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Takuo Fujita - One of the best experts on this subject based on the ideXlab platform.
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novel ultrasonic Bone Densitometry based on two longitudinal waves significant correlation with pqct measurement values and age related changes in trabecular Bone density cortical thickness and elastic modulus of trabecular Bone in a normal japanese
Osteoporosis International, 2010Co-Authors: G Iguchi, Takako Tobimatsu, Takahiko Otani, Kaoru Horii, Isao Mano, I Nagai, Takuo Fujita, K. Takahashi, Hisamitsu BabaAbstract:Summary A reference database for trabecular Bone density, cortical thickness, and elastic modulus of trabecular Bone for a novel ultrasonic Bone Densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population.
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novel ultrasonic Bone Densitometry based on two longitudinal waves significant correlation with pqct measurement values and age related changes in trabecular Bone density cortical thickness and elastic modulus of trabecular Bone in a normal japanese population
Osteoporosis International, 2010Co-Authors: H Sai, G Iguchi, Takako Tobimatsu, Takahiko Otani, Kaoru Horii, Isao Mano, I Nagai, K. Takahashi, H Iio, Takuo FujitaAbstract:A reference database for trabecular Bone density, cortical thickness, and elastic modulus of trabecular Bone for a novel ultrasonic Bone Densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population. A novel ultrasonic Bone Densitometry system (LD-100 system) was applied to create a reference database for trabecular Bone density (TBD), cortical thickness (CoTh), and elastic modulus of trabecular Bone (EMTb) for this device over a wide age range in a normal Japanese population. In a comparative study between LD-100 and peripheral quantitative computed tomography (pQCT) systems, 52 individuals were examined by both systems at the same radius simultaneously. To create a reference database, a total of 2,380 healthy subjects (1,179 men, 1,201 women), ages 18–99 years, were examined using the LD-100 system. Highly significant correlations between the LD-100 and pQCT systems were found in TBD (r = 0.877, p < 0.001) and CoTh (r = 0.723, p < 0.001). For the reference database, peak values of TBD, CoTh, and EMTb were observed at 30–34 years (255.09 mg/cm3), 20–24 years (5.23 mm), and 20–24 years (4.09 GPa) in men, and at 25–29 years (209.24 mg/cm3), 25–29 years (3.98 mm), and 20–24 years (3.33 GPa) in women, respectively. The TBD fell significantly (p < 0.05) beginning at 55–59 years in both sexes, with a relatively rapid decrease in women. The CoTh showed a significant decrease beginning at 40–44 years in men and 50–54 years in women. The EMTb showed a significant decrease beginning at 40–44 years in men and 55–59 years in women. The LD-100 system is a useful Bone Densitometry device and the database of age-related changes in TBD, CoTh, and EMTb established in this study will provide fundamental data for future studies related to Bone status.
Carrie H Colla - One of the best experts on this subject based on the ideXlab platform.
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overuse of short interval Bone Densitometry assessing rates of low value care
Osteoporosis International, 2014Co-Authors: Nancy E Morden, William L Schpero, Rebecca Zaha, Thomas D Sequist, Carrie H CollaAbstract:Summary We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation = 0.64), and unlike other DXAs, rates decreased with payment cuts.
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overuse of short interval Bone Densitometry assessing rates of low value care
Osteoporosis International, 2014Co-Authors: Nancy E Morden, William L Schpero, Rebecca Zaha, Thomas D Sequist, Carrie H CollaAbstract:We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation = 0.64), and unlike other DXAs, rates decreased with payment cuts. The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring Bone density more often than every 2 years as care “physicians and patients should question.” We measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) DXAs among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change. Using 100 % Medicare claims data, 2006–2011, we identified DXAs and short-interval DXAs for female Medicare beneficiaries over age 66. We determined the population rate of DXAs and short-interval DXAs, as well as Medicare spending on short-interval DXAs, nationally and by hospital referral region (HRR). DXA use was stable 2008–2011 (12.4 to 11.5 DXAs per 100 women). DXA use varied across HRRs: in 2011, overall DXA use ranged from 6.3 to 23.0 per 100 women (coefficient of variation = 0.18), and short-interval DXAs ranged from 0.3 to 8.0 per 100 women (coefficient of variation = 0.64). Short-interval DXA use fluctuated substantially with payment changes; other DXAs did not. Short-interval DXAs, which represented 10.1 % of all DXAs, cost Medicare approximately US$16 million in 2011. One out of ten DXAs was administered in a time frame shorter than recommended and at a substantial cost to Medicare. DXA use varied across regions. Short-interval DXA use was responsive to reimbursement changes, suggesting carefully designed policy and payment reform may reduce this care identified by rheumatologists as low value.
