Welcome Day 1

Join ISCD President, Dr. George Helmrich, MD, MS, MBA-HC, FACOG, NCMP, CCD and ISCD 2022 Annual Meeting Committee Chair, Dr. Jennifer J. Kelly, DO, FACE, CCD to kick-off the 2022 Annual Meeting.

Challenges in 2022 Osteoporosis Care

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 55 minutes.

This presentation will focus on factors that contribute to the osteoporosis treatment gap and strategies to optimize the care of patients with osteoporosis.

Learning Objectives:

• Define challenges in the care of patients with osteoporosis
• Describe strategies to overcome these challenges
• Identify new and emerging concepts aimed at reducing the global burden of osteoporosis

E. Michael Lewiecki, MD, FACP, FACE, CCD
Director
New Mexico Clinical Research & Osteoporosis Center, Inc.

Dr. George Helmrich, MD, MS, MBA-HC, FACOG, CCD
ISCD President
Greenville Hospital System

Jennifer Kelly, DO, FACE, CCD
Director of the Metabolic Bone Program
University Of Vermont

Lynn A. Kohlmeier, MD
Director
Endocrinology and Spokane Osteoporosis

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

This session will focus on osteoporosis screening in young postmenopausal women. Valuable contributions to this field were provided by the large prospective Women's Health Initiative (WHI) Study conducted at 40 clnical centers across the U.S.. Best evidence regarding potential pearls and pitfalls of osteoporosis risk assessment strategies for young postmenopausal women will be reviewed.

Learning Objectives:

• Discuss current osteoporosis screening guidelines for young postmenopausal women
• Recognize potential pears and pitfalls of formal osteoprosis risk assessment strategies.
• Implement a clinical "take home" approach regarding osteoporosis screening for young postmenopausal women

Carolyn J. Crandall, MD, CCD
Professor of Medicine
David Geffen School of Medicine at University of California, Los Angeles

Carey J. Field, MD
Chief of Rheumatology VAMC WRJ VT, Associate Program Director Rheumatology Fellowship Program at Dartmouth-Hitchcock Medical Center
Assistant Professor at the Geisel School of Medicine VA Medical Center, White River Junction, Vermont

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

The Least Significant Change (LSC) Principle helps us to provide relevant information to our patients. Without LSC values for the scans that are reported on, we could only report "possible" change. In serial DXA scanning LSC values allow facilities to state with confidence whether a change seen between visits is "real" verses "not statistically significant".

This session will discuss how these values are derived from Precision Studies and how they are used in clinical settings.

Learning Objectives:

• Define Least Significant Change as it applies to serial DXA scanning
• Calculate LSC values using site Precision studies and ISCD calculators for individual technologists and facilities
• Use LSC values to describe whether change between visits is considered to be "real" with 95% confidence.

Kyla Kent, BA, CBDT
Technical Director
SAMBA Lab, Stanford University School of Medicine

Dr. Christopher Cirnigliaro, PhD, CBDT
Investigator
James J. Peters VA Medical Center

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

This course will introduce pediatric DXA and the general considerations involved with bone assessment in children. Topics presented during this session will include: body sites used in children and rationale, identification of quality scans and commonly encountered challenges, scanning tips for typically developing children and those with special considerations, concerns around growing bone and serial changes, and interpretation.

Learning Objectives:

• Describe the recommended body sites & rationale for use in pediatric DXA
• Recognize proper positioning & ROI/line placement on pediatric scans
• Identify considerations for interpretation of DXA in growing bones

Heidi Kecskemethy, MS Ed, RDN, CSP, CBDT
Director of Radiology Research Operations
Nemours Children's Health

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

The purpose of this session will be to provide an overview of the methods used to develop the PVA Bone Health CPG and the appropriate drug therapy for the prevention and treatment of osteoporosis in persons with SCI.

Learning Objectives:

• Define the PVA Bone Health and Osteoporosis management methods including ES diagrams, Risk of Bias tools, and grading process for recommendations.
• Describe recommendations for the role of calcium and vitamin D intake for preventing bone loss and treating osteoporosis, including clinical considerations for the provision of dietary or supplementary forms of calcium and vitamin D.
• Identify appropriate drug therapy for prevention and treatment of osteoporosis considering therapy efficacy, duration, and fracture history.

Dr. Christopher Cirnigliaro, PhD, CBDT
Investigator
James J. Peters VA Medical Center

Anthony Scott. Burns, MD MSc
Professor of Medicine, University of Toronto
UHN - Toronto Rehabilitation Institute, Lyndhurst Centre

Cathy Craven, BA, MD, FRCPC. MSc, FASIA, FCAHS
Medical Director, Professor
University of Toronto/University Health Network

Jenny Kiratli, PhD
Director of SCI Clinical Research
Spinal Cord Injury & Disorders Center, VA Palo Alto Health Care System

ISCD DXA Atlas from ISCD on Vimeo.

