All about bone densitometry: what it is, methods of conducting, what hidden pathologies can be detected. X-ray densitometry Which densitometry

Over the years, bone tissue loses calcium, osteoporosis develops. Densitometry is an X-ray test that provides doctors with information about changes in bone density.

If osteoporosis is suspected or there are factors of its possible development, doctors prescribe densitometry every 2 years. This approach gives doctors the opportunity to see the development of osteoporosis in the early stages, start timely treatment, and prevent fractures.

Densitometry is an examination that determines the mineral composition of bone tissue, the presence of calcium compounds. In traumatology, the peripheral parts of the fracture sites are often investigated, however, according to the data obtained, doctors see a clinical picture of the general condition of bones throughout the body.

Elderly people suffer from complications after fractures due to the slow healing of bone fragments. Therefore, early diagnosis using densitometry is important. It helps prevent the formation of osteoporosis.

Indications for research

Osteoporosis develops in people of all ages, not just the elderly. Conditions that reduce blood calcium levels are manifold. But they all affect bone density and strength.

The indications for the study are:

• dysfunction of the parathyroid gland and pathology of its development; with hypoparathyroidism, the activity of the gland decreases, the synthesis of secretion - parathyroid hormone, which is responsible for obtaining calcium by bone tissues, reducing its excretion by the renal system;
• injuries accompanied by bone fractures;
• constant treatment with drugs that have the ability to lower the calcium content; these include steroid-type hormones, oral contraceptives, diuretics - Furosemide, Torasemide, anti-seizure drugs - Phenobarbital, Carbamazepine;
• the use of alcoholic beverages at the stage of alcohol dependence disease;
• women over 40; men over 60;
• patients over 30, when family members are diagnosed with osteoporotic disease;
• people who move a little;
• women on diets to lose weight;
• patients working in production with high physical exertion;
• dynamic observation of the patient during treatment, to assess the effectiveness of the chosen direction of therapy.

Densitometry for a woman is an important examination. Women are at risk for calcium loss due to fluctuations in the production of the female hormone - estrogen, so there is an additional list of prescriptions for such a procedure for them.

These are the situations:

• the period of menopause (it is important to check the condition of the bones at its early onset, before the age of 45);
• after operations of adnexectomy, extirpation of the uterus.

Densitometry is an examination that gives the doctor the necessary information about the condition of the patient's bone tissue.

Contraindications and restrictions

Densitometry is such a gentle examination, to which there are practically no contraindications. But the use of X-rays still has contraindications.

Investigation on installations with X-ray radiation examinations are not carried out:

Densitometry is such a serious examination during which a woman and a growing fetus may receive unwanted radiation. Therefore, an absolute contraindication for examination with X-ray radiation is given to pregnant women.

Research equipment

Medical devices for examining bone tissue are represented by two devices:

• Ultrasound densitometers using ultrasonic irradiation;
• x-ray densitometers with X-ray irradiation.

Pluses of ultrasonic devices:

• safe examination;
• quick examination;
• compact and mobile devices;
• there is computer support with special programs;
• the survey is possible in any room;
• democratic cost of the device.

The ultrasound densitometer does not provide the most accurate information.

Frequently used models of ultrasound densitometers:

• sonost 3000 device, Korean production: equipped with a monitor and a thermal printer, an interface based on the latest Windows models;
• mcCue CUBA Clinical apparatus, made in the USA: it has a high accuracy of examination, it can be connected to a computer with a printer if there is a special program;
• omnisense 7000 apparatus, made in Israel: equipped with a screen, a main unit, probes for examining various bones.

Advantages of X-ray densitometers:

• high-precision measurement;
• direct examination of the hip joints;
• examination of the lower back, the most accurate method for determining the presence of osteoporosis;
• examination of large sections of the bones.

Cons of devices:

• patients receive x-rays;
• a special room is required to install the device;
• expensive price of an X-ray densitometer.

The most popular models of X-ray devices:

• norland ELITE installation, manufactured by Norland Medical Systems: the largest device in the world, equipped with modern software;
• norland XR46 rig, production of the same company: gives accurate measurements with calibration of the mass of different tissues, there is a positioning system with a rotation angle;
• installing LUNAR iDXA: equipped with a program for examining children, studying the body index, analyzing the state of bone tissues;
• dEXXUM 3 device manufactured by the South Korean company OsteoSys conducts a study using the method of dual energy absorptiometry, an important advantage is the software in Russian.

