Description of diagnostics. What is spinal densitometry? Lumbar Densitometry

What is densitometry? Densitometry is a modern method of instrumental diagnostics that allows you to determine the mineral density and structure of bone tissue, as well as the thickness of the bone layer.

First of all, densitometry is performed to detect osteoporosis, a disease accompanied by a decrease in bone density and strength.

Such an examination is of great diagnostic value, since it allows timely detection and determination of the degree of damage to the human skeleton. Early diagnosis contributes to the timely start of treatment, which significantly reduces the risk of pathological development of the disease. Most often, densitometry of the lumbar spine, hip bones, and femoral neck is performed. In some cases, the entire skeleton is evaluated.

There are two main types of densitometry:

1. Ultrasonic densitometry. Used as a primary diagnostic. Ultrasound of the joints and bones does not have high-precision information content, but it has the highest safety and therefore can be used many times. However, it can determine the degree of elasticity and stiffness of the bones, as well as determine the density of the bone.
2. X-ray densitometry. The survey data are as accurate as possible. Since the duration of the procedure is insignificant, the dose of X-ray radiation received does not pose a health hazard.

Usually, if osteoporosis is suspected, ultrasound densitometry is initially prescribed, if the suspicions are justified and certain parameters need to be clarified, an X-ray examination is performed.

When is densitometry indicated?

It is known that bone densitometry is performed to determine the presence and degree of osteoporosis. Therefore, it is considered appropriate to conduct such a survey in individuals at risk for this disease.

The following are considered to be:

• persons who have received a fracture with minor injuries;
• women during menopause, especially if it occurred before reaching the age of 50;
• people leading a sedentary lifestyle;
• persons taking glucocorticoid drugs for the treatment of rheumatic diseases;
• people who have been taking medications for a long time that leach calcium out of the bones;
• persons with a history of diseases of the endocrine system;
• men and women who are underweight;
• everyone who has suffered any bone injury or suffers from pain in the lumbar spine;
• men over the age of 60.

X-ray examination, unlike spinal ultrasound, is not performed for pregnant women and women who are breastfeeding.

Bone densitometry is not performed if a radioisotope examination was performed two days before the proposed procedure and 5 days before a computed tomography or magnetic resonance imaging using a contrast agent.

How is the diagnostic procedure going?

Diagnosis of osteoporosis is absolutely painless, does not injure and does not cause discomfort in the patient. No special preparation is required before the procedure. It is recommended to exclude foods rich in calcium (cottage cheese, cheese) from the diet a few days before the procedure and not to use medicines containing phosphorus and calcium salts inside. It is necessary to inform the doctor in advance about the available pacemakers and metal implants. It is important to keep the body still during the procedure. It is not necessary to free the body from clothing. The duration of the procedure is about 30 minutes.

How is densitometry performed? To start the procedure, the patient must lie horizontally on the couch. Above it is a special sensor that will read information by measuring the intensity of x-rays.

The location of the body will depend on which area of ​​the body will be examined. When examining the bones of the spine or its specific section, the legs are bent at the knees and hip joints, and in this position they are placed on a special stand. When examining the femoral neck, the feet are placed in a special holder, with which the thigh is rotated inward. If for some reason it is not possible to perform densitometry of the entire spine or the lumbar spine, then the bones of the forearm are measured to assess the state of the skeletal system.

How are densitometry results interpreted?

The decoding is as follows: the device has pre-set the values ​​of all parameters for different parts of the body, they correlate with those indicators that were read by the sensor of the device from a particular person. As a result, the analysis and comparison of the obtained data with the norm is carried out. The basic indicators to be assessed are:

1. IUD - bone mineral content (in grams);
2. BMD - bone mineral density (in grams / square cm)

The results of the examination are evaluated according to two criteria for bone density - T score and Z score, the norm for each of them is different:

1. The first parameter - "T" - is the ratio of the received data to the average normal indicator. The optimal values ​​of this criterion are digital data +2 to -0.9.
2. The second parameter - "Z" - determines the nature of bone density in accordance with the age and gender of the patient.