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

In this session, we will focus on peripheral and axial quantitative ultrasound systems. The later one has been recently introduced to the market and showed promising results. The peripheral QUS will be discussed in the context of clinical dos and don'ts as well as in the light of ISCD position guidelines on its use. On the third part of the session, TBS practical aspect will be presented to you from an European perspective.

Learning Objectives:

• Define quantitative ultrasound and its associated technological diversities
• Explain the level of clinical useability in clinical environment
• Explain the rational of ISCD guidelines regarding pros and cons of clinical use of QUS for diagnosis, fracture prediction, screening, treatment initiation and monitoring

Didier Hans, PhD
Head of Research & Development in medical imaging
Lausanne University

Débora Meira Ramos Amorim
Fellow in Clinical Endocrinology
Universidade Federal de São Paulo - Center of Bone Diseases

Bjoern Buehring, MD, CCD
Department Head
Bergisches Rheuma-Zentrum

John J. Carey, MBBChBAO, MS, CCD, FRCPI
Physician in Rheumatology, Osteology, and Medicine / Professor in Medicine
Galway University Hospitals / University of Galway

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

FRAX has been available since 2008 and is widely used worldwide. This lecture will provide a background to FRAX, its potential and limitations, and ongoing efforts to update the FRAX tool. These updates range from taking account of less-validated risk factors (adjustments) to a full redevelopment of the FRAX risk factor calculation engine.

Learning Objectives:

• Identify basis of fracture probability compared to fracture risk
• Explain the minimum requirements for inclusion of risk factors within FRAX
• Describe the potential use of adjustments to FRAX probabilities

Eugene McCloskey, MD

University of Sheffield Metabolic Bone Centre

Kaitlyn Barrett, DO
Endocrinologist
The University of Vermont Medical Center

This session duration is 40 minutes.

Developed by Medimaps Group, TBS Osteo is an FDA and CE mark approved solution which is considered gold standard in bone micro-architecture assessment. It computes a Trabecular Bone Score (TBS), which provides useful clinical information on microarchitectural deterioration of bone tissue, thereby improving the accuracy of osteoporosis identification. Moreover, TBS has now 4 new dedicated CPT codes for US reimbursement.

Learning Objectives:

• Understand the clinical benefits of TBS
• How to use TBS in combination with BMD and FRAX in clinical practice
• How TBS can help fine-tune treatment decisions
• Learn about the reimbursement for TBS

E. Michael Lewiecki, MD, FACP, FACE, CCD
Director
New Mexico Clinical Research & Osteoporosis Center, Inc.

Andrea J. Singer, MD, FACP CCD
Director of Women’s Primary Care, Director of the Bone Densitometry Program, and Medical Director of the Fracture Liaison Service
MedStar Georgetown University Hospital in Washington, DC

Didier Hans, PhD
Head of Research & Development in medical imaging
Lausanne University

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 55 minutes.

Review several non-BMD approaches to assess skeletal fragility and fracture risk.

Learning Objectives:

• Identify the determinants of bone strength adn what can be measured by non-invasive imaging
• Define the current state of the use opportunistic CT, including Ct-based finite element analysis of bone strength, to identify individuals at high risk for fracture
• Identify the potentiuse of REMS ultrasound technology to identify individuals with low BMD

Mary L. Bouxsein, PhD
Associate Professor
Harvard Medical School

Karen L. Troy, PhD, CBDT
Professor
WORCESTER POLYTECHNIC INSTITUTE

This roundtable discussion duration is 30 minutes.
This roundtable discussion is designed to offer attendees the opportunity to connect directly with Industry Professionals to ask manufacturer-specific questions and learn more about the latest trends including body composition for athletic performance and disease states, TBS and more.

Thomas L. Kelly, PhD
Senior Principal Scientist
Hologic, Inc.

Matt Heinrich
Account Executive
Hologic, Inc.

Joe Joyce
Human Performance Specialist - West
Hologic, Inc.

Susan van der Kamp, RGN CDT
Clinical nurse Clinical Nurse Specialist
Consultant

This roundtable discussion duration is 30 minutes.

This roundtable discussion is designed to offer attendees the opportunity to connect directly with Industry Professionals to ask manufacturer-specific questions and learn more about the latest trends including neck-to-knee scans for body composition, TBS and more.

Claudio Mejia
Global General Manager
GE Healthcare

Mario Lois
Global Head & Sr. Director of A.I. for Women’s Health
GE Healthcare

Paul Markwardt
Engineering Manager Bone and Metabolic Health
GE Healthcare

Diane Krueger, BS, CBDT
Researcher
Osteoporosis Clinical Research Program - University of Wisconsin, Madison

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

DXA technology has expanded and progressed considerably. Numerous images, biometric data and algorithms are stored on these machines in specific formats, tables and linked pathways. This information used to generate clinical assessments for individuals is also a rich repository with great potential for clinical research. Understanding the data including how to save, clean, export and merge them is essential for robust clinical research.

