Several noninvasive measurement methods are used for evaluation of metabolic disease. Single-photon (125I) scans of the peripheral skeleton are useful in some diseases but are ineffective in osteoporosis (even on the distal radius or os calcis) because they cannot predict spinal or femoral density. Also, peripheral measurements show high percentages of false negatives, that is many patients with fractures have normal peripheral density. Dual-photon (153Gd) scans of the spine, femur, and total skeleton are precise and accurate (2% error) and provide direct measurements of bone strength at fracture sites. This gives the best discrimination of abnormality and the most sensitive monitoring. Quantitative computed computed tomography (QCT) allows measurement of the spine but not the critical proximal femur area. QCT has a large accuracy error because (a) the limited area measured (under 5 cm3) fails to represent the total vertebral body, (b) technical errors, and (c) variable fat and osteoid influence the results.
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