By Joan Trombetti

This article is from in the July 2007 issue of DOTmed Business News. A list of registered users that provide sales & service can be found at the end.

Meet the Inventor of the Machine. "There are now over 50,000 bone densitometers in the world. I doubt if more than 50 radiologists in the world know who invented the instrument." These are the words of the late John R. Cameron from 2002, professor emeritus at the University of Wisconsin, Madison, and the inventor of the bone densitometer.

In 1959, Cameron discovered that there was no way to detect early osteoporosis, even though many older women were breaking their hips and, in some cases, dying. He invented the densitometer in 1960, but it was not often utilized because there was no known treatment for the problem. Yet, on its 25th anniversary, Investigative Radiology listed one of Cameron's early bone densitometry publications (Invest. Radio. 3:141; 1968) as its single most cited article.

Today, the densitometer is an important diagnostic tool that is used to measure the amount of matter in a given bone, or bone mineral density (BMD). Cameron died in 2005, believing that he received little recognition for his invention. He did, however, believe that his contribution led to many useful clinical applications in accurately measuring bone densitometry. Lunar Radiation (now GE-Lunar) arose directly from early work done in Cameron's laboratory.




The Need For Bone Densitometers Grows
As life expectancy increases, so does the occasion of certain chronic disabilities, including osteoporosis, among the elderly. Osteoporosis is also a risk factor in postmenopausal women because of estrogen deficiency and other factors. Osteoporosis and osteopenia (BMD that is lower than normal peak BMD but not low enough to be classified as osteoporosis) affect as many as 44 million people age 50 and older in the United States alone.

Bone mass usually peaks between the third and fourth decades of life. After this time, there is a natural decline that is more prominent in elderly and postmenopausal women. In these groups, it has been observed that the higher the peak bone mass achieved, the less likely bone fractures will occur. Factors such as lifestyle and genetic makeup also affect bone density.

It is therefore essential to have an understanding of bone acquisition and bone loss so that physicians can plan more effective preventive and treatment protocols. There are several different methods of determining BMD, including some that utilize CT and ultrasound technologies, though the most prevalent is Dual energy X-ray absorptiometry (DEXA). DEXA uses two X-rays at different energy levels to measure BMD through the rate of absorption. With processes like these, researchers are finding new ways to treat the effects of aging, injury and disease.



A densitometer measures bone mineral density, assessing the strength of the bones and the probability of a fracture. It is a noninvasive procedure and, unlike a bone scan, a densitometer does not inject a radioactive contrast material into the bloodstream. Some bone densitometry machines are made for scanning extremities, and can be found in small practices; others are made for full-body scans and are usually based in a hospital, medical office, or clinic.

Companies that Provide Sales And Service
For this report, we interviewed several of the leading sales and service companies who sell bone densitometers manufactured by leading companies like GE Lunar, Hologic, Norland, Schick Technologies, DMS, and Osteometer Meditech. The equipment ranges from smaller, less expensive peripheral diagnosis units to larger DEXA tables that provide the gold standard in BMD.

TRITECH SERVICES out of Louisville, Kentucky specializes in Hologic and Lunar densitometers. Vice President John Cline revealed that the company's main engineer was a field engineer for Hologic and has been working on these systems for over 10 years. "He was also cross-trained on the Lunar products, and he can service Norlands," says Cline. Like some other companies we spoke with, TRITECH sells and services all of its refurbished equipment. Cline said that the company also stocks Hologic parts. Cline finds opportunity in the fact that those who are in the market to purchase a densitometer do not have to spend up to $100,000 on a new system when they can purchase a system with the exact same technology for 35 to 40 percent less.

Integrity Medical Systems of Fort Meyers, Florida has one of the largest medical equipment inventories in the country, including 70 to 80 bone densitometers in stock at any given time. CEO David Denholtz believes that when someone buys equipment from Integrity Medical Systems, they aren't just buying the equipment - they are buying into the company. Says Denholtz, "we sell from stock and have our own parts inventory and a dedicated factory-trained, bonded service team that specializes in refurbished and new bone densitometry equipment and parts. We have over 150 systems installed worldwide, 70-plus systems in stock and over 10,000 parts ready to ship. We treat our business like a science - offering the highest level of service and commitment to our customers." This CEO knows that servicing healthcare professionals, dealers, hospitals, OEMs and a host of international clients is a huge responsibility, but his company does it and does it well.

One of Denholtz's main concerns is the DRA (Deficit Reduction Act) and how it will affect Medicare reimbursement rates. He is worried that Medicare will pay less than the estimated cost of performing the procedure in physician offices, and that independent reimbursement for the bone densitometry tests necessary for the diagnosis of women at risk for osteoporosis (a recently enacted Medicare screening benefit) will be reduced by over 40%. "It will force many doctors and centers that offer bone density tests to discontinue the service, and that will definitely affect companies who sell densitometers and medical equipment," said Denholtz.

