, 2002

Dr.
Salt Lake City, UT

Re: (DOB: ;)

Dear Dr. :

On x/x/2002 we performed a DXA bone density test on your patient X. A Lunar Prodigy DXA scanner was used to evaluate hip and lumbar regions in the AP projection. The interpretation of the scan is enclosed. The results show OSTEOPOROSIS of the lumbar spine and OSTEOPENIA (low bone density) of the hips. No previous scans have been done. If you have any questions concerning the scan and results, please don’t hesitate to contact me.
Our center’s interest is focused on diagnosis, research, and education. It is our philosophy to have the patient’s personal physician prescribe and coordinate all treatment for osteoporosis. It is recommended that Mr. X have a repeat scan in approximately two years to assess the response to any medical interventions that might be recommended.

Sincerely,

John G. Skedros, M.D.
Clinical Densitometrist

P.S. Compared to females, males have a higher mortality rate from a femoral neck fracture. Also, recent investigations have demonstrated that “…the current WHO definition of osteoporosis in postmenopausal women can be appropriately applied to men.” (Selby et al., 2000 Osteoporosis International, 11:153-157.)

Summary of Clinical Data Findings*
This test was done to evaluate the bone density in X with the following indication(s): Advanced age; Corticosteroid use (ICD-9 V58.69); Insulin-dependent diabetes (ICD-9 250.0); Hypogonadism (ICD-9 257.2); Excessive alcohol consumption

Additional Patient History and Risk Factor Summary*
Caucasian or Asian race; Loss of more than 1.5 inches in height; History of: Inadequate exercise, Fracture as an adult, Fracture in a parent or sibling, Depression, Insulin-dependent diabetes (ICD-9 250.0), Excessive alcohol consumption; Use of : Tobacco, Caffeinated beverages, Diuretics

*This information was obtained from our standard survey, which includes many, but not all, risk factors for osteoporosis or osteoporotic fracture.
Patient’s Name: X () Test date: x/x/2002

INTERPRETATION OF THE CURRENT BONE DENSITY TEST

Impression: OSTEOPOROSIS of the lumbar spine, OSTEOPENIA of the hips.
This is according to the World Health Organization’s Diagnostic Categories.1

The total lumbar (L2-L4) T-score is substantially lower than the average value found in healthy young adults. The risk for fracture is significantly elevated, and is considered “moderate to high”.

The total T-score of the hip is lower than the average value found in healthy young adults. The risk for fracture is significantly elevated, and is considered “low”. 2

Limitations of study: The scans used appear to be of good technical quality, yielding reliable results for interpretation.

On this current exam this patient’s bone density is:
Compared to: Young normals Same age
T-score1 Percent Z-score1 Percent
AP L Spine (L2-L4) -2. % -1. %
Hip (total, right & left) -2. % -2. %
Forearm NA NA NA NA
NOTE: The areas of higher fracture risk show the following T-scores: L2 is –2. ; Average femoral neck is –2. ; Average Ward’s triangle is –2. .

1. Definitions:
· T-scores represent standard deviations from the mean of young normal adult women.
· Osteoporosis is a T-score at or below –2.5.
(Some authorities now set the T-score at or below –2.0.)
· Osteopenia is a T-score between –1.0 and –2.5.
· Normal bone mass is a T-score at or above –1.0.
· The Z-score is corrected for persons of the same age.
In postmenopausal females, treatment should be considered for a T-score that is at or below +1.0.

2. The individual fracture risk is based on femoral neck data in De Laet et al. (1998, J. Bone and Mineral Research, Vol. 13(10):1587-1593).

Additional note: There is current debate about how effective antiresorptive drugs are in reducing the incidence of fractures by increasing bone mineral density. Recent investigators compiled data from clinical trials of antiresorptive agents and plotted the relative risk of vertebral fractures against the average change in BMD for each trial. A conceptual model based on these data showed that treatments that increase spine BMD by 8% would reduce risk by 54%; most of the total effect of treatment was explained by the 8% increase in BMD (41% risk reduction). The small but significant reductions in risk that were not explained by measurable changes in BMD might be related to publication bias, measurement errors, or limitations in current BMD technology (Wasnich and Miller, 2000. J. Clinical Endocrinology & Metab., 85:231-236.).