If the "T" values ​​are reduced and are within -1 to -2.5, then this indicates the beginning of the process of osteoporosis. Significantly low parameters - from -2.5 and below- indicate a more pronounced stage of the disease. If the “Z” values ​​are too low, as a rule, additional examinations are prescribed.

Thus, osteoporosis affects the skeletal system (hips, humerus, etc.), so it is important to recognize it in a timely manner and begin its treatment. Depending on the results of the examination, an appropriate treatment will be selected, which should stop the further development of the disease.

Densitometry is a type of study of the structure of bone tissue used in the diagnosis of a number of diseases of the musculoskeletal system in general and the spine in particular. Densitometry is performed according to indications and in a planned manner (it is recommended to undergo it once a year for all people over 50 years old).

Unfortunately, it is not possible to do densitometry in every clinic due to the lack of equipment. In most cases, it is available only in large state hospitals, while it is rarely performed in polyclinics (with the exception of polyclinics in St. Petersburg and Moscow).

Densitometry is one of the types of bone tissue diagnostics that accurately determines bone mineral density. In simple terms, densitometry is the determination of the amount of bone loss.

This research method is based on measuring the level of calcium, which quite informatively reflects the strength of the bone.

For diagnostics, the most suitable bone structures are examined - the neck of the femur and the bones of the spinal column. These departments of the musculoskeletal system have a high diagnostic value, in particular, due to the fact that it is their defeat by pathologies that most often leads to disability in the patient.

Densitometry is carried out both in acute diseases of the musculoskeletal system, and in a planned manner. It is especially important to conduct it annually for all people over 55 years old, but doctors recommend that after 40 years, densitometry should be performed at least once every 1-3 years.

Types of procedure

In modern realities, densitometry is carried out in two ways: using ultrasonic waves and using X-rays. Despite the fact that both of these methods provide a lot of data on bone tissue, there are certain differences between them.

These two methods differ in the following nuances:

1. X-ray diagnostics (osteodensitometry). With its help, you can explore the entire spinal column. This method of research is the most informative, but there is a certain price for this - the patient receives a serious dose of radiation during each examination.
2. Ultrasound diagnostics (ultrasonometry). This research method is much less informative, but much safer and somewhat faster. Ultrasonometry is most preferable for diagnosing children or the elderly, whose body X-rays can be especially harmful.

What makes it possible to determine?

Densitometry cannot "tell" everything about bone tissue that could be useful for diagnosing or treating diseases of the musculoskeletal system. Its capabilities are limited by determining the density and, accordingly, the strength of the bone structure.

Both x-ray and ultrasound densitometry have the following diagnostic capabilities:

• able to accurately determine the amount of calcium in bone tissue;
• is able to compare the indications of the amount of calcium in a patient with international standard indicators (based on reference - average - indicators);
• is able to subsequently make relative comparisons for different age groups (it is quite obvious that the calcium norm for the elderly is different from the calcium norm for children).

Determining the amount of calcium in bone tissue is absolutely painless for the patient, since the technique is non-invasive (non-penetrating).

When and who should go?

After reaching the age of 55, densitometry is indicated for all people (doctors insist on an annual preventive study). It is also recommended to conduct it once every 1-3 years for all people who have reached the age of forty.

There is also a risk group for bone disease, which includes:

1. Women who have reached the age of menopause.
2. Elderly people with complaints of constant aching / stabbing pain in the back.
3. People who suffer from a progressive pathological change in posture and the appearance of body asymmetry.
4. People suffering from frequent fractures of unknown etiology (cause).

All people from the described risk group are required to undergo densitometry without fail. Delay in going to the doctor while at risk is fraught with the development of formidable complications, often leading to disability.

For what problems of the spine is it prescribed?

The risk group described above includes people who have obvious risk factors for the development of severe pathologies of the musculoskeletal system. But there is also a group of patients who already have spinal diseases.