X-ray and ultrasound densitometers of various production are successfully used in large diagnostic centers, medical departments at large manufacturing enterprises. Their choice and range of prices allows a medical institution to obtain a device that will suit the needs of an enterprise, city, region.

Types of densitometry

The study is carried out with special devices - densitometers.

They differ in the method of obtaining results:

The latter methods are rarely carried out due to their high cost.

Ultrasonic densitometry

Ultrasound densitometry is a study of the mineralization of bone tissue, which is performed by the method of indirect passage of radiation. Ultrasound - the wave travels through the bone tissue with different densities and speeds.

The device transmits ultrasound at a certain frequency along the bone of a given area, the examination indicators are captured by the output sensor.

Data with low information content is obtained, however, the device is used often. This is due to the safety and speed of research.

X-ray densitometry. CT densitometry

The method of rays of the X-ray machine examines the areas of the bone indicated by the doctors, the available program calculates the level of bone mineralization.

Today, various methods of X-ray densitometry have been developed and are used:

• dual energy; the technique is based on the passage of two x-ray beams - the first goes along the bones, the second - along the soft tissues; then the indicators of their promotion are compared; the analysis is carried out according to the general principle - if the mineralization of bones is high, then the permeability of the rays is low; this method usually examines the spine and thigh bones;
• peripheral densitometry; the same measuring principle is used, but the patient receives a lower dose of radiation; this method evaluates the parameters of bone tissue, and is also used to monitor treatment.

CT densitometry also uses exposure to ionizing radiation. CT scan gives a picture of the bones in volume. It is rarely used because of the high ionizing radiation and the high cost of the examination.

The indications for CT examination are:

• long-term intake of hormones;
• lingering inflammation in the digestive tract;
• pulmonary cystic fibrosis;
• connective tissue diseases;
• dysfunction of the lungs and kidneys;
• dysfunction in the sex glands, lack of production of sex hormones;
• genetic diseases of the musculoskeletal system.

Bone densitometry performed by CT provides doctors with indicators of a decrease in bone volume at the very beginning of the development of pathology. This is a good technique for early diagnosis of the disease.

Alternative diagnostic methods

• photon absorptiometrywhere the survey is carried out with photon beams; they pass through the bone tissue, and the calculation of mineralization is carried out by the absorption of photons during their passage through the tissues; low exposure is applicable here;
• x-ray computed tomography - RKT.

There are 2 photon-type absorptiometry:

• monochrome; used to study the mineralization of peripheral bones;
• dichromic; used to obtain data on the mineralization of the bones of the spine and hips.

Photonic absorbimetry provides gentle radiation and at the same time provides accurate test results. At the same time, scanning is much faster than examination on X-ray machines.

The principle of the X-ray examination is the passage of X-rays through the patient's body in a fan-shaped beam oriented along one projection.

When the beam passes through dense tissues, their intensity drops, this is recorded by a special detector. The bone density is determined by a program based on mathematical integration. When the computer analysis ends, the program builds a tomographic image in several projections.

Training

To get objective results from a densitometry examination, you should:

• in the case when other organs with contrast have been examined for the last 2 weeks, you need to tell this to the attending physician;
• the presence of pregnancy, even in the first week, must be told to the attending physician;
• dress so that it is comfortable to lie still for 15 minutes;
• remove metal objects, gold chains, earrings, as they can affect the result;
• stop taking calcium medications a day or two before the examination, including Vitrum, Kaltsinova.

It is necessary to tune oneself to hold a motionless posture indicated by the doctor, the time set for examination, this is usually 30-40 minutes.

How is densitometry

Densitometry is performed in a specially equipped office. If ultrasound densitometry is performed, then the patient lies down on the couch by the apparatus. An ultrasound examination uses sensors that are put on the patient's finger. The study of the movement of ultrasound waves along the tissues of the bones takes 3-5 minutes.

When the examination is carried out on an X-ray machine, the patient lies down on the diagnostic table, the operator checks the posture, fixes it and asks to stay in the given posture for the required amount of time. A radiation source is located under the plane of the table, and an apparatus that records the results of the study is above the patient.

