Bone density interpretation

I treat osteoporosis patients day in and day out. It is really rewarding to see patients' Bone Mineral Density (BMD) to improve with the treatment plan I develop alongside with my patients. 

It is very frustrating when I see worse BMD after 1-2 years of therapy. 

However, it is often because BMD was not done properly. I am seeing increasing amount of reports that show a huge discrepancy between actual BMD and reported BMD recently. I am not sure if it is due to labor shortage and therefore qualified BMD technician is not available. 

No matter what the reason is, I am seeing BMD drops in about 20% of cases without explanations. 

With busy practice, you don't have the time to look at individual BMD images all the time and often rely on the reports but now it has become my routine practice to request images themselves to be faxed over so I can review them because it is shocking what kind of errors are being made. 

Errors include 1. not deleting lumbar spine that has extremely different BMD from the rest of the spines, 2. hip positioning is off, 3. hip area of interest is marked wrong - sometimes I see hip RoI (region of interest) includes all the way down to the mid to lower trochanter (femur body) and sometimes I see RoI include all the way up to pelvic bone, 4. Some people get BMD measured with wired bra on etc.

If BMD does not make any sense to you, you need to ask your MD to look at the film to ensure the quality of BMD before making any therapeutic decision!!!