Nancy E Morden - One of the best experts on this subject based on the ideXlab platform.
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overuse of short interval Bone Densitometry assessing rates of low value care
Osteoporosis International, 2014Co-Authors: Nancy E Morden, William L Schpero, Rebecca Zaha, Thomas D Sequist, Carrie H CollaAbstract:Summary We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation = 0.64), and unlike other DXAs, rates decreased with payment cuts.
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overuse of short interval Bone Densitometry assessing rates of low value care
Osteoporosis International, 2014Co-Authors: Nancy E Morden, William L Schpero, Rebecca Zaha, Thomas D Sequist, Carrie H CollaAbstract:We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation = 0.64), and unlike other DXAs, rates decreased with payment cuts. The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring Bone density more often than every 2 years as care “physicians and patients should question.” We measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) DXAs among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change. Using 100 % Medicare claims data, 2006–2011, we identified DXAs and short-interval DXAs for female Medicare beneficiaries over age 66. We determined the population rate of DXAs and short-interval DXAs, as well as Medicare spending on short-interval DXAs, nationally and by hospital referral region (HRR). DXA use was stable 2008–2011 (12.4 to 11.5 DXAs per 100 women). DXA use varied across HRRs: in 2011, overall DXA use ranged from 6.3 to 23.0 per 100 women (coefficient of variation = 0.18), and short-interval DXAs ranged from 0.3 to 8.0 per 100 women (coefficient of variation = 0.64). Short-interval DXA use fluctuated substantially with payment changes; other DXAs did not. Short-interval DXAs, which represented 10.1 % of all DXAs, cost Medicare approximately US$16 million in 2011. One out of ten DXAs was administered in a time frame shorter than recommended and at a substantial cost to Medicare. DXA use varied across regions. Short-interval DXA use was responsive to reimbursement changes, suggesting carefully designed policy and payment reform may reduce this care identified by rheumatologists as low value.
John T Schousboe - One of the best experts on this subject based on the ideXlab platform.
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executive summary of the 2013 international society for clinical Densitometry position development conference on Bone Densitometry
Journal of Clinical Densitometry, 2013Co-Authors: John T Schousboe, John A Shepherd, John P Bilezikian, Sanford BaimAbstract:There have been many scientific advances in measurement of fat and lean body mass as determined by dual-energy X-ray absorptiometry (DXA). The International Society for Clinical Densitometry (ISCD) convened a Position Development Conference (PDC) on the use of DXA for body composition measurement. Previously, no guidelines to the use of DXA for body composition existed. The recommendations pertain to clinically relevant issues regarding DXA indications of use, acquisition, analysis, quality control, interpretation, and reporting were addressed. The topics and questions for consideration were developed by the ISCD Board of Directors and the Scientific Advisory Committee and were designed to address the needs of clinical practitioners. Three Task Forces were created and assigned these questions and asked to conduct comprehensive literature reviews. The Task Forces included participants from 6 countries and a variety of interests including academic institutions, private clinics, and industry. Reports with proposed Position Statements were then presented to an international panel of experts with backgrounds in DXA and Bone Densitometry and a variety of fields that use body composition measures. The PDC was held in Tampa, FL, contemporaneously with the Annual Meeting of the ISCD, March 21 through March 23, 2013. This report describes the methodology of the 2013 ISCD Body Composition PDC and summarizes the results. Three separate articles in this issue will detail the rationale, discussion, and additional research topics for each question the Task Forces addressed.