Learning Objectives:

• Identify DXA data type and format
• Discuss databases in clinical practice and research
• Implement DXA data processing and potential for research

John J. Carey, MBBChBAO, MS, CCD, FRCPI
Physician in Rheumatology, Osteology, and Medicine / Professor in Medicine
Galway University Hospitals / University of Galway

John T. Schousboe, MD, PhD, CCD
Director, Park Nicollet Bone Densitometry Center; Consultant Rheumatologist, Park Nicollet Clinic; Research Investigator, HealthPartners Institute
Park Nicollet Clinic

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

Medical knowledge pertaining to pediatric bone health has significantly grown over the past decade. This session briefly reviews the evolution of ISCD position statements related to the clinical use of densitometry in children at risk for skeletal fragility. Clinical scenarios focusing on malnutrition, steroid use, hormone deficiencies, chronic inflammation, and immobility will provide practical examples where DXA can aid in the diagnosis and management of children.

Learning Objectives:

• Recognize key modifiable risk factors affecting pediatric bone health
• Identify which DXA sites provide the most clinically relevant information based on the child's clinical presentation
• Discuss the strengths and limitations of DXA imaging in monitoring the growing child with skeletal fragility

Halley Wasserman, MD, MS, CCD
Assistant Professor of Pediatric Endocrinology
Cincinnati Children's Hospital Medical Center

Jennifer L. Miller, MD, CCD
Assistant Professor of Pediatrics, Attending Physician, Pediatric Endocrinology
Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University

Exhibit Hall

Poster Gallery

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 55 minutes.

We studied changes in body composition using different imaging techniques including magnetic resonance imaging (MRI) and dual-energy x-ray absorptiometry (DXA) as well as anthropometrics. The use of DXA to assess adiposity provides the most accurate and feasible tool to assess body composition and established cut-offs to several health status outcomes after SCI.

Learning Objectives:

• List the major health problems and the link to body composition adaptations after SCI.
• Identify the use of DXA to establish cut-offs of measuring visceral adiposity in persons with SCI.
• Define the relationships between DXA-%Fat mas and several of health outcomes including circulating testosterone, inflammation, and mitochondria health in persons with SCI

Ashraf Gorgey, PhD
Director of Spinal Cord Injury Research
Hunter Holmes McGuire VA Medical Center

Dr. Christopher Cirnigliaro, PhD, CBDT
Investigator
James J. Peters VA Medical Center

Welcome Day 2

Join Dr. Kelly as she provides an overview of the day's sessions.

Challenges in 2022 Osteoporosis Care

Session approved for 1 ASRT Category A Credit

This session duration is 55 minutes.

Learning Objectives:

• Identify challenges for Quality Densitometry
• Describe osteoporosis burden and DXA use
• Identify opportunities for Quality Densitometry

Angela M. Cheung, MD, PhD, FRCPC
ISCD Canadian Panel Chair
University of Toronto, CANADA

Wing P. Chan, MD
ISCD Asia Pacific Panel chair, Scientific Advisory Council chair, BOD member
Wan Fang Hospital, Taipei Medical University

Hao Xu, MD
ISCD China Panel
The First Affiliated Hospital of Jinan University Department of Nuclear Medicine

Henrique P. Arantes, CCD
ISCD Latin America Panel
IMEPAC ARAGUARI

Karen Hind, PhD
ISCD UK-Ire Panel, Associate Professor
Durham University

Carmen Gabriela Barbu, MD,PhD,CCD
Associate Professor of Endocrinology
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Jyoti Bhattarai, MD
Consultant Endocrinologist
Metro Kathmandu Hospital

Jennifer Kelly, DO, FACE, CCD
Director of the Metabolic Bone Program
University Of Vermont

This session duration is 30 minutes.

Join us for discussion regarding DXA performance. Bring your questions and cases regarding DXA acquisition and analysis. This informal session is designed to address issues that occur in DXA practice.

Diane Krueger, BS, CBDT
Researcher
Osteoporosis Clinical Research Program - University of Wisconsin, Madison

Susan van der Kamp, RGN CDT
Clinical nurse Clinical Nurse Specialist
Consultant

This session duration is 30 minutes.

This session will allow the audience to discuss challenging questions in metabolic bone diseases with a panel of experts.

Learning Objectives:

• Discuss challenging questions in metabolic bone diseases
• Review conundrums in musculoskeletal health
• Evaluate bone and calcium metabolism clinical cases

Robert Wermers, Doctor
Consultant and Chair Division of Endocrinology, Diabetes, Metabolism and Nutrition
Mayo Clinic, Rochester, Minnesota U.S.A.

