Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes

Opportunistic osteoporosis screening involves measuring the attenuation of L1 vertebrae on abdominal computed tomography (CT), which correlates with DXA T-score. We found that this approach is useful for detecting low bone mass in patients with diabetes and propose L1 attenuation ≤ 135 Hounsfield units (HU) as a threshold for which DXA should be strongly considered.

INTRODUCTION

Attenuation of the L1 vertebrae on computer tomography (CT) images done for other reasons ("Opportunistic Osteoporosis Screening") has been found to correlate well with DXA-derived T-score. However, the method and the thresholds have never been tested specifically in those with diabetes mellitus (DM), in whom the fracture risk is greater than explained by BMD.

METHODS

In a retrospective study of subjects with DM who had both abdominal CT and DXA within 6 months of each other, we compared L1 attenuation and DXA T-score to define the sensitivity and specificity of thresholds previously established in the general population.

RESULTS

There were 313 subjects among whom 18 (5.8%) had prior major osteoporotic fracture (MOF). Subjects with MOF had lower T-scores (- 2.3 ± 1.4 vs. - 0.9 ± 1.4, p < 0.001) and L1 attenuation (104 HU ± 46 vs. 149 HU ± 47, p < 0.001) than non-fracture subjects. L1 attenuation ≤ 160 HU was 91% sensitive for osteoporosis, while ≤ 110 HU was 80% specific. For a higher T-score of ≤ - 1.5, L1 attenuation ≤ 135 HU showed balanced sensitivity and specificity (65% and 69%, respectively).

CONCLUSION

Opportunistic osteoporosis screening with abdominal CT is useful in determining the need for DXA screening in subjects with diabetes. We propose L1 attenuation ≤ 135 HU as a reasonable threshold for detecting the T-score of ≤ - 1.5, which is likely associated with increased fragility in DM.

Computerized decision support and the quality of care

The notion of quality of care in medicine is not new, but it is becoming increasingly important as the competitive health care market demands objective measures to compare physicians, hospitals, and managed care organizations. Informatics researchers and health care vendors have responded with computer systems that promise to improve health care delivery. How well do these systems fulfill the promise? The answer requires an understanding of systems and the standards of quality used to assess them. This review paper will focus on the computerized methods designed to improve some components of quality of health care. The first section will provide a broad definition for quality of care and discuss the ways it is measured. The second portion of this article is a hypothetical case discussion of the implementation of strategies of quality improvement. We provide expectations of the effectiveness of these strategies with different degrees of computerized support. Finally, we review the literature in computer-based decision-support systems, and draw conclusions about their effects on aspects of quality.

"Virtual" clinical trials: case control experiments utilizing a health services research workstation

We created an interface to a growing repository of clinical and administrative information to facilitate the design and execution of case-control experiments. The system enables knowledgeable users to generate and test hypotheses regarding associations among diseases and outcomes. The intuitive interface allows the user to specify criteria for selecting cases and defining putative risks. The repository contains comprehensive administrative and selected clinical information on all ambulatory and emergency department visits as well as hospital admissions since 1994. We tested the workstation's ability to determine relationships between outpatient diagnoses including hypertension, osteoarthritis and hypercholesterolemia with the occurrence of admissions for stroke and myocardial infarction and achieved results consistent with published studies. Successful implementation of this Health Services Research Workstation will allow "virtual" clinical trials to validate the results of formal clinical trials on a local population and may provide meaningful analyses of data when formal clinical trials are not feasible.

Fabrication of interim acrylic resin removable partial dentures with clasps

An orderly sequence of steps for construction of an interim acrylic resin partial denture has been presented. The technique allows the dentist to fabricate an effective restoration that has a definite path of insertion and removal that can be placed in the patient's mouth with little time spent on adjustment and correction. This technique may be used with heat- or cold-curing acrylic resin.

An overdenture survey: preliminary report

The preliminary conclusions from this survey are listed: 1. The exceedingly high incidence of periodontal pathology seems to be the major problem in the long-term use of overdentures. 2. The incidence of caries is fairly low, but it remains a potential problem. 3. Subjective evaluations by the patients are favorable. 4. The overdenture technique as described by Lord and Teel seems to be practical and advantageous. 5. Additional research to find the most effective agent for inhibiting caries in overdenture support roots should be initiated. 6. Need exists for more surveys by other schools, institutions, or prosthodontists. 7. The overdenture is a valid alternative to complete denture therapy.