Evaluation of the Relationship between Osteoporosis Parameters in Plain Hip Radiography and DXA Results in 156 Patients at a Single Center in Turkey

Abstract

Background: The aim of the current study is to determine the relationship between osteoporosis findings in plain X-ray and dual-energy X-ray absorptiometry (DXA) measurement results and to create an alternative diagnostic method for osteoporosis without DXA measurement when necessary. Methods: DXA values and hip radiographs of 156 patients were retrospectively analyzed. Singh index (SI), Dorr index (DI), cortical thickness index (CTI), and canal-to-calcar ratio (CCR) measurements from both plain hip radiographs were determined by two observers. The correlation of the DXA parameters (hip total T-score, femoral neck T-score, hip total Z-score, hip total bone mineral density [BMD], and femoral neck BMD) and osteoporosis markers on plain hip radiography (SI, DI, CTI, and CCR) was calculated. In addition, patients were evaluated by dividing them into three groups according to the level of their T-scores (normal, osteopenia, and osteoporosis). In addition, cut-off values were calculated for CTI and CCR. Results: The mean age was 68.27 ± 8.27 (50–85) years. There was a strong correlation between hip total T-score values and SI, DI, and CTI (r = 0.683, −0.667, and 0.632, respectively), and a moderate correlation (r = −0.495) with CCR. When both hips were compared, there were strong correlations between radiographic parameters (r = 0.942 for SI, 0.858 for DI, 0.957 for CTI, and 0.938 for CCR, all with p < 0.001). When patients divided into three groups according to the T-score level were compared in terms of SI, DI, CTI, and CCR, it was found to be directly related to osteoporosis level (all p < 0.001). In the differentiation of osteopenia and osteoporosis, the cut-off values were 50.4 degrees for CTI and 60.3 degrees for CCR. Conclusion: Good correlations between hip total T-score values and SI, DI, CTI, and CCR (r = 0.683, −0.667, 0.632, and −0.495, respectively) indicate that the presence of osteoporosis can be detected by hip radiography findings without DXA.

Cortical Thickness Index and Canal Calcar Ratio: A Comparison of Proximal Femoral Fractures and Non-Fractured Femora in Octogenarians to Centenarians

“…However, the mean age of these studies was relatively young and ranged between 64 and 72 years, which does not represent the most vulnerable age. A recent study by Ilyas et al confirmed the correlation between reduced BMD and CTI, whereas they did not examine fractured proximal femora in a cohort of 156 patients with a mean age of 68 years [25]. Although the current mean age of patients with proximal femoral fractures is 75 years, the health system will be challenged by a growing population of even older patients in the upcoming years [26].…”

Towards the diagnosis of osteoporosis – contributions from coincidental diagnostic imaging findings in chiropractors' practice

“…Although SI suffers from inaccurate estimates, i.e. low sensitivity, it has a high specificity which allows its use as an indicator of osteopenia [ 32 , 34 , 35 ]. However, this index cannot stand alone and should be utilized in combination with other tools such as DEXA when diagnosing osteoporosis [ 33 ].…”