Metacarpal Morphometry Using a Semi-automated Technique in the Assessment of Osteoporosis and Vertebral Fracture Risk

Abstract

Metacarpal morphometry represents a potentially cheap and widely available non-invasive assessment of skeletal status. In two cross-sectional studies, we compared the performance characteristics of a semiautomated technique (the Teijin Bonalyzer) with an in-house manual measurement, and with measures of skeletal strength at other sites. The metacarpal cortical index (mCI) was measured on hand radiographs of 178 osteoporotic women using both the Teijin Bonalyzer and a digitizing tablet. Measurements on the latter were consistently lower than with the Bonalyzer except for mCI (0.443+/-0.080 vs 0.364+/-0.060, p<0.001), although correlation coefficients between these two methods were highly significant (r = 0.62-0.83, p<0.001). The reproducibility errors of metacarpal bone mineral density (mBMD) were constant (1.1-1.2%) whilst those for mCI showed a marked operator-dependency (2.0-7.9%). In 379 elderly community-dwelling women, Bonalyzer mCI and mBMD showed a significant decline with age (r = -0.30 and -0.27 respectively, p<0.05). Both mCI and mBMD correlated significantly with forearm BMD (r = 0.50 and 0.57 respectively, p<0.001) and hip BMD (r = 0.48 and 0.53 respectively, p<0.001). After adjustment for age and weight, hip BMD demonstrated the best discrimination for prevalent vertebral fractures as judged by the gradient of risk for a 1 SD decrease in measurement (odds ratio (OR) 2.17, 95% CI 1.56-3.01). Similar but smaller gradients of risk were shown by Bonalyzer mCI (OR 1.32, 95% CI 1.00-1.75), mBMD (OR 1.35, 95% CI 1.02-1.78) and forearm BMD (OR 1.39, 95% CI 1.08-1.80). MCI, and in particular mBMD, may be useful assessments of bone mass and fracture risk. In our study, it is comparable to peripheral assessment of skeletal status by forearm densitometry.

Digital X-ray Radiogrammetry Predicts Hip, Wrist and Vertebral Fracture Risk in Elderly Women: A Prospective Analysis from the Study of Osteoporotic Fractures

“…Therefore, theoretically, these measurements may not be useful for prediction of fracture risk at clinically relevant sites. However, previous retrospective studies found that radiogrammetry measurements of the metacarpals and radius are lower in individuals with prevalent vertebral and wrist fractures [9,[13][14][15][16]. In addition, both retrospective and prospective studies demonstrated an association between BMD of the phalanges computed using radiographic absorptiometry and fracture risk [38][39][40].…”

“…Radiogrammetry has potential to be useful for diagnosis of osteoporosis, as previous studies have shown that ageand menopause-related decreases in radiogrammetry measurements are similar to the observed decrements in bone mineral density (BMD) [9][10][11][12]. In addition, radiogrammetry measurements of the metacarpals and radius are associated with prevalent wrist and vertebral fractures [9,[13][14][15][16]. One major advantage to radiogrammetry measurements is that they can be performed on standard radiographs of the hand and forearm, thereby giving the procedure the potential to be widely available.…”

“…The use of radiogrammetry for osteoporosis assessment decreased with the introduction of single-and dual-photon absorptiometry techniques in the 1970s, and single-and dualenergy X-ray absorptiometry in the 1980s [7]. However, in the past several years there has been increased interest in radiogrammetry due to the improvement in digital imaging and the development of automated and semiautomated image analysis algorithms [8,9]. Radiogrammetry has potential to be useful for diagnosis of osteoporosis, as previous studies have shown that ageand menopause-related decreases in radiogrammetry measurements are similar to the observed decrements in bone mineral density (BMD) [9][10][11][12].…”

“…However, in the past several years there has been increased interest in radiogrammetry due to the improvement in digital imaging and the development of automated and semiautomated image analysis algorithms [8,9]. Radiogrammetry has potential to be useful for diagnosis of osteoporosis, as previous studies have shown that ageand menopause-related decreases in radiogrammetry measurements are similar to the observed decrements in bone mineral density (BMD) [9][10][11][12]. In addition, radiogrammetry measurements of the metacarpals and radius are associated with prevalent wrist and vertebral fractures [9,[13][14][15][16].…”

Computer‐aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis

“…Dey et al. 33 found significant correlations between total hip BMD and the metacarpal index ( r = 0.48, P < 0.001) when screening for osteoporosis in 379 elderly, community‐dwelling women aged 75 years and older. A comparison of our results with those of previous studies indicated that our CAD system might be a useful screening tool for osteoporosis.…”