Position StatementOfficial Positions of the International Society for Clinical Densitometry and Executive Summary of the 2007 ISCD Position Development Conference
Introduction
The International Society for Clinical Densitometry (ISCD) is a multidisciplinary non-profit professional organization dedicated to enhancing knowledge of bone densitometry and its application to skeletal health. ISCD accomplishes this mission through educational venues (scientific meetings, courses, and publications), certification programs, and recommendations for the use of bone densitometry: the ISCD Official Positions. New Official Positions are considered biannually according to the PDC format. Previously established Official Positions are also re-evaluated periodically at the Position Development Conferences (PDC), as required by new developments in this field. The Official Positions are widely utilized by clinicians and technologists as a reference for quality control, acquisition, analysis, interpretation, and reporting. They form the basis for much of the material taught in the ISCD Bone Densitometry Courses.
Official Positions resulting from prior PDCs held biannually from 2001–2005 have previously been reported 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. Most recently PDCs were held in Montreal, Quebec, Canada (Pediatric PDC), on June 20–21, 2007, and in Lansdowne, Virginia, USA (Adult PDC), on July 20–22, 2007. This report describes the methodology and results of the 2007 Lansdowne, Virginia PDC and contains a summary of all ISCD Official Positions.
The Official Positions resulting from the PDC are established in order to enhance quality and clinical utility of bone densitometry worldwide. They provide clinicians, technologists and researchers with a reference standard for skeletal health assessment. Since the field of bone densitometry is new and evolving, some clinically important issues that are addressed at the PDCs are not associated with robust medical evidence. Accordingly some Official Positions are based largely on expert opinion. Despite limitations inherent in any process such as this, ISCD believes it is essential to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry, and provide an important focus for the scientific community to consider further research to resolve areas of ambiguity and/or ongoing controversy.
The ISCD wishes to acknowledge the extraordinary efforts of the PDC Task Force Chairpersons and members, who are a most distinguished group of international experts. The dedication of these individuals for the past 2 yr has been exemplary.
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Topic Selection
Topics addressed at the 2007 PDC were selected by the ISCD Board of Directors (BOD) and Scientific Advisory Committee (SAC) according to criteria used for prior PDCs 1, 2, 14. Each topic selected must be judged to be clinically relevant, have a perceived need for an Official Position due to lack of overwhelming medical evidence or due to its controversial nature, and have a reasonable likelihood of achieving a consensus by the Expert Panel. Many potential topics were considered before
PDC Planning
The PDC Steering Committee oversaw the planning for, and conduct of the 2007 PDC. The Steering Committee consisted of the ISCD President-elect (SB), who served as Chair. Other members of the Steering Committee consisted of the President and Past-presidents of ISCD, and a prior PDC Task Force chair. The Steering Committee identified an ISCD member to serve as Task Force chair for each topic area. Task Force members were selected from the SAC and non-SAC experts in bone densitometry and other
PDC Expert Panel
Concurrent with Task Force work, international experts in the field of bone densitometry and societies specific to skeletal health were contacted by the PDC Steering Committee to serve as member panelists. Twelve experts agreed to participate on the PDC Expert Panel. In addition to individuals representing many regions of the world, official representatives from The American Society for Bone and Mineral Research (ASBMR), International Society for Bone and Mineral Research (IBMS), and the
PDC Moderators
PDC panel Moderators with experience in the RAND/UCLA Appropriateness Method (RAM) were selected by the Steering Committee. Two Moderators (JB and SS) assisted the Chair of the PDC (SB) in the development and refinement of statements derived from the initial Task Forces questions and sub-questions, and with the Chair of the PDC lead the discussion and the rating by the Expert Panel during the PDC in Lansdowne, Virginia, USA, July 20–22, 2007.
Grading of the Official Positions
All Official Positions for the 2007 PDC were rated by the Expert Panel in the following categories:
- 1.
Appropriateness: Statements that the Expert Panel rated as “appropriate without disagreement” according to predefined criteria derived from the RAM (20) were referred to the ISCD BOD with a recommendation to become ISCD Official Positions (see below). A statement was defined as “appropriate” when the expected health benefit exceeded the expected negative consequences by a significant margin such
PDC Procedures
Procedures of the 2007 PDC were different from previous PDCs 1, 2, 14, in that the formulation of statements from initial questions and sub-questions, rating process, and Expert Panel decisions were undertaken according to the RAM (20). The RAM has been applied worldwide for years as a mechanism to determine whether procedures or indications are expected to provide a specific health benefit, designated as “appropriate”, that exceeds the potential negative consequences by such a wide margin that
Selection of the 2007 ISCD Official Positions
Following completion of the PDC, the Steering Committee finalized recommendation wording without changing content. These recommendations were then presented to the ISCD BOD for review and voting. The BOD did not alter the content or wording of the proposed Official Positions. Recommendations approved by a majority vote of the ISCD BOD became ISCD Official Positions and are summarized below. The five accompanying papers from the Task Forces provide background, detailed rationale, and published
Participants
All 2007 PDC participants are listed in Appendix 1.
Financial Support
Financial support for the 2007 PDC was received in the form of unrestricted grants from The Alliance for Better Bone Heath (P&G Pharmaceuticals & Sanofi-Aventis Pharmaceuticals), Amgen Pharmaceuticals, Eli Lilly & Company, Hologic, Inc., Merck Human Health, and Wyeth Pharmaceuticals. These grantors had no role in the selection of PDC topics, participants or ratings for the final ISCD Official Positions.
Cumulative ISCD Official Positions
A summary of the ISCD Official Positions, combining those from the 2001, 2003 and 2005 PDCs with those resulting from this 2007 PDC held in Lansdowne Virginia, USA and the 2007 Pediatric PDC held in Montreal, Quebec, Canada, is provided in Appendix 2.
New ISCD Official Positions
The new ISCD Official Positions resulting from the 2007 PDC are summarized below. It should be noted for a number of Task Force topic questions the Expert Panel could not reach a median score sufficient to rate the associated recommendations as appropriate. This occurred for the DXA Technical Issues Task Force (How do we define and interpret high BMD?) and the VFA Task Force (What are the medical-legal responsibilities of interpreting VFA scans?). This does not imply that the questions were
Glossary
- BMC
- bone mineral content
- BMD
- bone mineral density
- DXA
- dual-energy X-ray absorptiometry
- ISCD
- International Society for Clinical Densitometry
- LSC
- least significant change
- NHANES III
- National Health and Nutrition Examination Survey III
- PA
- posterior anterior
- pDXA
- peripheral dual-energy x-ray absorptiometry
- pQCT
- peripheral quantitative computed tomography
- QC
- quality control
- QCT
- quantitative computed tomography
- QUS
- quantitative ultrasound
- ROI
- region of interest
- SSI
- strain strength index
- TBLH
- total body less head
- VFA
- vertebral
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