Digital X-ray radiogrammetry in the study of osteoporotic fractures: Comparison to dual energy X-ray absorptiometry and FRAX

Abstract

Osteoporosis is often underdiagnosed and undertreated. Screening of post-menopausal women for clinical risk factors and/or low bone mineral density (BMD) has been proposed to overcome this. Digital X-ray radiogrammetry (DXR) estimates hand BMD from standard hand X-ray images and have shown to predict fractures and osteoporosis. Recently, digital radiology and the internet have opened up the possibility of conducting automated opportunistic screening with DXR in post-fracture care or in combination with mammography. This study compared the performance of DXR with FRAX® and DXA in discriminating major osteoporotic fracture (MOF) (hip, clinical spine, forearm or shoulder), hip fracture and femoral neck osteoporosis. This prospective cohort study was conducted on 5278 women 65 years and older in the Study of Osteoporotic Fractures (SOF) cohort. Baseline hand X-ray images were analyzed and fractures were ascertained during 10 years of follow up. Age-adjusted area under receiver operating characteristic curve (AUC) for MOF and hip fracture and for femoral neck osteoporosis (DXA FN BMD T-score ≤ −2.5) was used to compare the methods. Sensitivity to femoral neck osteoporosis at equal selection rates was tabulated for FRAX and DXR. DXR-BMD, FRAX (no BMD) and lumbar spine DXA BMD were all similar in fracture discriminative performance with an AUC around 0.65 for MOF and 0.70 for hip fractures for all three methods. As expected femoral neck DXA provided fracture discrimination superior both to other BMD measurements and to FRAX. AUC for selection of patients with femoral neck osteoporosis was higher with DXR-BMD, 0.76 (0.74–0.77), than with FRAX, 0.69 (0.67–0.71), (p<0.0001). In conclusion, DXR-BMD discriminates incident fractures to a similar degree as FRAX and predicts femoral neck osteoporosis to a larger degree than FRAX. DXR shows promise as a method to automatically flag individuals who might benefit from an osteoporosis assessment.

Comparison of a mobile application to estimate percentage body fat to other non-laboratory based measurements

“…However given the previously mentioned limited access for this equipment [11,14], it was deemed appropriate to examine the software application against instruments with comparable access i.e. low-cost, convenience and portability [1].…”

“…Although there is some disagreement in the literature for what is considered the gold standard assessment of body composition in humans, there is agreement that these methods present difficulties such as expense, time-consumption, access, and portability [11,14]. Much of this equipment is expensive for front-line practitioners such as primary healthcare workers, nutritionists, personal trainers and strength and conditioning coaches, and is typically restricted to University laboratory / research settings.…”

Fracture risk assessment tool (FRAX) and for the diagnosis of osteoporosis in Japanese middle-aged and elderly women: Chiba bone survey

“…Another study shows that both FRAX with femoral neck BMD and FRAX without BMD predict major osteoporotic and vertebral fractures [17]. A recent study reports that FRAX without BMD discriminates major osteoporotic fracture and hip fracture during 10 years to the similar degree as BMD measured by digital X-ray radiogrammetry (DXR), but is inferior to DXR-BMD in predicting femoral neck osteoporosis [18]. FRAX score with femoral neck BMD may be required to diagnose osteoporosis.…”

Evaluation of low bone mass and prediction of fracture risk using metacarpal radiogrammetry method: a comparative study with DXA and X‐ray phantom

“…The performance of the measurement at different sites varies with technology. The peripheral measurements have a weaker ability to discriminate hip fractures than DXA measured BMD at the femoral neck . The BMD measurement at total hip has high precision, reproducibility and correlation with fracture risk, whereas the lumbar spine BMD measurements are also highly reproducible but their usage is limited due to artifacts .…”