Bone Density ASRT- Module 13- Patient Care and Bone Health Risk Factors

Total body composition tests

seek to break down this data and deliver comprehensive information about fat and fat-free components within the body. The fat components of the body are simply all the fats within the body; fat-free components include bone, muscle,
other components such as connective and organ
tissues, and water.

body mass index.

The standard measurement tool used to calculate the health of body composition and most common assessment of an individual's body composition

two-compartment methods

Other tools take measurements that separate fat andfat-free mass. These tools use what are known as

hydrodensitometry, skinfold thickness measurements, bioelectrical impedance measurement, and air displacement plethysmography

Two-compartment methods include

near-infrared interactance and dual x-ray absorptiometry, or DXA.

Three- and four-compartment methods also exist that break down the measurements of fat-free mass into separate categories. Three- or four-compartment methods include

below 18.5

under weight BMI

between 18.5 and 24.9

healthy normal weight BMI

25.0 and 29.9

If BMI is between ___________the patient is overweight

30

A BMI of _________or more indicates obesity

hydrostatic weighing.

this method weighs an individual normally, and then weighs them again while submerged in water. During the process, the subject wears little to no clothing, if possible. They are asked to blow all of the air out of their lungs, and are then submerged in water to be weighed. affected by the amount of air remaining in the lungs

Archimedes' principle

is key to underwater weighing, as materials with a greater de nsity than water will sink while materials with densities lower than water will float.

0.9 and 1.1

Siri or Brozek formulas assume that the fat and fat-free densities will remain constant at _______ grams per cubic centimeter and _____ grams per cubiccentimeter, respectively.

The Siri formula

assumes that body fat percent is equal to 4.950 divided by the measured bone density in kilograms per cubic meter, then multiplied by 100

Brozek formula

4.570 is divided by the bone density in kilograms per cubic meter, then multiplied by 100 to determine the body fat percentage

Siri; Brozek

The ______ equation provides more accurate results in younger individuals, while the equation is more accurate for older individuals.

skinfold thickness

One of the most common ways to obtain an estimated percentage of body fat is by utilizing a caliper to measure the ____________ of an individual in specific locations. In either case, the individual performing the test will pinch the site to be measured and pull the skin away from the tissue underneath. The caliper jaws are then placed over the skinfold and its width is measured.

abdomen, the triceps, the chest, the midaxillary line, and the thigh.

Measurements are obtained on the right side of the body at key sites. These sites include the

Jackson and Pollock

From these measurements, body density is estimated using a set of equations. The formula most often used is from _____________________, which uses either three or seven skinfold sites.

Bioelectrical impedance analysis

is a two-compartment method that is simple to perform and does not require much expertise to achieve accurate results.The exam can be performed in several ways. The first method has the subject lying on a table with electrodes hooked up to their arms an d/or legs. The second method has the patient standing without shoes or socks on a metal plate. In either method, a small voltage is applied to the patient, which travels through their body. The electrical charge is not uncomfortable or even felt by the patient, as the voltage applied is very low. The body's resistance to the electric al charge is then measured. Fat-free mass contains water which is an excellent conductor while fat is not a good conductor. Because of this, the resistance of the body to the electrical current can be used to measure body composition. Once the measurement is complete, equations are used to estimate fat-free mass percentages.

four hours; 8 hours; 48 hours

Hydration also affects the results acquired by bioelectrical impedance analysis, so anyone undergoing the exam should avoid drinking any fluids for _______ prior. Exercise should be avoided for__________ prior to exam and alcohol should be avoided for __________prior to the exam.

Air displacement plethysmography

a two-compartment method individuals are placed within an oval chamber where the volume of air displacement can be measured exactly. The subject mustwear very restrictive clothing and a swim cap to limit fluctuations due to the movement of their hair. Those being tested will sit within the chamber and breathe normally as the air pressure is modified and changes to the volume are recorded

Near-infrared interactance

is a three-compartment method that uses an infrared spectroscopy probe to measure body composition. To perform the test, a digital analyzer is connected to a fiber optic probe that emits infrared light. The probe is placed against the skin of the biceps. The light from the probe passes through the tissues of the body and is reflected back to the digital analyzer. Fat will absorb the light, whereas muscle and bone will reflect it. The light reflection from the site is compared with results using pre-calculated data from a standardized calibrator

biceps

Near-infrared interactance can be used at various sites within the body, but the most common and accurate site is reportedly at the

four-compartments method was originally engineered to evaluate bone mineral mass, in the process, formulas had to be created for it to differentiate between bone, muscle, fat, and skin. accomplishes this by using x-ray beams at two distinct levels of energy which are attenuated at different rates when passing through the same material.

DXA and hydrodensitometry

There is disagreement over which body composition test should be considered the gold-standard, but _____ and ____ are considered the most accurate

1. HIV patients who are taking antiretroviral agents,
2. bariatric patients when they are expecting weight loss to exceed 10% of their total weight
3. patients with musculoskeletal weakness or poor musculoskeletal function

The International Society forClinical Densitometry, or ISCD, supports DXA total body composition scans used for

Stavudine and Zidovudine.