Jad G. Sfeir, MD, MS
Assistant Professor of Medicine
Mayo Clinic

Exhibit Hall

Poster Gallery

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

To deliver the recent consensus of BTM in clinical practice. To share the clinical experience of BTMs along with different osteoporotic medications in both primary and secondary fracture prevention. To highlight the situation of BTMs in Asia-Pacific regions.

Learning Objectives:

• Recall the recommended BTMs in clinical practice.
• Explain the usage and limitations of BTM in clinical practice.
• Choose appropriate BTMs for different osteoporotic medication

Jad G. Sfeir, MD, MS
Assistant Professor of Medicine
Mayo Clinic

Chih-Hsing Wu, MD
Institute of Gerontology, College of Medicine
National Cheng-Kung University

Paul Miller, MD, HDSc (honorary)
Medical Director
Colorado Center for Bone Health/Miller Bone Center

View Exhibit Hall

Live Video Chat with GE

Session approved for 1 ASRT Category A Credit

Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

Primary hyperparathyroidism is a common endocrine disorder and a common secondary cause of osteoporosis. Patients with mild, asymptomatic disease may have reductions in both cortical and trabecular bone. Fracture risk is elevated, particularly risk for vertebral fractures. In this session, we will explore bone loss in primary hyperparathyroidism and discuss medical and surgical management of the disease.

Learning Objectives:

• Describe the bone loss that occurs in patients with primary hyperparathyroidism.
• Identify patients with primary hyperparathyroidism who meet guideline recommendations for parathyroid surgery.
• Develop a medical management plan for patients with primary hyperparathyroidism and bone disease.

Natalie Cusano, MD, MS, CCD
Director, Bone Metabolism Program
Lenox Hill/Northwell Health

Rachel Pessah-Pollack, MD, FACE
Clinical Professor
NYU Langone Hospitals

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 55 minutes.

Learning Objectives:

• Identify the fragility nature of periprosthetic fracture
• Improve fractures through bone health optimization
• Explain the consequences of Periprosthetic Fracture

Paul A. Anderson, MD, MS
Emeritus Professor of Orthopedics
University of Wisconsin

Dato' Dr. Joon-Kiong Lee, DSPN, DJN MBBS, FRCS, MS ORTHO, AM, CCD
Deputy Medical Director and Consultant Orthopedic Surgeon
Beacon Hospital

View Exhibit Hall

Live Video Chat with ClickView

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 60 minutes.

Best Research Abstract 
Long-term Effect of Denosumab on Bone Microarchitecture as Assessed by Tissue Thickness-Adjusted Trabecular Bone Score (TBS) in Postmenopausal Women with Osteoporosis: Results from the Freedom and Open-Label Extension (OLE)

Primary Author:  Didier Hans, PhD – Head of Research & Development in medical imaging, Lausanne University

Introduction: TBS is an indirect measure of bone microarchitecture assessed on lumbar spine (LS) DXA scans and provides information beyond bone mineral density (BMD). TBS algorithm has been updated to account for regional soft tissue noise in DXA images.

Objectives: This retrospective analysis applied updated built-in tissue thickness–adjusted TBS algorithm to investigate the long-term effect of denosumab on bone microarchitecture in FREEDOM and OLE.

Methods: This analysis included 279 postmenopausal women with LS or total hip BMD T-score <−2.5 and ≥−4.0 who completed the FREEDOM DXA substudy and continued in the OLE study: 150 women received denosumab 60 mg subcutaneously every 6 months for 3 years and same-dose open-label denosumab for 7 years (long-term denosumab group); 129 women received placebo for 3 years and open-label denosumab for 7 years (crossover denosumab group). BMD and TBS were assessed on LS DXA scans, blinded from treatment allocation, at FREEDOM: baseline, Month 1, and Years 1, 2, and 3; and at OLE: baseline, Years 1, 2, 3, 5, and 7.

Results: Baseline characteristics were similar between groups. Long-term denosumab led to significant and progressive increases in TBS over 10 years of treatment (Figure). A similar trend was observed in the crossover group during 7 years of denosumab therapy. In the long-term denosumab group, % of patients with normal microarchitecture (TBS >1.074) increased from 26.1% at baseline to 53.2% up to Year 10, and % of patients with degraded (TBS ≤1.027) or partially degraded (1.027< TBS≤1.074) microarchitecture decreased from 48.6% to 29.1% and from 25.4% to 17.7%, respectively (P < 0.0001; TBS thresholds equivalent to 1.230 and 1.310 for the classical TBS algorithm corrected for body mass index). A similar improvement in bone microarchitecture was observed in the crossover group from OLE baseline up to OLE Year 7 (P < 0.0001). Over the course of long-term denosumab treatment, TBS changes were largely unrelated to LS BMD changes: r2 was 0.05 from baseline to Year 10 in the long-term group and 0.28 from OLE baseline to OLE Year 7 in the crossover group.

