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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> > <a href="." class="crumb_link">June 1996</a>
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<td><h1><a name="h1" id="h1"></a>Health Technology Assessment </h1>
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<tr>
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<td><div id="centerContent"><div class="headnote">
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<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
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<a name="head1"></a>
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<h2>AHCPR releases two new health technology assessments</h2>
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<p>AHCPR's Center for Health Care Technology recently
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published two Health Technology Assessments. These reports, which are now
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available from AHCPR, are usually prepared to assist federally
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financed health care programs, such as Medicare and CHAMPUS
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(Civilian Health and Medical Program of the Uniformed Services),
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with coverage decisions. Health Technology Assessments
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present
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detailed analyses of the risks, clinical effectiveness, and uses
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of medical technologies.</p><p>
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<strong>Graham, A.A. (1996). <em>Plethysmography: Safety, Effectiveness,
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and
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Clinical Utility in Diagnosing Vascular Disease</em>, Health
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Technology Assessment No. 7 (AHCPR Publication No.
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96-0003).</strong></p>
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<p>Plethysmography, a semiquantitative method of measuring segmental
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blood flow and velocity in the carotid and peripheral vascular
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systems, is safe, easy to perform, and inexpensive. Impedance,
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strain gauge, air, and photoelectric plethysmographic methods are
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assessed in this report for their relative safety, efficacy, and
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clinical utility in diagnosing vascular disease. Clinical
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evidence has demonstrated, for example, that oculoplethysmography
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is not a reliable screening test for carotid artery disease,
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particularly in bilateral disease and nonocclusive unilateral
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disease. Thus, oculoplethysmography is no longer recommended for
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the diagnosis of carotid artery disease.</p><p>
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Impedance, strain gauge, and photoplethysmography methods can be
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used for the initial evaluation of acute and chronic venous
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insufficiency, although there is great variability in the
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reliability of these tests to predict venous disease in the
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presence of nonobstructive thrombi and comorbid conditions.
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Strain gauge and photoelectric plethysmography can be used safely
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for the evaluation of peripheral arterial disease, but surgical
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candidates for arterial reconstruction and some venous disorders
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may require additional imaging such as duplex ultrasound,
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venography, or arteriography for anatomic information that is not
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elucidated by plethysmography. Evaluation of the ability of the
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plethysmographic techniques reviewed in this report to predict
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the presence of flow reduction in the carotid and peripheral
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circulations was based on the technical performance of the tests
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as compared with a reference method. Establishing evidence-based
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conclusions proved to be difficult in light of biases such as
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nonrandomization, unstated patient selection criteria, poor
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followup of patients, and lack of blindness in some studies.</p>
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<p><strong>Erlichman, M. and Holohan, T.V. (1996). <em>Bone Densitometry:
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Patients with End-Stage Renal Disease</em>, Health Technology
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Assessment No. 8 (AHCPR Publication No. 96-0040).</strong></p><p>
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The loss of bone mass and osteoporosis are associated with
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various conditions, such as end-stage renal disease (ESRD), and
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treatments, such as prolonged steroid therapy. Bone densitometry
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is used to measure bone mass density, determine the degree of
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osteoporosis, and estimate fracture risk. Bone densitometers
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measure the radiation absorption by the skeleton to determine
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bone mass of the peripheral, axial, and total skeleton. Common
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techniques include single-photon absorptiometry (SPA) of the
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forearm and heel, dual-photon absorptiometry and dual-energy
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x-ray absorptiometry of the spine and hip, quantitative computed
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tomography of the spine or forearm, and radiographic
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absorptiometry of the hand. Part I of this report addresses
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important technical considerations of bone densitometers,
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including radiation dose, site selection, accuracy, and
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precision, as well as cost and charges. Part II evaluates the
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clinical utility of bone densitometry in the management of
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patients with ESRD. End-stage renal disease affected more than
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242,000 Americans in 1992, and each year 10,000 to 20,000 new
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cases are diagnosed. Although the survival rate of ESRD patients
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has improved, metabolic bone diseases that fall under the generic
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term "renal osteodystrophy" represent abnormal development of
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bone and major long-term complications. Issues addressed in this
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assessment are the type and extent of bone loss associated with
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ESRD and whether these patients have an increased risk for
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fracture.</p>
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<a name="head2"></a>
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<h2>Value of bone densitometry to improve the outcomes of
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patients with bone loss remains unproven</h2>
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<p>About 1.3 million fractures that occur each year in the United
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States in people over age 45 are attributed to osteoporosis. Bone
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densitometry is used to measure bone mass density to determine a
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person's degree of osteoporosis and fracture risk. Whether use of
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bone densitometry effectively alters the medical management of
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patients at risk for bone loss remains controversial. Debate
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continues over selection of the best technique and measurement
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site, as well as the availability of effective treatments to
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prevent progression of osteoporosis, if significant bone loss is
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detected.</p><p>
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Some concern also remains about the accuracy and precision of
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these techniques, explain Martin Erlichman, M.S., and Thomas
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Holohan, M.D., of the Center for Health Care Technology, Agency
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for Health Care Policy and Research. In a recent book chapter,
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they describe and compare bone densitometry techniques, discuss
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issues surrounding measurement site selection and accuracy and
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precision of the techniques, and summarize alternative bone mass
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measurement techniques such as ultrasound and biochemical markers
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of bone turnover.</p>
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<p>In addition, the authors address conditions for which bone
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densitometry has been used in clinical practice, such as
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asymptomatic primary hyperparathyroidism, long-term steroid
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therapy, and estrogen deficiency. Although patients with these
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conditions are at increased risk for bone loss, it is not yet
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clear whether use of bone densitometry to measure bone loss
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ultimately improves their outcomes. More data from randomized,
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controlled clinical trials are needed before this conclusion can
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be reached, according to the authors.</p><p>
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For more information, see "Bone densitometry," by Mr. Erlichman
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and Dr. Holohan, in <em>Nuclear Medicine: Diagnosis and
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Therapy,</em> edited by John C. Harbert, William C. Eckelman, and Ronald D.
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Neumann; New York: Thieme Medical Publishers, Inc., 1996, pp.
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865-880.</p>
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<p class="size2"><a href=".">Return to Contents</a><br />
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<a href="dept5.htm">Proceed to Next Section</a></p>
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<div class="footnote">
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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