Such patients without fail require densitometry, both to determine the tactics of treatment and to monitor changes during therapy.

Densitometry is indicated in the presence of the following diseases of the spinal column:

• rheumatoid arthritis;
• osteoporosis of any form and stage;
• pathologically short stature and/or extremely low body mass index (BMI);
• the presence of thoracalgia of unknown etiology;
• partial or complete immobilization (immobility) in the spine or hip joints;
• partial or complete paralysis of the lower or upper limbs;
• deformities of the spinal column, asymmetry of the body.

How is it carried out?

In the manipulation room, the patient is asked to take the most convenient position for the diagnosis. The specific posture depends on two factors: the specific type of densitometry to be used, and the patient's complaints/diseases, due to which he turned to the doctor.

A sensor is placed over the part of the bone where the research will be carried out, the signal from which passes to the computer, which processes it and projects the image onto the monitor. For a detailed and accurate diagnosis, the doctor moves the sensor over the problem area very slowly and carefully.

The patient does not experience any pain or discomfort. The procedure itself takes from 15 (ultrasound method) to 35 minutes (X-ray method). The peripheral examination does not take more than five minutes at all.

The data obtained as a result of the examination are entered into a medical report, which must be taken to the attending physician for subsequent decoding.

Preparation for the procedure

Preparation for densitometry is extremely simple and does not require any serious measures. To prevent distortion of the results of the study, the following restrictions should be observed:

1. 24 hours before the procedure, you must completely abandon any medications that have calcium supplements. It is also recommended to refuse food that is rich in calcium for a day ( e.g. dairy products).
2. Before the procedure, the doctor should be informed about previous studies and treatment of the spine: whether contrast was used, whether pins, implants were inserted. You should also notify the doctor about the presence of pregnancy, an implanted pacemaker, and so on.
3. Directly during the study, the patient should minimize their movements and try to remain motionless throughout the diagnosis.

Contraindications for carrying out

Like any other medical study, densitometry also has a number of contraindications. At the same time, ultrasonic densitometry has no specific contraindications (it is also allowed during pregnancy).

In contrast, X-ray densitometry has the following contraindications:

• the presence of pregnancy;
• lactation period (breastfeeding);
• the presence of metal implants in the body, a conditional limitation is an implanted pacemaker (permission for diagnostics in this case is negotiated both with the attending physician and with the radiologist);
• the presence of a contrast agent in the body after a recent (five days preceding the procedure) radioisotope study or computed tomography with contrast;
• a conditional limitation is the presence of arthritis of the spinal column or a recent fracture in the patient.

Densitometry of the spine and hip (video)

Results and their interpretation

After the research procedure has been carried out, its results will be known almost immediately. The data is entered into a medical report, and the attending physician should deal with their decoding.

You can get a general idea of ​​​​the results of the study yourself, for this you should pay attention to the T-criterion and the Z-criterion.

The decoding of densitometry according to these indicators is as follows:

1. T-test. Gives an idea of ​​the density of the patient's bone tissue relative to the density of bone tissue in healthy people. Readings between +2 and -1 are normal. Scores below -2.5 are a strong indication of osteoporosis.
2. Z-criterion. Gives an idea of ​​the ratio of the bone density of the patient relative to the average (reference values) in healthy people of the same age group and the same sex. Pathology is a Z-score below -2.0.

Densitometry is an effective way to study the mineral structure of bone tissue, which allows you to see a picture of a decrease in bone density and identify violations in its structure. This diagnostic technique is used for osteoporosis and other diseases that cause a decrease in bone density. The short procedure is absolutely painless and does not require special preparation. As a rule, densitometry is performed on the lumbar spine, on the hip bones, less often on the forearm, in some cases, the entire skeleton can be examined.

Today, the conventional x-ray examination is somewhat outdated, it allows you to make a diagnosis only with 25% loss of bone mass. Densitometry of the spine makes it possible to detect structural changes in bone tissue in the range from 1% to 5% of the total bone mass, which makes it possible to diagnose osteoporosis at the earliest stage. Such a diagnosis will allow prescribing timely treatment and reduce the risk of further development of the disease.

