdrawn from the skeleton potassium The recommend calcium dose for individuals age 19-50 is ___mg/day 1000 The most critical period for bone health is during ___ adolescence gastrointestinal disturbances with some severe reactions have been reported in patients taking ___ for the treatment of osteoporosis. bisphosphonates recent findings have linked ___ therapy to increased incidence of heart attack and stroke and physicians frequently reconsider its use in the treatment of osteoporosis estrogen The risk for vertebral and non vertebral fractures has been proven to be reduced by ___ after one year of treatment. Bisphosphaonate
The distance the technologist should stand or sit from the x-ray tube when preforming DXA scans is ___ft 3 ft Osteoporosis is diagnosed when BMD is: 2.5 SD or more below that of a young-normal adult Recommended frequency of BMD testing states that at least ___ months must have passed since the month of the last measurement except in specific situations 23 the NOF recommends BMD testing of: postmenopausal women age 65 and older and me age 70 and older if the BMD measurement by central DXA of the lumbar spine or the femoral neck cannot be obtained, the NOF recommends BMD measurement by DXA at the on third (33%): radius site the final carpal bone to ossify by 9 yr old is: pisiform. it is a large sesamoid bone and is the last to ossify the type of vertebral deformity caused by vascular insufficiency during fetal development and may affect more than one vertebrae is: hypoplasia there are ___ pairs of spinal nerves.
