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Reverse positioning may improve detection of vertebral fractures.

SAN DIEGO -- More vertebral fractures were detected when right lateral decubitus positioning was used in densitometric assessment, Diane Krueger reported during a poster session at the annual meeting of the International Society for Clinical Densitometry.

"If you're using a densitometer that does not always provide excellent visualization, simply repositioning patients--having them roll over on their other side--will give you more vertebral bodies to assess and will help you detect fractures with more confidence because it improves clarity," Ms. Krueger, research program manager for the Osteoporosis Clinical Research Center at the University of Wisconsin, Madison, said in an interview.

In the study, 30 men and 3 women with a mean age of 70 underwent densitometric vertebral fracture assessment with standard left lateral decubitus positioning and right lateral decubitus (reverse) positioning. Reverse positioning was performed because standard left lateral positioning yielded suboptimal vertebral visualization, defined as the "inability to label vertebral bodies with a high degree of confidence due to lack of clearly defined disc spaces on two or more consecutive vertebral bodies below T7."

With standard left lateral decubitus positioning, the investigators were able to visualize 62% of vertebral bodies from T4 to L5. The addition of right lateral decubitus positioning increased the percentage of evaluable vertebral bodies from T4 to L5 to 83%, an improvement of 21%.

In addition, right lateral decubitus positioning identified four previously undetected fractures, including two in patients with no known fracture.

"In all but 1 of these 33 patients, either an increased number of vertebrae visualized, improved clarity, or both was observed," the researchers wrote. Although they were not able to clearly define the reason for improved visualization with right lateral decubitus positioning, the researchers noted that "it is likely that the presence of scoliosis or spinal degenerative disease explains some of the poor vertebral visualization in these patients."

The study's lead author was Nellie Vallarta, a certified radiologic and bone densitometry technologist at the Osteoporosis Clinical Research Center.

BY DOUG BRUNK

San Diego Bureau
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Title Annotation:Endocrinology
Author:Brunk, Doug
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:May 15, 2006
Words:330
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