Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study
Abstract Background Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-07127-w |
| _version_ | 1797276183306436608 |
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| author | Alana O’Mara Faes Kerkhof Deborah Kenney Nicole Segovia Paige Asbell Amy L. Ladd |
| author_facet | Alana O’Mara Faes Kerkhof Deborah Kenney Nicole Segovia Paige Asbell Amy L. Ladd |
| author_sort | Alana O’Mara |
| collection | DOAJ |
| description | Abstract Background Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD). Methods We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves. Results 2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores. Conclusions These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems. |
| first_indexed | 2024-03-07T15:24:42Z |
| format | Article |
| id | doaj.art-4cb2ce643c6e4add8f8732cef8829782 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-07T15:24:42Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-4cb2ce643c6e4add8f8732cef88297822024-03-05T17:24:42ZengBMCBMC Musculoskeletal Disorders1471-24742024-02-0125111010.1186/s12891-023-07127-wOpportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort studyAlana O’Mara0Faes Kerkhof1Deborah Kenney2Nicole Segovia3Paige Asbell4Amy L. Ladd5Department of Orthopaedic Surgery, Stanford UniversityDepartment of Orthopaedic Surgery, Stanford UniversityDepartment of Orthopaedic Surgery, Stanford UniversityDepartment of Orthopaedic Surgery, Stanford UniversityDepartment of Orthopaedic Surgery, Stanford UniversityDepartment of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford UniversityAbstract Background Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD). Methods We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves. Results 2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores. Conclusions These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.https://doi.org/10.1186/s12891-023-07127-wBone mineral densityForearm fracturesOsteoporosisHand x-rays |
| spellingShingle | Alana O’Mara Faes Kerkhof Deborah Kenney Nicole Segovia Paige Asbell Amy L. Ladd Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study BMC Musculoskeletal Disorders Bone mineral density Forearm fractures Osteoporosis Hand x-rays |
| title | Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study |
| title_full | Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study |
| title_fullStr | Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study |
| title_full_unstemmed | Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study |
| title_short | Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study |
| title_sort | opportunistic hand radiographs to screen for low forearm bone mineral density a prospective and retrospective cohort study |
| topic | Bone mineral density Forearm fractures Osteoporosis Hand x-rays |
| url | https://doi.org/10.1186/s12891-023-07127-w |
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