Conclusions: Up to 10 years of denosumab treatment significantly and progressively improved TBS assessment of bone microarchitecture independently of BMD in postmenopausal women with osteoporosis.

Best Technology Applications Abstract 
Soft Tissue Standardization Improves Humerus Tissue Thickness Precision and Lowers BMD in Total Shoulder Arthroplasty Patients

Primary Author:  Lucas Andersen, BS – Clinical Research Coordinator, University of Wisconsin

Introduction: DXA technology requires soft tissue attenuation measurement. This sampling is confined within a standard soft tissue region of interest (ROI) defined by the blue squares on Figure 1, which is automatically placed and used to compare with radiation absorption over bone. Variable placement of the soft tissue ROI likely alters BMD measurement and reproducibility. The aim of this study was to measure humeral BMD in total shoulder arthroplasty (TSA) patients. As no shoulder feature is available in GE Lunar enCORE v18, hip atypical femur fracture (AFF) software was utilized. In preliminary evaluation, we observed that soft tissue ROI placement and amount of tissue sampled were inconsistent (Figure 2).

Objectives: We hypothesized that use of a consistent soft tissue ROI would change BMD and improve precision. The purpose of this analysis was to compare humerus BMD and precision prior to and following soft tissue ROI standardization.

Methods: After manufacturer consultation, all scans were reanalyzed using a soft tissue ROI of a fixed size (100 pixels tall, 50 pixels wide) manually placed on every scan distal and lateral to the humeral head (Figure 3). This study of TSA patients, 1-5 years post-surgery, included full humerus scans obtained on a GE Lunar iDXA with v17 or v18 software and analyzed with v18. Each participant had bilateral shoulder scans performed twice to assess precision and humerus BMD was measured at custom ROIs. BMD and tissue thickness obtained with automated and manual approaches were compared using T-test. Precision was determined using the ISCD calculator and compared between methods with F-test.

Results: Thirty subjects were included (20M/10F) with mean age and years post-surgery of 70.6 and 2.7 respectively. Average tissue thickness was reduced 13.5% (p < 0.01) with manual tissue sampling. Mean BMD among the nine custom ROIs was 2.2-8.5% lower (p < 0.01) with manual tissue sampling (Table 1). Additionally, tissue thickness %CV improved (p < 0.01) from 47.6 to 14.8% and 25.9 to 9.6%. Similarly, BMD precision improved (p < 0.01) at the 1/3 humerus and distal implant ROIs on the TSA side (Table 2).

Conclusions: When measuring skeletal sites without optimized software available, it is necessary to critically evaluate software performance. In this study, soft tissue ROI standardization markedly improved tissue thickness sampling and reduced BMD at custom humerus ROIs. Optimization and automation of humerus DXA software would likely further improve BMD precision and measurement.

Best Clinical Abstract 
Novel Body Composition Approaches with DXA: Comparison with Classical Total Body Scans

Primary Author:  Diane Krueger, CBDT, BS – Researcher, University of Wisconsin

Introduction: Traditionally, total body (TB) DXA scans to assess body composition include the entire body, however novel abbreviated scan acquisition methods are available in new software. For example, total body less head (TBLH) is recommended given the head contains lean mass that cannot be altered by intervention. Recently, to reduce scan time and radiation exposure, a neck to knee (N-K) acquisition option is available. Finally, scans limited to the lower extremity might be useful to evaluate regional mass change after surgery/injury and in sarcopenia assessment.

Objectives: The purpose of this study was to evaluate comparability of measured and estimated body composition results using TBLH, N-K and lower extremity (LE; pelvis to toes) acquisition techniques. We hypothesized that body composition data with the 3 novel methods would not differ from the traditional TB method.

Methods: Each subject had 4 scans: TB, TBLH, N-K and LE. A subset of 30 had repeat N-K and LE scans with repositioning between. A Lunar iDXA (GE, Madison, WI) with enCORE v18.0 was used to acquire and analyze scans. TB scans were acquired per ISCD guidance. TBLH and N-K scans were acquired using automated software features that limited the anatomy scanned; N-K estimates non-scanned leg mass. LE scans were started at L3 and auto stopped past the toes. Automated analysis, with manual correction, was used for all but LE scans which were analyzed manually by compressing all upper body ROIs above the pelvis then placing lower body ROIs at the top of pelvis, bisecting the femur neck and separating the legs. Pearson Correlation and Bias plots were used to compare regional lean, fat and BMC measurements from the 3 novel scans to TB. Precision determined by the ISCD Precision Calculator was compared to TB historical control by F-test.