The sensor reading the data moves over the body, measures the rate of passage of the irradiation, transfers the data to the computer. Here the totals are processed and analyzed. The result is obtained in the form of X-rays.

If the study is carried out on an installation with one unit, then the specified part of the body is placed in the apparatus, the results of the study are issued by a computer program. Often, to improve the quality of the image, a part of the body is fixed with additional attachments.

During an X-ray examination, the image is transferred to a computer, where the program analyzes it. The procedure lasts from 10 minutes to ½ hour, depending on the scope of the examination.

What densitometry shows. Decoding the results

Densitometry shows:

• microarchitectonics of bone tissue;
• mineralization;
• microdamages on the bone trabeculae.

As a rule, sections of the spine and hip joints are examined. According to the indications of the study, the general structure of the bones is assessed. The result of densitometry is deciphered according to the algorithm of computer programs.

3 survey parameters are important here:

• bone tissue density, unit of measurement - g / cm2; these are classic indicators SD, or in Russian it is written WITH, which means the same, in percentage terms with the norms. Each unit of deviation from the standard doubles the risk of osteoporotic fractures;
• T-score, is analyzed as a statistical hypothesis; the obtained results of mineralization are compared with the standard data;
• Z-data, standardized; the results of the T-study are compared with standard data for healthy people.

T- and Z-data have a standard grading scale that helps doctors assess the condition of bone tissue in a subject:

1. Readings from 0 to -1.5 are considered normal.
2. Readings from -1.5 to -2.5 indicate a slight decrease in density, diagnosed as osteopenia.
3. Readings below -2.5 indicate complete osteoporosis.

The values \u200b\u200bof the Z index are interpreted differently for children and adults:

• women in the period before menopause, bone density is estimated below normal at Z;
• men under 50 years of age, low tissue density is assessed at Z as a significant decrease in age norms;
• children and adolescents with Z are diagnosed with a pathology of bone tissue development.

Modern densitometers have standard indicators for age and sex in the base. The program compares the received data and decrypts the result.

In pediatrics, the diagnosis of osteoporosis is not established based on the results of densitometry, because the bone mass is not yet fully formed. This process ends only by the age of 25. The fact that the Z and T indices change slightly after 45 years is also taken into account, their decrease by 13-15% is not the basis for the diagnosis. An additional examination is required here.

The price of different types of research

Prices for studies of osteoporosis by different methods vary according to the type of medical institution, routine or emergency examination. Public hospitals set prices for all types of examinations cheaper than private medical centers. In private prices depend on the level of the center, its popularity.

An appointment scan costs less than an on-call scan. The cost of the examination is influenced by the qualifications of a specialist, the availability of additional services.

A screening examination to determine the damage to the bone tissue of the spine and parts of the thigh bones on MRI costs about 15,000 rubles if the examination is carried out without a doctor's referral.

Price with referral - 14 250 rubles. There are benefits for disabled people, pensioners, medical workers, children under 12 years old, affected by the Chernobyl accident, blockade soldiers, veterans of the Great Patriotic War. For them, prices fluctuate between 12-13 thousand rubles.

Ultrasound densitometry is an examination using such different devices, which is evaluated differently in different cities.

On average, it costs from 622 rubles. for 2 places of examination up to 700 rubles. for 1st place. Prices are set differently in different cities of the country. So, in Voronezh, a patient will pay 845 rubles for the examination of 6 places, in Moscow up to 175 places are examined in different centers, the average price is 2205 rubles.

Article design: Lozinsky Oleg

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Bone densitometry: what is it?

Densitometry is a test method for determining tissue mineral density. This method is the main way to diagnose osteoporosis.

Osteoporosis is a disease of the skeleton, in which tissue density decreases, bone fragility increases. This disease often occurs due to age-related or hormonal changes.

Kinds

• KUDM - quantitative ultrasonic densitometry
• DXA - Dual Energy X-ray Absorptiometry
• MRI - quantitative magnetic resonance imaging
• QCT - quantitative computed tomography

Contraindications

• Pregnancy;
• Recent x-ray or computed tomography examinations, especially with contrast media.

How is it done?

The patient takes a position on a special table. The sensor moves over a specified area, the image is projected on the computer screen.

During the study, it is necessary to remain immobile. Duration 10-30 minutes.

Preparation for research

No special training required. The only thing to do is stop taking calcium supplements the day before the procedure.

