Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk—a study in 5,420 women and 2,837 men

Abstract

ObjectivesTo assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk.MethodsA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age ≥ 40 years, no prior hip fracture and observation time > 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression.Results8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men.ConclusionsDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men.Key Points• Digital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk.• Digital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men.• Osteoporosis can potentially be identified in patients with suspected wrist fractures.• DXR can potentially be used for selective osteoporosis screening.

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

“…Previous studies have shown DXR-BMD measurements to predict hip, spine and other fractures to a similar degree as other peripheral BMD measurements [12–15]. Furthermore, DXR-BMD did also predict osteoporosis as measured by central DXA [15–17].…”

“…DXR can be performed on hand images acquired with any digital X-ray machine including those used for digital mammography. This means that DXR can be opportunistically integrated in existing mammography screening workflows with small impact on the workflow [11], or used to automatically process all forearm fracture images [12]. …”

Exploring the relationship between bone density and severity of distal radius fragility fracture in women

“…Digital X-ray radiogrammetry (DXR) is a feasible method which calculates cortical BMD in the metacarpal bones from plain X-rays [13,14]. Assessment by this method has revealed a significant reduction in DXR-BMD in patients with distal radius fracture compared with individuals in the general population and has been shown to be a predictor and risk factor for distal radius fracture and hip fracture [15-17]. The primary aim of the present study was to explore if there also is an association between reduced cortical hand BMD measured with DXR and fracture severity.…”

Bone Densitometry in Children

“…Consequently, DXR has proved a useful tool in adults as a predictor of long-term outcomes in rheumatoid arthritis and fracture prediction. 85,86 In children there are DXR reference data published, 87 and the technique has been applied to fracture prediction and the study of normal bone growth and development, and the differences between patient groups and healthy children. More recently, DXR has been combined with automated bone age assessment; in the BoneXpert system a pediatric bone index is provided 88 whose clinical value is still to be established.…”