Results: The study sample included 82 subjects, 41F/41M mean (SD) age 51.0 (18.4) years and BMI 25.5 (3.7) kg/m2. Mean lean, fat and bone mass were very similar among all approaches with some statistical, but likely not clinical, differences (Tables 1&3). Composition from all regions with the 3 novel methods was highly correlated with TB measurement, r=0.99-1.0, p< 0.001 with mean bias of 14-237g lean, 7-121g fat and 0.3-13.3g BMC (Table 2). N-K and LE precision was excellent ranging from 0.45-2.31 %CV (Table 3).

Conclusions: These 3 novel approaches to either measure or estimate regional body composition are consistent with traditional TB measurement and may be considered as substitutes when appropriate.

Young Investigator Abstract
Dual X-Ray Absorptiometry Scan Procedural Variants in the Transgender Population

Primary Author:  Quinnlyn Walcott, BS – Medical Student, University of Kansas School of Medicine
Speaker:  Johnathan Dallman, BS – Medical Student, University of Kansas School of Medicine

Introduction: Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons must initially receive a diagnosis of gender incongruence, previously known as gender dysphoria [1], in order to begin the management of their incongruence with the help of medical interventions such as surgical procedures, and/or hormone replacement therapy (HRT). Despite the expanding use of hormone replacement therapies, the long-term outcomes of HRT on bone health and metabolism, are still relatively unknown. To explore HRT’s effects on bone health via measuring bone mineral density, dual-energy x-ray absorptiometry, or DXA, scan has been labeled the gold standard [2]. By using bone densitometry, health care providers are able monitor bone health over time, as well as provide a diagnosis of osteoporosis by using T- and Z-scores.
1. Moser, C., ICD-11 and Gender Incongruence: Language is Important. Arch Sex Behav, 2017. 46: p. 2515–2516.
2. Punda, M. and S. Grazio, [Bone densitometry--the gold standard for diagnosis of osteoporosis]. Reumatizam, 2014. 61(2): p. 70-4.

Objectives: This study’s purpose was to analyze what sex and gender was used to calculate T-score and Z-score for individuals who identify as TGNC in the authors’ hospital system.

Methods: A retrospective chart review was utilized to determine how DXA technicians and physicians are recording, scoring, and reading DXA scans for the TGNC population. The qualitative data was determined as "correct" or "incorrect" based on positions provided from the International Society of Clinical Densitometry (ISCD).

Results: 13 DXA scans results were obtained between 11 transgender and gender non-conforming patients. In total, 24 T-scores and Z-scores of the 13 DXA were reviewed and scored. Based off ISCD positions, 58% of the T-score and Z-scores were calculated incorrectly.

Conclusions: Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. This was seen in our present study evaluating standards for bone densitometry in the TGNC population at TUKHS. Ultimately, access to appropriate training regarding gender identity and future research looking to determine HRT’s effects on BMD in the TGNC population in the United States is needed to help correct this healthcare disparity.

Quinnlyn Walcott, BS
Medical Student
University of Kansas School of Medicine

Johnathan Dallman, BS
Medical Student
University of Kansas School of Medicine

Didier Hans, PhD
Head of Research & Development in medical imaging
Lausanne University

Diane Krueger, BS, CBDT
Researcher
Osteoporosis Clinical Research Program - University of Wisconsin, Madison

Lucas Andersen, BS
Clinical Research Coordinator
University of Wisconsin

Jennifer Kelly, DO, FACE, CCD
Director of the Metabolic Bone Program
University Of Vermont

This Product Theater duration is 40 minutes.

As the only enzyme replacement therapy for people with perinatal/infantile-onset and juvenile-onset hypophosphatasia (HPP), STRENSIQ is an at-home prescription medication that provides: Skeletal healing and mobility.

Upon completion, participants will be able to understand 

• more about the clinical manifestations of Hypophosphatasia.
• the impact of bone mineral density in patients with Hypophosphatasia.
• more about enzyme replacement therapy

Eric T. Rush, MD, FAAP
Clinical Geneticist, Associate Professor
Children’s Mercy Kansas City, University of Missouri - Kansas City School of Medicine

Susan Starling Hughes, MS, CGC
Certified Genetic Counselor
Children’s Mercy Kansas City

Suzanne Lee, BS
Thought Leader Liaison
Alexion Pharmaceuticals

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 55 minutes.

Learning Objectives:

• Discuss different treatment options
• Discuss the desired outcomes of treatment
• Identify factors that affect combination and sequence of treatments

Nelson B. Watts, MD, FACP, MACE, FASBMR, CCD
Director of Osteoporosis and Bone Health Services
Mercy Health, Cincinnati OH

Jennifer Kelly, DO, FACE, CCD
Director of the Metabolic Bone Program
University Of Vermont

Exhibit Hall

Poster Gallery

This session duration is 55 minutes.