Decoding

Densitometry results in two indicators: T-score and Z-score.

The T-score compares the patient's score with the reference. Norm: 1 point or more. A value from -1 to -2.5 indicates low mineral density, less than -2.5 indicates osteoporosis with a high risk of fractures.

This examination, which determines bone mineral density, is divided into 2 types:

1. Ultrasonic densitometry;
2. X-ray densitometry.

The first type is considered to be more gentle. The ultrasound wave passes through the thickness of the bone tissue (the heel bone is most often examined). In this case, the speed of passage of the wave is recorded by a special device. The data is fed into a productive computer, then processed and sent to the screen. As a result, the doctor will be able to determine the presence of osteoporosis - a disease of the skeleton that carries the risk of fractures. However, this will only be a primary diagnosis.

In order to establish with maximum accuracy the features of the development of osteoporosis, a second step is needed - an X-ray examination.

This second type of procedure involves passing X-rays through the bone tissue. The number of minerals "met" by the ray on its way is calculated and compared with the norm. In this case, the object of study can be the thigh bones, the lumbar spine, the wrist, or even the entire skeleton.

It is not so easy to do densitometry in Moscow: it requires specific equipment. Especially when it comes to the X-ray type of examination. Therefore, in order to diagnose osteoporosis in a timely manner, start treatment on time and avoid serious consequences, you should consult a specialist. As a rule, such questions are within the competence of a rheumatologist. But you can also be referred to the procedure by an endocrinologist, gynecologist or orthopedist. They will also indicate the nearest clinic equipped with the necessary equipment.

Do I need to prepare for the examination?

There are several "golden rules" to follow. Before doing densitometry in Moscow, the doctor will advise:

• exclude, on the eve of the study, substances containing calcium, as well as any drugs that can increase the calcium content in the blood;
• pregnant women - bring their condition to the attention of a doctor;
• before the procedure - remove jewelry containing metal;
• wear clothes without metal zippers and buttons.

How is the examination going? In the case of an ultrasound examination, you simply place your heel (sometimes your toe) in a groove. Within a few minutes, ultrasound passes through the object of study, after which the processed results are displayed on a computer monitor.

If we are talking about X-rays, in this case you will be offered to lie down on a soft table. The radiation source is located at the bottom, and the image processing apparatus is at the top. During the procedure, the radiologist will ask you not to move and even hold your breath so that the image is not blurred. After taking a picture, the "smart" device will send it to the computer, where processing will take place. The doctor will then compare the bone density with the norm for your gender and age and give his verdict.

When is it worth going for an examination?

The procedure is indicated not only for patients who come to clinics with certain diseases, but sometimes for those people whose health is normal. Here is a list of indications for this procedure:

• diseases of the parathyroid glands;
• at least one fracture due to minor trauma;
• in women - the fact of removal of the ovaries, early menopause;
• the fact that a family member has been diagnosed with osteoporosis;
• the adoption of funds that "wash" calcium from the bones;
• maintaining a sedentary lifestyle;
• short stature + low weight;
• regular high-intensity physical activity.

Are there any contraindications to the procedure?

Ultrasound densitometry has no contraindications, being a completely harmless method. Speaking about the X-ray method of examination, it should be noted that it is not recommended for women at the time of carrying a child and breastfeeding.

Densitometry is a method for determining the mineral density of human bone tissue (BMD). Bone density can be determined using x-ray or ultrasound densitometry. The data obtained in the course of densitometry is processed by a computer program that compares the results with the indicators accepted as the norm for people of the corresponding sex and age. Bone density is the main indicator that determines the strength of the bone, its resistance to mechanical stress.

The main task of densitometry is to detect osteopenia and osteoporosis (a decrease in bone mineral density with an increase in its fragility). Osteoporosis is a widespread disease that most often occurs in women after menopause. That is why, according to the recommendations of the Russian Association for Osteoporosis and the European Society for the Treatment of Osteoporosis, regular densitometry is mandatory for women over the age of 65.

Indications for osteodensitometry

• For women in the first few years after menopause (especially after removal of the ovaries)
• All people with two or more risk factors for osteoporosis
• All people who have had one or more fractures over the age of 40 years not associated with serious injuries (car accident,fall from a great height, sports injuries)
• People taking glucocorticoid hormones for a long time(prednisone), thyroid hormones thyroid
• People who are suspected of having osteoporosis while undergoingx-ray examination of bones
• People who have received osteoporosis drug therapy to controleffective treatment
• People suffering from endocrine and rheumatic diseases (including children)

Densitometry is indicated in all cases when a decrease in bone density and its mineralization can be suspected.