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cost effectiveness of Bone Densitometry among caucasian women and men without a prior fracture according to age and body weight
Osteoporosis International, 2013Co-Authors: John T Schousboe, Margaret L Gourlay, Howard A Fink, Brent C Taylor, Eric S Orwoll, Elizabeth Barrettconnor, L J Melton, S R Cummings, Kristine E EnsrudAbstract:Summary We used a microsimulation model to estimate the threshold body weights at which screening Bone Densitometry is cost-effective. Among women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to identify those for whom Bone Densitometry is cost-effective.
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cost effectiveness of Bone Densitometry followed by treatment of osteoporosis in older men
JAMA, 2007Co-Authors: John T Schousboe, Howard A Fink, Brent C Taylor, Eric S Orwoll, Joseph L Melton, Steven R Cummings, Robert L Kane, Douglas C Bauer, Kristine E EnsrudAbstract:ContextOsteoporotic fractures are common among elderly men.ObjectiveTo evaluate among older men the cost-effectiveness of Bone Densitometry followed by 5 years of oral bisphosphonate therapy to prevent fractures for those found to have osteoporosis (femoral neck T score ≤−2.5), compared with no intervention.Design, Setting, and PopulationComputer Markov microsimulation model using a societal perspective and a lifetime horizon. Simulations were performed for hypothetical cohorts of white men aged 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data sources for model parameters included the Rochester Epidemiology Project for fracture costs and population-based age-specific fracture rates; the Osteoporotic Fractures in Men (MrOS) study and published meta-analyses for the associations among prior fractures, Bone density, and incident fractures; and published studies of fracture disutility.Main Outcome MeasuresCosts per quality-adjusted life-year (QALY) gained for the Densitometry and follow-up treatment strategy compared with no intervention, calculated from lifetime costs and accumulated QALYs for each strategy.ResultsLifetime costs per QALY gained for the Densitometry and follow-up treatment strategy were less than $50 000 for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture. These results were most sensitive to oral bisphosphonate cost and fracture reduction efficacy, the strength of association between Bone mineral density and fractures, fracture rates and disutility, and medication adherence.ConclusionsBone Densitometry followed by bisphosphonate therapy for those with osteoporosis may be cost-effective for men aged 65 years or older with a self-reported prior clinical fracture and for men aged 80 to 85 years with no prior fracture. This strategy may also be cost-effective for men as young as 70 years without a prior clinical fracture if oral bisphosphonate costs are less than $500 per year or if the societal willingness to pay per QALY gained is $100 000.
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reliability and accuracy of vertebral fracture assessment with Densitometry compared to radiography in clinical practice
Osteoporosis International, 2006Co-Authors: John T Schousboe, Rowan C DeboldAbstract:Absorptiometry of the thoraco-lumbar spine at the time of Bone Densitometry to detect vertebral deformities consistent with fracture is now available. The performance of absorptiometry in clinical practice compared to radiography has not been fully established, especially in the presence of osteoarthritis or scoliosis. Our first objective was to compare absorptiometry to radiography for detection of vertebral deformity in elderly women who were referred for Bone Densitometry with or without scoliosis or disc space osteoarthritis excluded. Our second objective was to assess the effect of osteoarthritis and scoliosis on the inter-rater reliability of both technologies. The study group comprised two hundred five women age 65 and older referred for Bone Densitometry in a large multispecialty group practice. Lateral and antero-posterior (AP) absorptiometry images and lateral spine radiographs were obtained on all participants. The vertebrae on all images were evaluated for vertebral deformity by two observers according to the Genant semiquantitative criteria who were blinded to each other’s readings. Disc spaces were evaluated on radiographs for osteoarthritis. Absorptiometry AP images were evaluated for scoliosis. In the absence of scoliosis, the sensitivity and specificity of absorptiometry for persons with one or more radiographic grade 2–3 deformities (>25% reduction of vertebral height) for the two readers were 87–93% and 93–95%, respectively. The inter-rater reliability of absorptiometry improved in the absence of moderate or severe disc space osteoarthritis. A strategy of absorptiometry with follow-up radiography only in those with scoliosis or apparent grade 2 deformity accurately identifies those with prevalent grade 2 or 3 deformity on radiography (accuracy 0.98 and kappa 0.86 for reader 1; accuracy 0.99 and kappa 0.92 for reader 2). Lateral and AP absorptiometry imaging of the spine with selective follow-up radiography accurately identifies elderly women with vertebral deformity consistent with moderate or severe fracture, but extra caution is necessary when evaluating vertebrae in the presence of adjacent disc space osteoarthritis.
