The clinical necessity of a distal forearm DEXA scan for predicting distal radius fracture in elderly females: a retrospective case-control study

Abstract

Background Recent studies have demonstrated that the distal forearm dual-energy X-ray absorptiometry (DEXA) scan might be a better method for screening bone mineral density (BMD) and the risk of a distal forearm fracture, compared with a central DEXA scan. Therefore, the purpose of this study was to determine the effectiveness of a distal forearm DEXA scan for predicting the occurrence of a distal radius fracture (DRF) in elderly females who were not initially diagnosed with osteoporosis after a central DEXA scan. Methods Among the female patients who visited our institutes and who were over 50 years old and underwent DEXA scans at 3 sites (lumbar spine, proximal femur, and distal forearm), 228 patients with DRF (group 1) and 228 propensity score-matched patients without fractures (group 2) were included in this study. The patients’ general characteristics, BMD, and T-scores were compared. The odds ratios (OR) of each measurement and correlation ratio among BMD values of the different sites were evaluated. Results The distal forearm T-score of the elderly females with DRF (group 1) was significantly lower than that of the control group (group 2) (p < 0.001 for the one-third radius and ultradistal radius measurements). BMD measured during the distal forearm DEXA scan was a better predictor of DRF risk than BMD measured during the central DEXA (OR = 2.33; p = 0.031 for the one-third radius, and OR = 3.98; p < 0.001 for the ultradistal radius). The distal one-third radius BMD was correlated with hip BMD, rather than lumbar BMD (p < 0.05 in each group). Conclusion Performing a distal forearm DEXA scan in addition to a central DEXA scan appears to be clinically significant for detecting the low BMD in the distal radius, which is associated with osteoporotic DRF in elderly females. Level of evidence III; case-control study.

Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study

“…Additionally, both femoral neck and spine T-scores overestimated T-scores in the forearm of the fracture group [ 14 ]. Ma and colleagues further demonstrated the importance of local forearm BMD assessment with retrospective data showing patients who sustained distal radius fractures had significantly lower forearm BMD and low T-scores about the radius were a predictive risk factor for fracture, while femoral neck, hip and spine T-scores were not significant risk factors for the occurrence of distal radius fractures [ 27 ]. These studies highlight the importance of determining local forearm osteopenia and osteoporosis separate from weight-bearing locations.…”

“…Research shows a 25.9% reduction in fracture risk at any site for those screened before the standard age of 65 [ 25 , 26 ]. Screening specifically for forearm BMD is extremely beneficial as it has a much stronger odds ratio (3.98) to predict distal radius fractures than BMD from the hip (OR = 0.27) or femoral neck (OR = 0.26) [ 27 ]. Expanded screening tools could help patients receive calcium supplementation and or vitamin D, start on osteoporosis treatment, forestall further injury, or disability.…”

Associations between ultra-distal forearm bone mineral density and incident fracture in women

“…In a retrospective case–control study including women aged ≥ 50 years, BMD UDforearm was better at discriminating those with distal radius fracture than BMD measured at the hip or spine [ 5 ]. The authors did note, however, that T-scores for the ultra-distal radius site were lower than those at the hip or spine.…”

“…Measuring BMD UDforearm is quick, with a lower radiation dose [ 4 ], but more data are needed to understand how it may assist fracture prediction. BMD UDforearm has been associated with BMD at the hip and spine [ 4 , 5 ]. Additionally, individuals with distal radius fractures have been reported to have lower BMD at the hip and spine [ 6 ].…”

An Automated Assessment Method for Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Utilizing Metacarpal Cortical Percentage

“…Recent research has shown that DXA of the distal forearm may be a superior method for screening bone mineral density (BMD) and assessing the risk of distal forearm fractures compared to central DXA scans. Article [17] examined the medical records of 384 female patients with distal radius fractures. Their findings indicate that BMD of the distal onethird radius is more closely correlated with hip BMD than lumbar BMD (p < 0.05 in each group).…”