Anita Colquhoun, RTNM, MRT(N), CDT
Charge Technologist
Women's College Hospital

Wing P. Chan, MD
ISCD Asia Pacific Panel chair, Scientific Advisory Council chair, BOD member
Wan Fang Hospital, Taipei Medical University

Bruno Muzzi. Camargos, PhD
Densitometry Coordinator
Rede Mater Dei de Saúde

Heidi Kecskemethy, MS Ed, RDN, CSP, CBDT
Director of Radiology Research Operations
Nemours Children's Health

Pauline Camacho, MD
Professor of Medicine
Loyola University Medical Center

John T. Schousboe, MD, PhD, CCD
Director, Park Nicollet Bone Densitometry Center; Consultant Rheumatologist, Park Nicollet Clinic; Research Investigator, HealthPartners Institute
Park Nicollet Clinic

Lawrence Jankowski, CBDT
Chief DXA Technologist/Research Coordinator
Illinois Bone and Joint Institute, LLC

John J. Carey, MBBChBAO, MS, CCD, FRCPI
Physician in Rheumatology, Osteology, and Medicine / Professor in Medicine
Galway University Hospitals / University of Galway

Exhibit Hall

Poster Gallery

This session duration is 20 minutes.

ISCD will hold its Position Development Conference (PDC) at the ISCD 2023 Annual Meeting. The PDC works to advance the field of skeletal assessment by developing Position Statements on important topics in skeletal assessment through a rigorous, validated method. 

Dr. Shuhart will share the topics that were selected from the submissions of our ISCD members. The topics and issues addressed at the Conference can help advance the field of skeletal assessment for our membership and the bone health community. 

Christopher R. Shuhart, MD, MHA, CCD
Medical Director
Swedish Bone Health and Osteoporosis

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

This session will provide a shallow dive into deep learning and artificial intelligence. It will provide a brief overview of the key principles involved in machine learning. These principles will be used to illustrate potentials and pitfalls of applying vertebral fracture assessment (VFA) for automated detection of vertebral fracture and automated scoring of abdominal aortic calcification.

Learning Objectives:

• Define deep learning
• Recall general principles of machine learning
• Identify potentials and pitfalls of using vertebral fracture assessment (VFA) for vertebral fracture and abdominal aortic calcification.

William D. Leslie, MD MSc FRCPC CCD
Professor of Medicine and Radiology
University of Manitoba, Winnipeg, Canada

John T. Schousboe, MD, PhD, CCD
Director, Park Nicollet Bone Densitometry Center; Consultant Rheumatologist, Park Nicollet Clinic; Research Investigator, HealthPartners Institute
Park Nicollet Clinic

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

The Bone health and Exercise Science lab led 7 systematic reviews and a Cochrane review on exercise for individuals at risk of fractures that informed new Osteoporosis Canada guidelines. We led a consensus process on the non-pharmacological management of osteoporotic vertebral fractures. We lead exercise clinical trials, and implementation science initiatives, to mobilize our research findings so that they can be used by patients and healthcare professionals.

Learning Objectives:

• Identify the findings of the seven recent systematic reviews on exercise for individuals at risk of fractures that will be used to inform forthcoming Osteoporosis Canada guidelines;
• Recognize insights on what we know (and what we don’t) about non-pharmacological management of osteoporotic vertebral fractures;
• Explain practical tips for applying exercise science to prevention of falls, fractures and frailty.

Lora Giangregorio, PhD
Professor and Schlegel Research Chair in Mobility and Aging, Dept of Kinesiology and Health Sciences
University of Waterloo

Dr. Christopher Cirnigliaro, PhD, CBDT
Investigator
James J. Peters VA Medical Center

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

Transgender and gender diverse people may take gender affirming hormone therapy to affirm their gender identity and to improve quality of life and well-being. Very little is known about the impact of gender affirming hormone therapy on skeletal health in this population. Will discuss screening for low bone mass in this population prior to and after receipt of gender affirming hormone therapy and the available data on gender affirming hormone therapy on skeletal health.

Learning Objectives:

• Define transgender identity and the prevalence of transgender identity
• Identify reasons to perform bone densitometry screening in transgender and gender diverse people
• Describe risk factors for low bone density in transgender and gender diverse people

Vin Tangpricha, MD, PhD
Professor of Medicine, Eminent Physician
Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine

Rachel Hopkins, MD
Associate Professor of Medicine
Division if Endocrinology, State University of New York Upstate Medical University

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

This session will briefly review evidence supporting opportunistic use of existing abdominal and chest CT scans to evaluate patients bone status. How to perform this clinically will be demonstrated and practical considerations of potential confounders of this approach will be discussed. Additionally, the potential for opportunistic CT to evaluate sarcopenia will be considered.

