In most instances in small cities, towns, villages and the rural areas, osteoporosis is suspected after a broken bone in both older women and men. Most older women and men in small cities, towns, villages and the rural areas have no access to bone density testing for several reasons beyond their control, e.g., lack of medical facilities in their area of residency, inadequate and infrequent outreach programs by the clinicians, long travel distances to a clinic, etc.
Bone density is defined as the measurement of the calcium and other bone minerals that are packed into a segment of the bone. Bone density is determined into two scores, i.e., T-score and Z-score. Bone density testing, also called dual-energy x-ray absorptiometry (DXA) or bone mineral density (BMD), is an enhanced version of x-ray scan that is used to measure bone loss. BMD tests are usually done on bones in the spine (vertebrae), hip, forearm, wrist, fingers and heel.
Bone density testing is commonly recommended in menopausal women and not taking estrogens, men with clinical conditions associated with bone loss, such as rheumatoid arthritis, chronic kidney or liver disease. Bone density testing is also advised in few other clinical conditions, e.g., use of medications (prednisone), excessive collagen in urine, hyperthyroidism, hyperparathyroidism, type 1 diabetes, etc. All these clinical conditions demand access to radiologist, endocrinologist, rheumatologist, pulmonologist, etc., and these specialists are not easily accessible in rural areas.
We have solved this problem by sending “Mobile Medical Van” to small cities, towns, villages, and the rural areas with an installed General Electric DXA machine and other instruments for the evaluation of the person. The DXA scan is transmitted employing Zoom and Dicom to a radiologist working in an urban area and the interpretation is available in thirty (30) minutes.
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3) Patient education: Bone density testing (Beyond the Basics). Update.com/contents/bone-density-testing-beyond the basics. Sheu A, Diamond T. Bone mineral density: testing for osteoporosis. Aust Prescr 2016; 39(2): 35-39.
4) Rothman MS, Lewiecki EM, Miller PD. Bone Density Testing is the Best Way to Monitor Osteoporosis Treatment. The American Journal of Medicine 2017. https://doi.org/10.1016/j.amjmed. 2017.05.044
5) Recently published articles from Journal of Clinical Densitometry (October-December 2019). Journals.Elsevier.com/Journal-of-clinical-densitometry/recent articles