RE: forearm osteoporosis

[Guest guest]

I have only seen dexascans done on the forearm when there has been a problem with obtaining a reliable result from the spine or hip ( due to previous fracture or because there is metal present in those areas for instance). Was the forearm imaged as part of this radiology office's "routine?" I don't think it is standard.

Lonna

Subject: forearm osteoporosisTo: Date: Sunday, January 25, 2009, 12:49 PM

Clinical curbside consult for the group.I have a young woman, early 40's, who has gone through early menopause. Her first DEXA showed osteopenia in the spine and one hip, normal density in the other hip and osteoporosis in the forearm.The study had been ordered by her Gyn at a local rheum office that also has DEXA services.Now, due to her age and history, my recommendations are going to be the same as if she had osteoporosis in spine or hip. But, my question is whether the forearm part of the study is becoming part of the standard protocol and what it means in light of it being different from spine/hip in severity. I haven't been seeing that before. And I'm wondering what other folks are seeing or how you fit it into the picture of the DEXA just of spine/hip when it varies.Any thoughts and experience is appreciated.Tim------------ --------- --------- --------- - Malia,

MD (phone / fax)www.MaliaFamilyMedi cine.comwww.SkinSenseLaser. comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.------------ --------- --------- --------- -

[Guest guest]

Yes, it was part of the office's standard report. I don't know of any other clear

reason to check her forearm.Tim

I have only seen dexascans done on the forearm when there has been

a problem with obtaining a reliable result from the spine or hip ( due

to previous fracture or because there is metal present in those areas

for instance). Was the forearm imaged as part of this radiology

office's " routine? " I don't think it is standard.

Lonna

From: Malia, MD Subject: forearm osteoporosisTo:

Date: Sunday, January 25,

2009, 12:49 PM

Clinical curbside consult for the group.I have a young

woman, early 40's, who has gone through early menopause. Her first DEXA

showed osteopenia in the spine and one hip, normal density in the other

hip and osteoporosis in the forearm.The study had been

ordered by her Gyn at a local rheum office that also has DEXA

services.Now, due to her age and history, my recommendations

are going to be the same as if she had osteoporosis in spine or hip. But, my question is whether the forearm part of the study is becoming

part of the standard protocol and what it means in light of it being

different from spine/hip in severity. I haven't been seeing that

before. And I'm wondering what other folks are seeing or how you fit it

into the picture of the DEXA just of spine/hip when it varies.Any thoughts and experience is appreciated.Tim------------ --------- --------- --------- - Malia,

MD (phone / fax)www.MaliaFamilyMedi

cine.comwww.SkinSenseLaser. comMalia Family Medicine

& Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450-- Confidentiality Notice

--This email message, including all the attachments, is for the

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please contact the sender immediately by reply email and destroy all

copies of the original message, including attachments.------------

--------- --------- --------- -

---------------------------------------- Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the

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[Guest guest]

Forearm osteoporosis develops early in hyperparathyroidism, so

it would be done if that were suspected, or if a good hip and lumbar spine DXA

could not be obtained. It is preferable to get usable scans of at least

two areas of the body, and the hip or lumbar spine might not be interpretable due

to previous fracture, scoliosis, or osteoarthritis.

So, you might get a Calcium and PTH (and of course Vitamin D) on

this patient.

Don

ISCD Certified Clinical Densitometrist (I think until the end of

this year)

From:

[mailto: ] On Behalf Of

Malia, MD

Sent: Sunday, January 25, 2009 12:50 PM

To:

Subject: forearm osteoporosis

Clinical curbside consult for the group.

I have a young woman, early 40's, who has gone through early menopause. Her

first DEXA showed osteopenia in the spine and one hip, normal density in the

other hip and osteoporosis in the forearm.

The study had been ordered by her Gyn at a local rheum office that also has

DEXA services.

Now, due to her age and history, my recommendations are going to be the same as

if she had osteoporosis in spine or hip. But, my question is whether the

forearm part of the study is becoming part of the standard protocol and what it

means in light of it being different from spine/hip in severity. I

haven't been seeing that before. And I'm wondering what other folks are

seeing or how you fit it into the picture of the DEXA just of spine/hip when it

varies.

Any thoughts and experience is appreciated.

Tim

----------------------------------------

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of the

intended recipient(s) and contains confidential information. Unauthorized use

or disclosure is prohibited. If you are not the intended recipient, you may not

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----------------------------------------

[Guest guest]

Thanks. Good one. I'll add the PTH to the labs that were being ordered.TimOn Sun, January 25, 2009 11:35 pm

EST, T. , MD wrote:

Forearm osteoporosis develops early in

hyperparathyroidism, soit would be done if that were suspected, or if a good

hip and lumbar spine DXAcould not be obtained. It is preferable to get usable

scans of at leasttwo areas of the body, and the hip or lumbar spine might not

be interpretable dueto previous fracture, scoliosis, or osteoarthritis.

So, you might get a Calcium and PTH

(and of course Vitamin D) onthis patient.

Don

ISCD Certified Clinical Densitometrist

(I think until the end ofthis year)

From:

[mailto: ] On Behalf Of

Malia, MDSent: Sunday, January 25, 2009

12:50 PMTo: Subject: forearm osteoporosis

Clinical curbside consult for the group.I have a young woman, early

40's, who has gone through early menopause. Herfirst DEXA showed osteopenia in

the spine and one hip, normal density in theother hip and osteoporosis in the

forearm.The study had been ordered by her Gyn at a local rheum office

that also hasDEXA services.Now, due to her age and history, my

recommendations are going to be the same asif she had osteoporosis in spine or

hip. But, my question is whether theforearm part of the study is becoming

part of the standard protocol and what itmeans in light of it being different

from spine/hip in severity. Ihaven't been seeing that before. And I'm

wondering what other folks areseeing or how you fit it into the picture of the

DEXA just of spine/hip when itvaries.Any thoughts and experience

is appreciated.Tim---------------------------------------- Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family

Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square

MallFairport, NY 14450-- Confidentiality Notice --This email

message, including all the attachments, is for the sole use of theintended

recipient(s) and contains confidential information. Unauthorized useor

disclosure is prohibited. If you are not the intended recipient, you may notuse, disclose, copy or disseminate this information. If you are not theintended recipient, please contact the sender immediately by reply email anddestroy all copies of the original message, including attachments.----------------------------------------

---------------------------------------- Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the

attachments, is for the sole use of the intended recipient(s) and contains

confidential information. Unauthorized use or disclosure is prohibited. If you are

not the intended recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the sender

immediately by reply email and destroy all copies of the original message, including

attachments.----------------------------------------