Prediction of Osteoporosis through Radiographic Assessment of Proximal Femoral Morphology and Texture in Elderly; is it Valid and Reliable?

Abstract

The purpose of this study was to determine the best predictive radiographic measurement method to identify the presence of osteoporosis and test the inter-observer and intra-observer reliability and validity of these methods in postmenopausal women. Materials and Methods: Ninety-two elderly female patients who presented with hip pain were included. Hip radiographs were used to determine the values of Singh index (SI), canal-to-calcar ratio (CCR), and cortical thickness index (CTI). All measurements were performed by two independent observers on two separate occasions, at least 4 weeks apart. Bone mineral density (BMD) was assessed by DEXA. In the first part of the analysis, reliability of the all measurement methods was tested. In the second part, correlation coefficient (Pearson r) was used to determine the relationship between the measurement methods and BMD. Finally ROC curve analysis was performed to determine the sensitivity, specificity, and threshold values for each radiographic measurement method. Results: Intra-observer reliability analysis of SI revealed kappa coefficient of 0.359 for observer A, and 0.224 for observer B. Inter-observer reliability analysis of SI revealed kappa coefficient of 0.070 for observer A and 0.051 for observer B. The intra-observer and inter-observer reliability was good and excellent for CTI and CCR for both observers (ICC: 0.920 and ICC: 0.936). There was no correlation between SI and BMD (p=0.818). On the other hand, there was a significant correlation between CTI and CCR and BMD (p=0.001). All measured indices were significantly different (p<0.05) between osteoporotic and non-osteoporotic patients. CTI value less than 0.3 or CCR value less than 0.47 reflects the presence of osteoporosis with 100% sensitivity and 98% specificity. Conclusion: SI is not reliable and do not correlate with BMD. However, both CTI and CCR showed good and excellent reliability, and each index correlated well with the real BMD values.

Primary total hip arthroplasty using a short bone-conserving stem in young adult osteoporotic patients with Dorr type C femoral bone

“…CCR was calculated as the ratio of the isthmus canal width divided by the calcar canal dimension (Fig. 2 ) [ 16 ]. According to the Dorr classification, a CCR > 0.64 is considered to indicate type C bone [ 1 ].…”

“…Short bone-conserving cementless stems have been introduced to preserve proximal bone stock and allow for a more physiological proximal loading [14,15]. With the tapered-wedge design and shorter length or reduced distal end of the conventional cementless stem [16][17][18][19], the shortened tapered stems can achieve stable fixation in the proximal femur, which does not depend on metaphyseal hoop stress in the wide isthmus. Meanwhile, decreased resection of the upper femur and/or less reaming of the femoral shaft is beneficial for preserving the femoral canal and facilitating future revision in young adults.…”

Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis

“…To verify the finite element model, strain was measured by attaching a strain gauge at a total of 20 points on the anterior, posterior, medial, and lateral sides of the model, and compared with the previous study according to the method conducted by Heiner et al [19]. An osteoporotic FEM was reproduced according to the previously verified method [21]. Kose et al [21] reported that cortical thickness index (CTI) was significant measurement indicators to represent the osteoporotic bone model.…”

“…An osteoporotic FEM was reproduced according to the previously verified method [21]. Kose et al [21] reported that cortical thickness index (CTI) was significant measurement indicators to represent the osteoporotic bone model. CTI is calculated as the ratio of cortical thickness to bone diameter 10 cm distal to the lesser trochanter.…”

The correlation of Singh index and cortical thickness index toward bone mineral density in women older than 60 years old with femoral neck fracture

“…8,9 In addition, other parameters used to assess the degree of osteoporosis is CTI based on the morphology. 10,11 The gold standard to diagnose osteoporosis is by measuring bone mineral density through dual-energy X-ray absorptiometry (DXA). 12 DXA used for measuring BMD is not commonly available so that sometimes it can be difficult to diagnose osteoporosis, especially in remote areas where the modalities are very limited.…”