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. 2024 Feb 20;25(1):159.
doi: 10.1186/s12891-023-07127-w.

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

Alana O'Mara  1 , Faes Kerkhof  2 , Deborah Kenney  2 , Nicole Segovia  2 , Paige Asbell  2 , Amy L Ladd  3
Affiliations

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

Alana O'Mara et al. BMC Musculoskelet Disord. .

Abstract

Background: Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).

Methods: We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.

Results: 2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.

Conclusions: These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.

Keywords: Bone mineral density; Forearm fractures; Hand x-rays; Osteoporosis.

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Conflict of interest statement

AO, FK, DK, NS, PA, and AL declare they have no conflicts of interests, both personal or institutional, regarding specific financial interest that are relevant to the work conducted and ported in this manuscript.

Figures

Fig. 1
Fig. 1
Measurement of second metacarpal percentage using hand radiographs. (A) measures the cortical diameter at the isthmus and (B) measures the intramedullary diameter
Fig. 2
Fig. 2
Significant differences of BMD comparisons by anatomical location. Right location is marked in light blue, left in light green, and AP in dark green. All pair-wise comparisons between forearm locations and weight bearing regions were significantly different with p < .001. Boxes represent interquartile range (IQR) with median bar, whiskers showing minimum to maximum, individual dots represent outliers. P < .001 not marked
Fig. 3
Fig. 3
Optimal cutoff value of cortical percentage for 1/3 Distal Forearm. Receiver Operator Curves for cortical percentage cutoff for optimal sensitivity and specificity for osteopenia (a) and osteoporosis (b) of 1/3 distal forearm, box and whiskers blot showing cutoff (dashed red line) of 52.3% for osteopenia (c), and 48.3% for osteoporosis (d) of the 1/3 distal forearm
Fig. 4
Fig. 4
Optimal cutoff value of cortical percentage for Most Distal Forearm. Receiver Operator Curves for cortical percentage cutoff for optimal sensitivity and specificity for osteopenia (a) and osteoporosis (b) of the most distal forearm, box and whiskers blot showing cutoff (dashed red line) of 49.8% for osteopenia (c), and 50.8% for osteoporosis (d) of most distal forearm
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