These patients may also experience unexpected changes int heir bodies' dispersal of fat. This side effect is seen most often in patients taking the medications

HIV

patients often have an increase in fat around the abdominal region, and a loss of subcutaneous fat in the arms, legs, buttocks, and face. In these patients, fat also can increase in the breasts and shoulders, causing the appearance of a hump.

antiretroviral medications.

HIV-infected patients are often treated with

62%; 26%

Individuals in the Americas have a very high rate of obesity, and __________of the population is overweight. Over ________ of the population is obese

diabetes, hypertension, stroke, and increased risk of certain cancers.

Obesity in itself is not the main concern, but the medical problems associated with obesity include

the maximum table weight, table size, and under-penetration of low radiation doses.

While DXA total body composition scans are useful in evaluating bariatric patients, the limitations of DXA can make scanning bariatric patients difficult. These limitations include

Athletes

The scan can evaluate the effectiveness of a training regimen and show them what areas need improvement for who?

Anorexia nervosa

is an eating disorder that results in extreme weight loss.
Body composition scanning has shown to be very useful in understanding the patient's deficits in fat and lean mass. DXA lean tissue mass results are not consistent in evaluating nutrition, and should not be used to determine protein or other nutritional intake in anorexic patients.

sarcopenia

The natural process of aging leads to ___________, which is loss of muscle mass, as well as loss of musclefunction.

30% and 50%

Sarcopenia affects _______ of people over 60 years of age and ________ of people over the age of 80

3% to 5%

inactivity results in losses of ___________% of total muscle mass per decade

relative skeletal muscle index, or RSMI.

Classification of sarcopenia commonly uses the

7.26 /5.45

For diagnosis of sarcopenia, the RSMI values for men should be below ________and below _________for women

3% and 2%.

Precision testing results should meet the minimum acceptable percentages set by the ISCD. The 2015 ISCD official positions recommend total fat mass results should be within _________. For both total lean mass and percent fat mass, the results should be within ________

weekly

the ISCD recommends a ______________ body composition scan on a phantom with tracking and plotting of the data.

F-fluorodeoxyglucose

is a radiopharmaceutical used in positron emission tomography, or PET, scanning. On the scan, it appears to increase total body fat mass and decrease total body lean mass results.

Fast

Patients are required to ________because the intake of foods and fluids may affect the total and regional percentages of fat-free components.

Body fat

_______________ percentages are not affected by intake of food or fluids.

strenuous exercise

DXA results also are more accurate if the patient refrains from______________the day of the test and comes to the appointment well-rested.

same time of the day

For serial scanning, it is best to scan at the ______________ as the previous scan.

void their bladder

For consistency of scanning, the patient should _____________ before the scan

whole pelvis

If using on offset scan method on large patient what part of the body still needs to be included in its entirety ?

feet; mandible

In some cases, a patient may be too tall to fit within the scanning length of the table. In this situation, it's best to make sure the ________are included in the exam. However, The ___________must still be within the scan field to ensure accurate head and body ROI placements.

total body

The ___________ region of interest includes data from the entire body.

8 and 85

For comparing body composition information, it is most appropriate to use data obtained from the National Health and Nutrition Examinations Survey, or NHANES, from 1999 to 2004. This information is relevant for male and female patients of all races between the ages of _______________.

22.9% and 30.9%

Males demonstrated a low mean body fat of _______ between age 16 to 19, and a higher mean body fat of _________ between age 60 to 79

32.0% and 42.4%

The female body fat range was lowest, _________, at ages 8 to 11 which increased to _________ between age 60 to 79.

android region

is located at the midsection. Males usually carry more fat in this area. Individuals with more fat in this region are considered "apple-shaped".

gynoid region

is located around the hips and thighs. Females tend to carry more fat in this area. Individuals with more fat in this region are considered "pear-shaped".

Subcutaneous

_______________fats are found just underneath the skin

visceral

___________ fats are deeper in the body and surround the internal organs

5%

While healthy levels of fat can vary by individual, it is recommended for optimal health that men should not drop below ______body fat

12%

women should not drop below ________ body fat.

Lean mass index

can be obtained by adding the lean mass and bone mineral content in kilograms,then dividing them by the height in inches squared. Lean body mass includes muscle, bone, ligaments,tendons, and organs. These tissues are considered fat-free mass.

Appendicular lean mass, or ALM,

is the amount of lean mass in the arms and legs, not including bone.This value is important in the evaluation of patients with sarcopenia.

ALM to BMI ratio

Gaining ground as a better way to estimate sarcopenia risks in some individuals. This value is obtained by dividing the ALM by the BMI.

0.789 and 0.512

Ratios that have been linked to mobility impairment and fatigue are those lower than _____________in men and lower than in women.

Resting metabolic rate, or RMR, also known as resting energy expenditure,

is the estimated calorie requirement for the body to maintain a functional level of energy while performing minimal tasks for a day.This includes cardiac function, regulation of body temperature, respiration, and other vital processes.

lean body tissue.

The highest metabolic activity is seen within

the head, andprovide the BMI, BMD, BMC, total mass, total lean mass, total fat mass, and percent fat mass

At the very minimum, the recommendations provided by the ISCD should be followed. All reports should be calculated based on the total body including