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Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPs  AHCPR Archived Technology AssessmentsBone Densitometry: Patients with End-Stage Renal Disease Prepared by: Martin Erlichman, M.S., and Thomas V. Holohan, M.D., FACP Health Technology Assessment: Number 8 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland March 1996 AHCPR Pub. No. 96-0040 View the Medline Citation and Related Citations using PubMed AbstractBone mass loss and osteoporosis are associated with various conditions, such as end-stage renal disease (ESRD), and treatments, such as prolonged steroid therapy.
Bone densitometry is used to measure bone mass density to determine the degree of osteoporosis and to estimate fracture risk.
Bone densitometers measure the radiation absorption by the skeleton to determine bone mass of the peripheral, axial, and total skeleton.
Common techniques include single-photon absorptiometry (SPA) of the forearm and heel, dual-photon (DPA) and dual-energy x-ray absorptiometry (DXA) of the spine and hip, quantitative computed tomography (QCT) of the spine or forearm, and radiographic absorptiometry (RA) of the hand.
Part I of this report addresses important technical considerations of bone densitometers, including radiation dose, site selection, and accuracy and precision, as well as cost and charges.
Part II evaluates the clinical utility of bone densitometry in the management of patients with ESRD.
End-stage
renal disease affected more than 242,000 Americans in 1992, and each year 10,000 to 20,000 new cases are diagnosed.
Although the survival rate of ESRD patients has improved, metabolic bone diseases that fall under the generic term "renal osteodystrophy" represent abnormal development of bone and major long-term complications.
Issues addressed are the type and extent of bone loss associated with ESRD and whether these patients have an increased risk for fracture.
The other assessments in this series address the clinical utility of bone densitometry for patients with asymptomatic primary hyperparathyroidism, steroid-dependent patients, estrogen-deficient women, and patients with vertebral abnormalities. The Center for Health Care Technology (CHCT) evaluates the risks, benefits, and clinical effectiveness of new or unestablished medical technologies. In most instances, assessments address technologies that are being reviewed for purposes of coverage by federally funded health programs. CHCT's assessment process includes a comprehensive review of the medical literature and emphasizes broad and open participation from within and outside the Federal Government. A range of expert advice is obtained by widely publicizing the plans for conducting the assessment through publication of an announcement in the Federal Register and solicitation of input from Federal agencies, medical specialty societies, insurers, and manufacturers. The involvement of these experts helps ensure inclusion of the experienced and varying viewpoints needed to round out the data derived from individual scientific studies in the medical literature. CHCT analyzed and synthesized data and information received from experts and the scientific literature. The results are reported in this assessment. Each assessment represents a detailed analysis of the risks, clinical effectiveness, and uses of new or unestablished medical technologies. If an assessment has been prepared to form the basis for a coverage decision by a federally financed health care program, it serves as the Public Health Service's recommendation to that program and is disseminated widely. CHCT is one component of the Agency for Health Care Policy and Research (AHCPR),
Public Health Service, Department of Health and Human Services.
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