Learning Objectives:

• Recognize how opportunistic evaluation of CT and MRI can be useful in clinical practice
• Perform opportunistic Hounsfield Unit measurement from chest/abdominal CT
• Discuss the possibility that opportunistic CT may assess sarcopenia

Neil Binkley, MD, CCD
Professor of Medicine
University of Wisconsin-Madison

Leon Lenchik, MD
Professor
Wake Forest School of Medicine

Our 2022 Virtual Annual Business Meeting will be held via Zoom and will feature from the Society and recognize our 2022 ISCD Award recipients as well as our Abstract Award recipients. Please join us to hear the officers' report and Yanling Zhao, MD, CCD give her Presidential Address. 

If you are unable to attend the Annual Business Meeting and have not already done so, we ask that you complete the proxy form by clicking here and authorizing the current president to vote on your behalf so we may obtain a quorum at the meeting.

Register to Attend    Assign Proxy 

Welcome Day 3

Join Dr. Rachel Pessah-Pollack, MD, FACE, Vice-Chair ISCD 2022 Annual Meeting Planning Committee when she presents the day's highlights.

Challenges in 2022 Osteoporosis Care

Session approved for 1.5 ASRT Category A Credit

This session duration is 80 minutes.

Learning Objectives:

• Discuss the impact of COVID Pandemic on Osteoporosis
• Describe the challenges for osteoporosis care during the COVID Pandemic
• Recognize the limitations of Osteoporosis treatment during a global pandemic

Angela M. Cheung, MD, PhD, FRCPC, ISCD Canadian Panel Chair

Wing P. Chan, MD, ISCD Asia Pacific Panel chair, Scientific Advisory Council chair, BOD member

Hao Xu, MD, ISCD China Panel

Carmen Gabriela Barbu, MD,PhD,CCD, Associate Professor of Endocrinology

Henrique P. Arantes, CCD, ISCD Latin America Panel

Robert Wermers, Doctor, Consultant and Chair Division of Endocrinology, Diabetes, Metabolism and Nutrition

Susan van der Kamp, RGN CDT, Clinical nurse Clinical Nurse Specialist

Rachel Pessah-Pollack, MD, FACE, Clinical Professor

This session duration is 40 minutes.

Tom Hagan, RPh, MBA, National Sales Manager

David K. Martinez, Chief Operating Officer and Founder

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

Supportive data will include review of critical factors affecting imminent risk of fracture, the relationship between bone density after osteoporosis treatment and subsequent risk of fracture, the probability of attaining bone density targets with different medications and the importance of treatment sequence.

Learning Objectives:

• Discuss the rationale for considering osteoporosis treatment targets for patients at different levels of risk and how the clinical implementation of goal directed therapy affects therapeutic decision-making.
• Identify the factors associated with very high risk of fracture, including high imminent risk, and the importance of choosing therapy that rapidly reduces that risk.
• Recognize the relationship between bone density achieved after osteoporosis treatment and the subsequent risk of fracture, and the probability of attaining bone density targets with different medications and treatment sequences.

Felicia Cosman, MD, Professor of Medicine at Columbia University College of Physicians and Surgeons

Rachel Pessah-Pollack, MD, FACE, Clinical Professor

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

Topics to be covered include pre-screening, transferring onto and off of the scan table, positioning and scan acquisition, and analysis. The presentation will review the current state of the field regarding BMD of the knee as this is the most common fracture site for individuals with SCI and will reference the recent ISCD Position on BMD after SCI as well as two upcoming clinical practice guidelines for bone health and fracture management in this population.

Learning Objectives:

• Explain specific barriers and limitations related to performing DXA studies with individuals with SCI.
• Discuss considerations for acquiring BMD of the knee in individuals with SCI.
• Create a plan for conducting DXA studies with individuals with SCI.

Jenny Kiratli, PhD, Director of SCI Clinical Research

Dr. Christopher Cirnigliaro, PhD, CBDT, Investigator

Challenges in 2022 Osteoporosis Care

Session approved for 1.5 ASRT Category A Credit

Session approved for up to 1.25 AMA PRA Category 1 Credits™

This session duration is 75 minutes.

Review key papers from the 2021 issues of the JCD-their strength and limitations.

Learning Objectives:

• Discuss the top 5 JCD articles for physicians and their application in both the clinical and research setting.
• Discuss how the top 5 JCD articles for technologists can be used to improve technologists' skills when obtaining musculoskeletal measurements across a variety of populations.
• Discuss audience recommendations for the inclusion of articles addressing new topics in future editions of JCD.

Close the 2022 Annual Meeting

Paul Miller, MD, HDSc (honorary), Medical Director

Dr. Christopher Cirnigliaro, PhD, CBDT, Investigator

Jennifer Kelly, DO, FACE, CCD, Director of the Metabolic Bone Program