1. Chapter 66 Chapter 66 Clinical Use of Bone Densitometry Copyright © 2013 Elsevier Inc. All rights reserved.

2. FIGURE 66.1 FRAX ® data entry screen for web-version 3.4. This screen appears after the user selects the appropriate calculation tool based on the country and race of the patient. This is the tool for US Caucasians. Notice that the radio button for “no” is selected by default for each of the risk factors shown in nos. 5–11. Height and weight must be entered in cm and kg, respectively. A conversion utility is seen on the viewer's right for original measurements made using inches and pounds. Source: image used with permission of the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield. FRAX ® is registered to Professor JA Kanis, University of Sheffield. 2

3. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.2 FRAX ® with completed data entry for web-version 3.4. Input of the patient's name is optional. Age or birth date must be entered and the appropriate radio button for gender must be selected. This patient is a 67- year-old Caucasian woman from the US. The conversion utility for height and weight automatically transferred the calculated metric equivalents to the calculation tool. Because the patient smokes, the radio button for “yes” was selected for #7. After selecting GE Lunar from the drop down box in #12, the BMD in g/cm 2 was entered. Clicking on “calculate” resulted in the display of a T-score of −2.1 and the 10-year absolute fracture probabilities. This screen can be printed by clicking on the print icon in the upper right of the box containing the fracture probabilities. Because the 10-year probability of hip fracture is 3.5%, this woman meets current National Osteoporosis Foundation guidelines for consideration of pharmacologic intervention to reduce fracture risk. Source: image used with permission of the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield. FRAX ® is registered to Professor JA Kanis, University of Sheffield. 3

4. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.3 CAROC initial screen. To launch the fracture risk calculator, the user must click on on “calculator.’’ Source: image reproduced with the permission of Osteoporosis Canada. 4

5. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.4 CAROC data entry screen. After clicking on “calculator” the data entry screen appears. Sex, age, and femoral neck and lumbar spine bone density must be entered. The radio buttons for hip or spine fracture or prior systemic corticosteroid use should only be clicked if they apply to the patient. Otherwise, they should be left unclicked. If the patient has not experienced any nonvertebral fractures, the box should be left empty. NOTICE: the risk gradient scale at the bottom of the screen. Image reproduced with the permission of Osteoporosis Canada. 5

6. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.5 CAROC data entry screen completed. Data entry has been completed for a 66-year-old woman with a femoral neck T-score of −1.8 and a lumbar spine T-score of −0.9. She has a prior history of corticosteroid use but has not experienced any fractures. Notice at the bottom of the screen that the arrows indicate a “moderate” fracture risk. Source: image reproduced with the permission of Osteoporosis Canada. 6

7. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.6 Garvan fracture risk calculator data entry screen. Data has been entered for a 68-year-old woman. She had fallen once in the last year and has a femoral neck bone density of 0.627 g/cm 2. The DXA study was performed on a Hologic device. She has not had any prior fractures. Because this calculator may be accessed by patients without physician oversight, there is a disclaimer which must be acknowledged prior to clicking on “calculate risk factor.” If the user indicates that bone density results are not available by clicking on “no” in response to “Do you have a bone mineral density (BMD) measurement?” a box will appear into which the patient's weight in kg must be entered before results can be calculated. Source: image reproduced with the permission of the Garvan Institute of Medical Research. 7

8. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.7 Garvan fracture risk calculator results. 5- and 10-year absolute risk predictions for hip fracture and any osteoporotic fracture are shown here along with the risk factors used to calculate the probabilities. This screen may be printed by clicking on “print” seen at the bottom left of the screen. Source: image reproduced with the permission of the Garvan Institute of Medical Research. 8

9. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 66.8 VFA image. An SQ 2 wedge deformity is seen here at the level of L1. Source: case courtesy of Hologic Inc., Bedford, MA, USA. 9