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universal Bone Densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost effective for elderly women
Journal of the American Geriatrics Society, 2005Co-Authors: John T Schousboe, Kristine E Ensrud, Joseph L Melton, John A Nyman, Robert L KaneAbstract:Objectives: To investigate the cost-effectiveness of universal Bone Densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T-score ≤−2.5). Design: A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective. Setting: Women living independently and those in nursing homes. Participants: Caucasian women aged 65, 75, 85, or 95. Intervention: Bone Densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (Densitometry or drug therapy). Measurements: Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. Results: The cost per QALY gained for the screen-and-treat strategy was $43,000 per QALY gained for 65-year-old women and $5,600 per QALY gained for 75-year-old women. For 85- and 95-year-old women, the screen-and-treat strategy was cost saving. Sensitivity analyses showed that the screen-and-treat strategy was cost-effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture. Conclusion: Universal Bone Densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost-effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).
G Iguchi - One of the best experts on this subject based on the ideXlab platform.
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novel ultrasonic Bone Densitometry based on two longitudinal waves significant correlation with pqct measurement values and age related changes in trabecular Bone density cortical thickness and elastic modulus of trabecular Bone in a normal japanese
Osteoporosis International, 2010Co-Authors: G Iguchi, Takako Tobimatsu, Takahiko Otani, Kaoru Horii, Isao Mano, I Nagai, Takuo Fujita, K. Takahashi, Hisamitsu BabaAbstract:Summary A reference database for trabecular Bone density, cortical thickness, and elastic modulus of trabecular Bone for a novel ultrasonic Bone Densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population.
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novel ultrasonic Bone Densitometry based on two longitudinal waves significant correlation with pqct measurement values and age related changes in trabecular Bone density cortical thickness and elastic modulus of trabecular Bone in a normal japanese population
Osteoporosis International, 2010Co-Authors: H Sai, G Iguchi, Takako Tobimatsu, Takahiko Otani, Kaoru Horii, Isao Mano, I Nagai, K. Takahashi, H Iio, Takuo FujitaAbstract:A reference database for trabecular Bone density, cortical thickness, and elastic modulus of trabecular Bone for a novel ultrasonic Bone Densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population. A novel ultrasonic Bone Densitometry system (LD-100 system) was applied to create a reference database for trabecular Bone density (TBD), cortical thickness (CoTh), and elastic modulus of trabecular Bone (EMTb) for this device over a wide age range in a normal Japanese population. In a comparative study between LD-100 and peripheral quantitative computed tomography (pQCT) systems, 52 individuals were examined by both systems at the same radius simultaneously. To create a reference database, a total of 2,380 healthy subjects (1,179 men, 1,201 women), ages 18–99 years, were examined using the LD-100 system. Highly significant correlations between the LD-100 and pQCT systems were found in TBD (r = 0.877, p < 0.001) and CoTh (r = 0.723, p < 0.001). For the reference database, peak values of TBD, CoTh, and EMTb were observed at 30–34 years (255.09 mg/cm3), 20–24 years (5.23 mm), and 20–24 years (4.09 GPa) in men, and at 25–29 years (209.24 mg/cm3), 25–29 years (3.98 mm), and 20–24 years (3.33 GPa) in women, respectively. The TBD fell significantly (p < 0.05) beginning at 55–59 years in both sexes, with a relatively rapid decrease in women. The CoTh showed a significant decrease beginning at 40–44 years in men and 50–54 years in women. The EMTb showed a significant decrease beginning at 40–44 years in men and 55–59 years in women. The LD-100 system is a useful Bone Densitometry device and the database of age-related changes in TBD, CoTh, and EMTb established in this study will provide fundamental data for future studies related to Bone status.