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Learning Center

Application of Least Significant Change Principles to Determine Change in BMD

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Activity approved for 1.0 ASRT Category A Credits
Activity approved for up to 1.0 AMA PRA Category 1 Credits™
Activity Expires July 31, 2023

The Least Significant Change (LSC) Principle helps us to provide relevant information to our patients. Without LSC values for the scans that are reported, we could only report "possible" changes. In serial DXA scanning, LSC values allow facilities to state with confidence whether a change seen between visits is "real" versus "not statistically significant". This session will discuss how these values are derived from Precision Studies and how they are used in clinical settings.

Session Objectives:

  1. The attendee should understand the rationale for using  a precision assessment to decide on the LSC
  2. The attendee should understand how to perform the precision assessment,
  3. The attendee should understand how to use the data generated in order to calculate the LSC
  4. Define Least Significant Change as it applies to serial DXA scanning
  5. Calculate LSC values using site Precision studies and ISCD calculators for individual technologists and facilities
  6. Use LSC values to describe whether change between visits is considered to be "real" with 95% confidence.

Instructions: Clinicians and Technologists are required to answer a set of online test questions following the review of the video and will have up to three attempts to answer questions correctly before losing credit for the activity. Once the activity test has been passed (75% or higher), you will be asked to evaluate the activity online and then be allowed to claim credit and print certificates.

Kyla Kent, BS

Technical Manager for SAMBA Center at Stanford

Stanford Medicine

Kyla Kent, BA, CBDT, Technical Director of the SAMBA (Stanford Assessments of Muscle and Bone across the Ages) Lab, has been with Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care system since 1991 in the Stanford Prevention Research Center, the Musculo-Skeletal Research Lab and most recently the SAMBA Lab. Responsibilities include development and technical assessment of research protocols, clinical facility management, supervisor for clinical staff, performance of DXA, HRpQCT, Biodex and other measures related to research conducted in the areas of bone metabolism, structural assessment, body composition, exercise, sleep and healthy aging. Ms. Kent is a consultant in study design and instructor in bone density related imaging modalities for the Stanford Children’s Hospital, Palo Alto VA Hospital and Stanford Hospital/Stanford School of Medicine and internationally for bone mass measurement technique and analysis in growing skeletons. Currently acting in the position of Technical Director for the SAMBA Lab and as consultant developing a program for Quality DXA across all of Stanford’s clinical networks. Ms. Kent is an active member of the International Society for Clinical Densitometry (ISCD. She also has acted as the Director, clinical instructor and lecturer for a State certified training program for DXA.

Disclosures: No relationships to disclose.

Dr. Christopher Cirnigliaro, PhD (Moderator)

Investigator

James J. Peters VA Medical Center

Dr. Christopher M. Cirnigliaro, is the research laboratory manager and Investigator for the Veterans Affairs Rehabilitation, Research, and Development National Center for the Medical Consequences of Spinal Cord Injury located at the James J. Peters VA Medical Center. He is a clinical exercise physiologist and certified bone densitometry technician, with expertise in DXA analysis. His research investigates the prevention and reversal of bone and muscle loss after SCI, including clinical trials of bisphosphonates and denosumab, and extensive cross-sectional documentation of body composition changes following SCI. Dr. Cirnigliaro was also a member of the ISCD task force to develop the bone density testing guidelines in persons with SCI and is currently a member of the committee assigned to write the Clinical Practice Guideline entitled “Bone Health and Osteoporosis Management in Individuals with Spinal Cord Injury” that is sponsored by the Paralyzed Veterans of America.

Disclosures: No relationships to disclose.

Course Planners and Managers

Harold Rosen, MD, CCD No Financial Relationships to Disclose

Wendy Tolman-Andrews, CBDT No Financial Relationships to Disclose

Peter Brown, MS No Financial Relationships to Disclose

Jesse Palmer No Financial Relationships to Disclose

Course Content Reviewers

S. Kumar, MD, CCD No Financial Relationships to Disclose

Course Faculty and Content Authors

Kyla Kent, CBDT No Financial Relationships to Disclose

Chris Cirnigliaro, CBDT, PhD No Financial Relationships to Disclose

ACCME Accreditation Statement:
The International Society for Clinical Densitometry is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to offer continuing medical education for physicians. This activity is provided by the International Society for Clinical Densitometry. For information about the accreditation of this program, please contact ISCD at +1.860.259.1000 or inquire at education@iscd.org.

AMA PRA Category 1 Credit(s)™ The International Society for Clinical Densitometry designates this enduring educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credits commensurate with the extent of their participation in the activity.

ASRT Credit Designation: This activity is approved by ASRT for 1.0 Category A continuing education credits.

Date of Original Release and most recent Review or Update: This activity was most recently reviewed and released on July 11, 2023, and will expire on July 31, 2023.

Statement of Independence The ISCD maintains a policy on the use of commercial support, which ensures that all educational activities sponsored by the ISCD provide in-depth presentations that are fair, balanced, independent, and scientifically rigorous. ISCD requires faculty, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by ISCD for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. Individual disclosures are included in course material. No Commercial Support has been provided for this activity

Disclaimer  The information and suggestions presented at the courses, seminars and other programs sponsored by ISCD and other collaborating societies are subject to change and therefore should serve only as a foundation for further investigation and study. Any forms presented at our seminars or programs are samples only and are not necessarily authoritative. All information, procedures, and forms contained or used in such seminars or programs should serve only as a guide for use in specific situations.

Disclosure of Unlabeled Use  This educational activity may contain a discussion of published and/or investigational uses of agents that are not indicated by the FDA. ISCD does not recommend the use of any agent outside of the labeled indications. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

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