Metropolis International of Long Island City, New York buys, sells and rents quality pre-owned medical equipment. President Leon Gugel believes that when it comes to densitometers, "any system that a hospital or clinic purchases should be purchased from a trusted and reputable company. The end user has to find a comfort level with a particular company or person and then move on to pricing and manufacturer preference." Gugel adds, "if a hospital is dealing with a reputable company like Metropolis International, they will always get a great price and great service." When asked what he felt the biggest challenges were facing bone densitometer ISOs (independent service organizations), he said, "Having the right experienced people to perform the work that may be required. Some people fix things without really knowing what they are doing." He said that the most common problems with bone densitometers are the drive belts or a missing positioner, but over the past 10 to 12 years, the bone density systems are "good robust" systems that are pretty much "break free."

"When the technicians at Metropolis International refurbish a bone densitometer, they test the unit first to see what needs to be done. They replace all belts, boards, and peripherals and test the system. The panels are stripped, primed and repainted. The units are rebuilt and tested to make sure they are up to OEM specifications," explained Gugel.

Michael D. Lies, owner of Medical Advantages Inc., began in the medical field fourteen years ago. His business and clinical background and knowledge as a licensed radiologic technologist gives him an understanding of his clients' need to succeed in the highly competitive medical services field. Lies sells all diagnostic imaging systems, including densitometers, and uses dedicated contractors in every modality. "We provide turnkey deals, i.e. our trained engineers will install, calibrate and provide applications training, logistical and operational support for any late model bone densitometry system(s) that a customer purchases," explains Lies. He feels that all OEMS are friendly to third parties -- when the ISOs come looking for parts, that is -- and he is also concerned about the DRA proposed cutbacks. When asked what he felt was the most common problems that need repair in a bone densitometer, Lies said, "When we refurbish a densitometer, we look at the detectors that frequently need to be replaced, as well as replace all wiring, tubes and any worn parts."

Absolute Medical Equipment specializes in new and used equipment from top manufacturers that includes bone densitometers, and other equipment.

Abe Sokol, marketing director, said that sales and service of the machines are accomplished by using a network of affiliated bone densitometer technicians nationwide. He believes that problems can arise when a piece of equipment is installed or removed. "Installations and deinstallations must be done professionally to avoid damaging valuable equipment. We have come across equipment that was not deinstalled properly and have seen problems ranging from missing parts to damaged tubes," explained Sokol.

The Bottom Line

When purchasing bone densitometry equipment it is imperative to choose an informed provider. A steady demand in the market for refurbished equipment has brought about an increase in the number of companies that sell preowned equipment at prices 40 to 60 percent less than the cost of a new one.

All of us realize that healthcare budgets are tight, but as baby boomers get older, the demand for BMD scans will only increase. Sales people that are out in the field looking for densitometer buyers should try new healthcare sites including primary care facilities, pharmacies and other wellness centers and specialty clinics. And education efforts should create awareness about the importance of bone density testing and how the Deficit Reduction Act (DRA) of 2005 will drastically cut Medicare reimbursements for bone density exams. The payment reductions will affect a broad range of medical imaging, including a 40% cut in bone densitometry studies for osteoporosis.

Thanks to groups like Access to Medical Imaging Coalition, a coalition of industry groups and companies affected by the legislation, bills are now in the House and Senate calling for a two-year delay on cuts. This will allow for a re-evaluation of this legislation, and a realization of the value that bone densitometers have to many Medicare patients.

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DOTmed Registered Bone Densitometer Sales & Service Companies

Domestic
Abe Sokol, Absolute Medical Equipment , NY
DOTmed 100
Gus Antus, Ampro International, Ltd , AZ
DOTmed Certified
Pete Garris, Back Pain Relief Medical Centers, MS
Patrick Doyle, Complete Medical Services , MI
DOTmed Certified
Desmond Johnson, DEXAScanners, Inc. , TN
Samir Dahdah, Doral Medical Equipment , FL
Teddy Cohen, Elite Medical , NY
DOTmed Certified
David Denholtz, Integrity Medical Systems, Inc. , FL
DOTmed Certified/100
Don Settergren, IO Sales , WI
Michael Lies, Medical Advantagess , PA
DOTmed Certified
Leon Gugel, Metropolis International, NY
DOTmed Certified/100
Mark Ralston, Scientific Instrument Center , OH
John Cline, Tritech Services, KY

International
Gautam Sehgal, Ads diagnostic limited, India
DOTmed 100

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