Types of densitometry

1. X-ray densitometry (dual-energy X-ray absorptiometry). This research method provides the most accurate information about bone density. The procedure is based on the use of two different x-rays. Dense bone tissue transmits fewer rays. Thus, by comparing the results of the absorption of rays, it is possible to identify deviations in bone density. The procedure is carried out quickly enough, and the radiation dose does not pose a danger to the patient's health.
2. Ultrasonic densitometry. The procedure is based on obtaining data on the speed of movement of ultrasonic waves through the layers of the bone, as well as on fixing the magnitude of the scattering of waves in the cavities of the bones. The technique is absolutely safe and does not take a lot of time, but has a lower measurement accuracy than the X-ray method.
3. Quantitative. The procedure allows obtaining a three-dimensional image of the structural density of bones, but since the method loads the body with a fairly high radiation load, it is used very rarely.

In our time, to diagnose the early stage of osteoporosis, ultrasound methods of research have become more often used. This diagnostic method is an absolutely harmless technique that makes it possible for children and women to be examined during pregnancy. The method allows you to check different parts of the skeleton with high accuracy. The results of the study are compared with the corresponding normal indicators, while many features of the patient are taken into account. The data of the conducted research are displayed on the screen of the densitometer in the form of a graphic dependence. The graph is quite simple and does not require special interpretation of the data. The patient immediately receives all the information about the examination, he is diagnosed and prescribed the appropriate treatment.

In a situation where ultrasound establishes significant indicators of bone loss, doctors resort to clarifying diagnostics. For this, the patient needs to undergo X-ray densitometry. Radiation exposure on modern densitometers is very small and does not harm the health of the patient. Such a technique will allow not only to establish the exact value of bone mineral density, but also to find out its strength, elasticity, as well as the thickness of the cortical layer and microstructures.

Passage of diagnostics

Preparation for the procedure

There are no strict guidelines for preparing for densitometry, but there are still some points that require attention:

• When using drugs containing calcium, it is necessary to abandon them 24 hours before the diagnosis.
• If you have pacemakers or metal implants, you should tell your doctor in advance.

How is the diagnosis carried out?

You will be asked to lie down on a horizontal couch, above which a sensor is located that reads information about the degree of absorption of x-rays. The emitter itself is located under the couch. In the case of a spine examination, you will be asked to bend your legs at the hips and knees, and then lay them on a stand. During the diagnosis, the body should be fixed in a fixed position.

Contraindications for radiological densitometry

• Pregnancy or the period of breastfeeding a child.
• In the case of a CT scan or with the introduction of a contrast agent within the last 5 days.
• When undergoing radioisotope diagnostics within the last 2 days.

Who needs to be tested?

1. People predisposed to the development of osteoporosis.
2. Women over 45 and men over 60.
3. Persons over 40 who have had fractures of various kinds.
4. Women who have taken hormonal drugs for a long time.
5. People taking drugs that help leach calcium from the bones.
6. People with endocrine or rheumatic diseases.
7. Men and women who are underweight.
8. People with osteoporosis found on a routine x-ray.
9. People who have various diseases of the spine (, kyphosis,).
10. Patients suffering from osteoporosis, for the appointment of effective treatment.

Price for spine densitometry

The cost of spinal densitometry depends largely on the equipment used for the study, the method of diagnosis, as well as the authority of the clinic. Examination of one section of the spine will cost approximately 1000-2500 rubles, in most cases lumbar densitometry is performed. In the case when a study of the entire skeleton is required, the price can be 4000-6000 rubles.

Deciphering the results of densitometry

In the densitometric apparatus, the norms of bone tissue density of the human skeleton are laid, which are different for each individual area. Based on these norms, age, gender and individual characteristics of the patient, an analysis of bone parameters is performed. The main indicators are:

• BMC (g) is an indicator of bone mineral content.
• BMD (g/cm2) is an indicator of bone mineral density.

