Utility of Heel Dual-Energy X-ray Absorptiometry in Diagnosing Osteoporosis

Abstract

While peripheral dual energy X-ray absorptiometry (DXA) measurements have been found to predict fractures in population studies of Caucasians, little is known about their utility in other races and in patients with higher fracture risk. In a cross-sectional study of 874 women referred for bone mineral density (BMD) testing, we examined the utility of heel BMD in African-American (AA) compared to Caucasian (CA) women and in women using glucocorticoids. The ability of heel T-score to predict central osteoporosis was similar in AA and CA women (OR per 1 unit decrease in T-score of 2.79 [CI 2.16–3.60] and 3.15 [CI 2.53–3.92], respectively). The association between heel T-score and prevalent vertebral fractures was also similar in the two races (OR 1.46 [CI 1.15–1.85] in AA and 1.42 [CI 1.16–1.74] in CA). In women using glucocorticoids heel T-score was better than central T-score in predicting presence of vertebral fractures (OR 1.38 [CI 1.03–1.85] and 1.22 [CI 0.86–1.73], respectively). We conclude that in a multiracial referral population heel BMD predicts central osteoporosis and prevalent vertebral fractures equally well in AA as in CA women and may be better than central BMD in assessing fragility in glucocorticoid users.