A separate and very interesting feature of our device is the "Whole body" function, which allows you to measure the total body weight with a detailed assessment of the mineral density of the bone tissue of the whole body, muscle and fat mass in grams and percentage. This function is commonly used in endocrinology, dietetics and sports medicine.

Densitometry is a painless, non-invasive and absolutely safe diagnostic method that allows not only making a correct diagnosis, but also assessing the effectiveness of therapy.

To record for densitometry:

• The passport
• Direction
• OMS policy + photocopy on both sides
• contact number

Classical densitometry is a study using low-dose X-rays. Bone density is determined automatically by the digital diagnostic unit: depending on how much the X-ray radiation is attenuated when passing through the bones. The procedure does not create a high radiation load and is safe for the body.

Training

Any patient preparing for densitometry needs a few days before the procedure:

• Stop taking medications containing calcium and phosphorus
• Avoid foods high in foods
• Do not schedule other X-ray examinations with contrast (barium), as this may distort the diagnostic results

If the patient is a woman, and she is about to undergo X-ray or CT densitometry, it is necessary to make sure that there is no pregnancy: even low doses of X-rays can harm the fetus.

Before X-ray densitometry, you should also tell your doctor about any other radiation tests that were done during the previous year. This is important for calculating the permissible radiation exposure.

Immediately before the procedure, it is required to remove and remove from the pockets all metal accessories and other objects that may cause inaccuracies in the research results.

Densitometry

The X-ray densitometry procedure is carried out in a separate room where the diagnostic equipment is installed. Typically, densitometry examines the spine and femoral neck. The patient lies down on the densitometer table, and the part of the apparatus where the ray tube (sensors) is located is fixed over the examined area of \u200b\u200bthe body. Depending on the area of \u200b\u200bexamination, the person may be asked to lie on their back or take a certain body position.

Then the technologist turns on the apparatus, and scanning begins. An image is transferred to the screen of the device, and the densitometer computer starts processing the data. The patient does not experience any sensations during the diagnostic process. To get the most accurate results, it is not recommended to move during the procedure.

The total duration of the study is 10-20 minutes, then the specialist prepares and issues the results. The examined person does not need supervision and can immediately leave the clinic.

Densitometry of local areas (for example, only the bones of the forearm with delayed union of a fracture) takes less time than a full examination. In such cases, the patient is not placed on the table; only the examined part of the body (limb) is placed under the sensor.

The cost of densitometry depends on the number of areas examined.

A healthy person is recommended to undergo a study every 2 years in order to notice signs of mineral deficiency in bones in time and prevent the development of osteoporosis. The survey results should be saved in order to track the dynamics of changes in the future.

Indications and contraindications

The procedure is performed to detect a decrease in bone density. It is recommended for everyone who may experience this disorder:

• For persons over 40 years of age as a preventive procedure
• Postmenopausal women
• Elderly men
• Patients with diseases and disorders accompanied by the loss of calcium and other minerals (prolonged bed rest, chronic diseases of the digestive system, kidneys, liver, some metabolic diseases)
• Patients with repeated or long-term non-healing fractures
• For symptoms of bone abnormalities (eg, bone pain) with unknown causes
• If you have risk factors for osteoporosis (such as being overweight or underweight)
• With prolonged use of hormonal or other drugs that disrupt mineral metabolism

There are few contraindications to the study:

• Pregnancy (with X-ray densitometry)
• Pain syndrome, involuntary movements and other conditions due to which the patient cannot remain motionless during the examination

Densitometry results

Data analysis during the study is carried out automatically. After completing the procedure, the device gives out two indicators: T-score and Z-score.

The T-score shows the deviation of the patient's bone density relative to the general norm. The indicator is considered normal if it is 1 point or higher. If a T-score is determined from - 1 to - 2.5 points, then this is the basis for the diagnosis of osteopenia. This is the name given to decreased bone density, which can predispose to osteoporosis. If the T-score is less than 2.5 points, the patient is diagnosed with osteoporosis. In such cases, bone mineral density is critically low: fractures are possible.