The results of the study are presented in the form of two main criteria:

• T-score - shows the ratio of bone density in your body to the bone density of a completely healthy person of the same sex and age.
• Z-score - shows the ratio of bone density in your body to the average bone density of a group of people of the same sex and age.

The norm for the T-criterion is the value from "+2" to "-0.9", with the appearance of the initial stage of osteopenia (decrease in bone density), the numerical data will be in the range from "-1" to "-2.5". The development of osteoporosis is characterized by a value below "-2.5". In the case of too low values ​​of the Z-criterion, additional studies are most often assigned.

Currently, most modern medical centers provide the opportunity to conduct a densitometric examination of the spine. Your attending physician should prescribe the procedure and determine the frequency of its passage.

Spinal densitometry is the latest technology with which you can examine the degree of mineral strength of the tissue. This is the first tool in the diagnosis of osteoporosis, determining its stage. The main advantage of the procedure is safety, accuracy of the results obtained, and painlessness.

• Patients who regularly take or have taken hormonal drugs, anticoagulants, diuretics, anticonvulsants.
• Patients diagnosed with diseases of the endocrine system and rheumatic diseases.
• Women at the beginning of menopause (in the first few years).
• Men over 50 years old.
• People with a predisposition to osteoporosis.
• Women over 45 (in this case, it is recommended to undergo the procedure 2 times a year).
• People with risk factors (early menopause, menstrual problems, being underweight, having two or more children, not having children, having fractures).

In the presence of risk factors (fractures, injuries, and so on), the procedure is recommended regardless of age. Upon reaching a certain age limit, densitometry should be included in the list of mandatory annual examinations. The procedure can also be performed by children from three years old with a referral from a pediatrician. The technique is an excellent way to diagnose diseases in the early stages, as it allows you to determine even 2-5% deviations from the norm.

Detection of the disease in the early stages is so important because in this way it is possible to carry out treatment in a timely manner at minimal cost.

Features of diagnostics

Densitometry of the spine can be performed on equipment from various manufacturers. When comparing results obtained with different equipment, the results may vary slightly. This is not a fundamental point, since the percentage of error is minimal.

However, if you are undergoing the procedure on a regular basis to control the development of the disease, it is recommended that you undergo the procedure on the same equipment. So the picture of the disease will be more accurate and clear. In the course of treatment of osteoporosis, it is recommended to undergo such an examination 2 times a year.

Densitometry of the lumbar spine is very popular. The reason for this is simple - the lumbar region is most at risk in osteoporosis.

Expert opinion

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The day before densitometry, you should completely stop taking medications and vitamin complexes with calcium content. On the day of the examination, it is recommended to wear clothes without decorative metal elements. These are the only points to consider before the procedure. There are no additional conditions.

The procedure takes a minimum of time. In total, it lasts 10-20 minutes. Before starting densitometry, the patient is asked to remove shoes and outerwear. Then the person lies down on a special table. The scanning console then turns on.

The picture is given to the patient, after which he must take it to the doctor. The specialist will be able to determine from the image the presence of the danger of the occurrence of the disease, the development of the disease, its stage.

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• Ultrasonic equipment. Completely safe. Has no contraindications. This is the best option if you need regular examinations.
• X-ray equipment. It gives the same accurate results, but it is not recommended to undergo such an examination more than once a year, since it is better if the x-ray exposure of the body is minimal.

Cost of diagnostics

The cost of spinal densitometry depends on a number of factors. In many ways, the price is determined by the amount of work, that is, the number of zones that are planned to be scanned. The cost of an examination, for example, of the femoral region is approximately 1200-1500 rubles.

In the event that densitometry of the spine and femoral neck is performed, the cost will be 2-3 thousand. A complete diagnosis of the skeleton will cost 4-5 thousand. The cost of the service largely depends on the pricing policy of the diagnostic center. Therefore, it is recommended to consider different options to choose the most profitable.
In addition, professional consultations may be included in the cost of densitometry. Their cost, in paid centers, will be approximately 500-700 rubles.

