Skeleton Pirate

Skeleton Pirate
Artist: LindaB


Have you experienced, or read about, negative, and even dangerous, side effects from Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate), and other bisphosphonates prescribed for osteoporosis? If you have, then rest assured there is a safe, effective treatment for this condition. Strontium, primarily in the form of strontium citrate, is taken orally once a day.

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Thursday, December 18, 2014

Study Demonstrates DXA Scan Is Obviously Flawed

Most clinically important vertebral body compression fractures found on abdominal multidetector computed tomography (CT) scans would go unreported if sagittal reconstructions were not routinely evaluated, according to a new study.

"At this point, it is routine to evaluate sagittal reconstructions at abdominal multidetector CT (MDCT), and whenever vertebral fractures are detected, they are reported." However, this has not always been the case, said Travis Lauder, BS, a fourth-year medical student at the University of Wisconsin School of Medicine and Public Health in Madison.

"The studies we reviewed were done before 2007, when sagittal reconstructions were not automatically provided. We showed that without them, we missed a lot of vertebral compression fractures in patients who underwent abdominal multidetector CT," he explained.

Lauder presented the study results at the American Roentgen Ray Society 2013 Annual Meeting in Washington, DC. First results were published online February 28 in Radiology.

Lauder and his team retrospectively analyzed 2041 consecutive patients (mean age, 70.8 years) who had undergone abdominal multidetector CT and dual-energy x-ray absorptiometry (DXA) within 6 months of each other. The images were taken from 2000 to 2007, before sagittal CT reconstructions were routinely obtained.

The researchers used the Genant visual semiquantitative method to review transverse (axial) and retrospective sagittal multidetector CT reconstructions for the presence of moderate to severe fractures of the lower thoracic and lumbar spine. They also reviewed the electronic medical records of these patients to determine whether the fracture was reported at prospective CT interpretation, was known previously, or was subsequently diagnosed.

"At least 1 moderate or severe vertebral body compression fracture was retrospectively identified on CT in 97 patients," the researchers report. The fractures involved 1 level in 67 patients and 2 or more levels in 30 patients. In total, 141 fractures were identified.

In patients with an unreported fracture, vertebral body compression fracture was not recognized clinically in 64% and there was no evidence of osteoporosis on DXA in 48%.

"DXA is still the gold standard," Lauder noted, "but this analysis demonstrated that a lot of these patients have false negatives on DXA, and that the DXA test is obviously flawed."

Incidental findings are a well-known "double-edged sword" in cross-sectional imaging, said Abraham Dachman, MD, professor of radiology and director of the fellowship programs at the University of Chicago in Illinois, who was asked by Medscape Medical News to comment on the study.

"Many findings — some previously known by the referring physician and some not — can be found on CT. It is often difficult for the radiologist to know what findings to report, what findings to ignore, and what incidental findings are sufficiently important to require personal communication with the referring physician," Dr. Dachman said.

However, this study highlights the potential of abdominal CT to detect vertebral body compression fractures, he noted. Coronal and sagittal reconstructions are often done by the technologist who performs the exam using software on the CT scanner console; they do not require dedicated workstations.

"This study did not address how often the observation of vertebral body compression fractures changed patient management because it was retrospective in nature," Dr. Dachman said. "Still, it highlights the potential of CT to reveal information and provides a rationale to radiologists who wish to routinely report this observation."

This article appeared on Medscape under the title, “Vertebral Fractures Go Undetected without Sagittal Views.”
The abstract and full text with CT images for “Unreported Vertebral Body Compression Fractures at Abdominal Multidector CT,” which was published in Radiology  in July 2013, can be read here:
For an excellent description of computed tomography (CT) and multidetector computed tomography (MDCT), see:
For a description of an abdominal CT scan, see:
For information on computed tomography angiography (CTA), see:

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Wandering Skeleton

Wandering Skeleton
Artist: Joel Hoekstra

Osteoporotic Bone

Osteoporotic Bone

How Strontium Builds Bones

Strontium is a mineral that tends to accumulate in bone. Studies have shown that oral doses of strontium are a safe and effective way to prevent and reverse osteoporosis. Doses of 680 mg per day appear to be optimal. See my "For More Information About Strontium" links section.

Osteoporosis is caused by changes in bone production. In healthy young bones there is a constant cycle of new bone growth and bone removal. With age, more bone is removed and less new bone is produced. The bones become less dense and thus more fragile.

Scientists believe that strontium works in two ways. It may stimulate the replication of pre-osteoblasts, leading to an increase in osteoblasts (cells that build bone). Strontium also directly inhibits the activity of osteoclasts (cells that break down bone). The result is stronger bones.

When taking strontium, be sure to take 1200 mg calcium, 1000 IU vitamin D3, and 500 mg magnesium daily. It is best to take strontium late at night on an empty stomach. Calcium and strontium may compete with each other for absorption if taken together.