How to forget about pain in the back and joints?

We all know what pain and discomfort are. Arthrosis, arthritis, osteochondrosis and back pain seriously spoil life, limiting normal activities - it is impossible to raise a hand, step on a foot, get out of bed.

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Diagnosis is the most important initial step in the treatment of osteoporosis. Conventional radiography, unfortunately, is more often a fact that states osteoporosis, when it has already won thirty percent of bone tissue. Therefore, its significance in terms of preventing more severe consequences is minimal. Much more useful is another type of more accurate examination - densitometry of the spine.

Densitometry is the best way to diagnose osteoporosis

Appears in our life for many reasons.

In some cases this:

• Hereditary disorders of bone formation processes
• Hormonal age changes

In others:

• Some diseases (rheumatoid arthritis, osteomyelitis, etc.)
• Taking certain medications (hormones, corticosteroids)

Third:

• Predominance in the diet of foods low in calcium and phosphates
• Too much alcohol, smoking and coffee

Possibilities of densitometry

With it you can:

• Measure calcium content in bone tissue
• Compare it to the general standard
• Make a relative comparison, depending on age

It does not require any penetration into the bone and the collection of material.

Such diagnostics is very valuable, as it allows:

• Carry out reinforced even before the fracture
• Monitor the therapeutic process by comparing results before and after treatment

Who needs densitometry

Densitometry of the spine is primarily needed for the following categories of patients:

• Those at risk for the above factors (at least two factors)
• Women who have gone through menopause
• Elderly people with complaints of aching back pain
• People with rapidly progressive posture changes
• To all those with frequent, unexplained fractures

They should have their bone density checked at least once every two years.

Types of densitometric examination

There are four types of densitometry.

Three of them are quantitative. This:

• Ultrasonic densitometry
• Magnetic resonance
• Computer

fourth kind:

• DXA (dual energy x-ray absorptiometry)

All of them are practically harmless, especially ultrasound and MRI..

With CT-densitometry and X-ray absorptiometry, a scanty radiation exposure occurs, twenty times less than with ordinary fluorography

Which type to choose, the doctor will tell you.

What areas are examined most often?

Those most at risk of fractures:

• Departments of the spine
• Head and neck of the femur
• hip bones
• Knee-joint
• Rib cage
• Clavicle and humerus
• Radial wrist

Rules for passing densitometry

1. Stop taking calcium supplements the day before the examination
2. The interval between barium-related procedures and densitometry should be at least ten days
3. Pregnancy is a contraindication for measuring bone density
4. All metal objects must be removed from the body and clothing, which should be free.
5. Try not to move while examining

The duration of the procedure is from several minutes to half an hour. It all depends on the size of the area being examined..

Evaluation of results

The result is evaluated by T - score and Z - score.

• In the T category, one point is considered standard.
  • Osteoporosis is diagnosed if the T score is between -1 and -2.5
  • The indicator below - 2.5 - is a critical level at which a fracture is already possible
• The Z score compares the patient's PCT and the average density index for his age.
  If the discrepancies are too large, additional studies may be assigned.:
• Biochemical analyzes
• Bone biopsy
• X-ray of the spine, etc.

Printout of results after densitometry takes 15 minutes.

Examination price

The price of densitometry may depend on:

• Type of survey:
  Examination of the entire spine will cost much more than examination of one department or peripheral area
• Clinic class:
  In the capital's medical center, the price may be higher than in the regional, with the same quality
• Promotions of price discounts:
  If you are lucky enough to get on such a promotion, you will be able to conduct an examination at half the price of the regular price.

For example, in the Invitro clinic, where X-ray densitometry is performed, prices range from 900 rubles to 6400:

• The cost of examining one forearm for the promotion is 900 r Regular price is 1800 r
• Densitometry of the lumbar spine is done in combination with two hip joints or with the femoral neck:
  • Regular prices, respectively - 4800 and 3200 r
  • For shares - 2400 and 1600

Video: Densitometry