Radiographic techniques for early detection of osteoporosis.
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Sequelae of osteoporosis such as fracture and deformities usually occur when the bone mass has been severely reduced. Since the lost bone mass cannot be replaced, management of osteoporosis is aimed at preventing, halting, or retarding its progression. Early detection of osteoporosis and the identification of individuals at high risk for the disease are crucial if therapy is to be effective. Several radiographic techniques are currently available for osteoporosis screening, including dual photon absorptiometry (DPA), quantitative computed tomography (QCT), and dual-energy radiographic absorptiometry (DRA). This paper discusses the relative value and limitations of these techniques.Keywords:
Dual energy
Dual-Energy X-ray Absorptiometry
Bone disease
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Osteoporosis is a common bone disease in postmenopausal women that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, and bone micro- and macroarchitecture deteriorates. Osteoporosis is defined by the World Health Organization as a BMD of 2.5 standard deviations or more below the mean peak bone mass (average of young and healthy adults) as measured by dual energy X-ray absorptiometry (DEXA). Diagnosis of osteoporosis can be made using BMD measurement. The most popular method of measuring BMD is DEXA. In treatment, we can use various exercises and nutritional supplementation, medications, and lifestyle modification for the prevention of fractures.
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Peak bone mass
Bone Health
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Objective: To determine the validity of radiographic absorptiometry (RA) of the phalanges in detecting osteoporosis of the femoral neck, measured by dual energy X-ray absorptiometry (DXA). Material and Methods: In a group practice, 494 Causasian women aged 55 to 84 years were recruited. Hand radiographs and DXA measurements of the hip were performed in 449 women. 409 (91.1%) hand radiographs had sufficient quality for analysis by RA. Change of bone mass by age was obtained by using linear regression. Correlations between RA and DXA were calculated. Sensitivity and specificity of RA were calculated for several RA cut-off levels. Results: The mean bone mineral density at the femoral neck was 0.866 g/cm and 92.57 arbitrary units at the phalanges. A moderate correlation of 0.53 (p<0.01) was found between RA and DXA. Depending on the cut-off level used, the sensitivity and specificity of RA in detecting osteoporosis at the femoral neck was 0.84–0.55 and 0.61–0.88, respectively. Conclusion: RA may be used as a screening technique to detect osteoporosis, but confirmation is necessary in the subgroup with a positive outcome on RA.
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Objective To understand the clinical significances between the results obtained by calcaneal radiography and dual energy X－ ray absorptiometry (DEXA) for diagnosis of immobilization osteoporosis in children.Methods Twenty－ two patients kept in the bed measured the bone mineral density(BMD) lun DEXA in calcaneum, the upper and lower end of the tibia, lumbar spines (L1－ 4) and underwent calcaneal radiography before keeping the bed and one month, three months after keeping the bed. Results The BMD of the locations of examined and Jhamaria's grade of calcaneum were gradually lowered with increasing of lying in bed.Jhamaria's grade of calcaneum was positively associated with the BMD of the locations of examined.The positive rate of finding in osteoporosis between calcaneal radiography and the DEXA of the positions of examined was significantly difference in calcaneum over three months on bed. There was significant correlation between calcaneal radiogrphy and the BMD of the calcaneum over three months in bed.Conclusion calcaneal radiography is the best fundamental diagnostic method that suited to the condition of our coundry in immobilization osteoporosis in children.
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Objective To understand the clinical significances between the results obtained by calcaneal radiography and dual energy X－ray absorptiometry (DEXA) for diagnosis of immobilization osteoporosis in children.Methods Twenty－two patients kept in the bed measured the bone mineral density(BMD) lun DEXA in calcaneum, the upper and lower end of the tibia, lumbar spines (L1－4) and underwent calcaneal radiography before keeping the bed and one month, three months after keeping the bed. Results The BMD of the locations of examined and Jhamaria's grade of calcaneum were gradually lowered with increasing of lying in bed.Jhamaria's grade of calcaneum was positively associated with the BMD of the locations of examined.The positive rate of finding in osteoporosis between calcaneal radiography and the DEXA of the positions of examined was significantly difference in calcaneum over three months on bed. There was significant correlation between calcaneal radiogrphy and the BMD of the calcaneum over three months in bed.Conclusion calcaneal radiography is the best fundamental diagnostic method that suited to the condition of our coundry in immobilization osteoporosis in children.
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Objective To assess the sensitivity of quantitative ultrasound(QUS) in measuring bone mass comparing with dual energy X-ray absorptiometry(DEXA).Methods bone mineral density(BMD) at lumbar spine and proximal part of the femur was measured by DEXA and stiffness(STI) at calcaneus by QUS in 3266 subjects (2055 women,1211 men) of 20～89 years old in Nanjing.Results The peak value of STI and BMD was observed in the 20～29 age group in men,while in the 30～39 age group respectively in women.Parameters were decreased sharply in females after 50 years of age and after 70 year of age in male.There was no statistically significant difference between ultrasound and DEXA in osteoporsis detection rate.The correlation coefficients between STI and BMD were 0.21～0.26.Conclusions QUS is used mainly for detemining change in bone structure and DEXA in bone mass.It is better to use these two methods together to diagnose osteoporosis and predict the risk of fracture due to osteoporosis.
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Dual-Energy X-ray Absorptiometry
Densitometry
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It is a well-known fact that osteoporosis affects the people with old age and remains unnoticeable until the patient presents with fracture. Various studies in the literature reveal that panoramic radiographs may prove to be beneficial in the detection of Osteoporosis in patients. Henceforth this present study was aimed to validate the use of Klemetti Index (KI) on panoramic radiographs so as to detect osteoporosis in the patients at an early stage.60 postmenopausal women were selected. A panoramic radiograph was taken to grade their mandibular cortex on the basis of Klemetti Index. All the panoramic radiographs were evaluated by 5 different Oral Medicine and Radiology specialists. Later all the patients were subjected to dual energy X-ray absorptimetry (DEXA) scan for bone mineral density evaluation. The results were evaluated statistically.The average accuracy of the five observers to demonstrate normal bone, osteopenia and osteoporosis when compared to DEXA scan was 58.08%, 63.3% and 64.74% respectively. The observations of the 5 observers on the basis of KI were not statistically different from the BMD evaluation done with the help of DEXA Scan.Panoramic radiographs can be used as a screening tool for the evaluation as well as early detection of osteoporosis with the usage of Klemetti Index.
Osteopenia
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Plain radiography
Dual-Energy X-ray Absorptiometry
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Dual energy X-ray absorptiometry contributes to the effective treatment of osteoporosis, although several conditions are required, such as use of effective drugs for bone mass, non-deformed lumbar spines, and enough periods before evaluation of the efficacy. Recent clinical works suggest amelioration of bone quality is more important than the bone mass increase for fracture prevention. But, measurement of bone mass is still essential for the evaluation of osteoporosis treatment under the circumstance that no modalities for bone quality are available clinically.
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Peak bone mass
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Bone mass is the primary, although not the only, determinant of fracture. Over the past few years a number of noninvasive techniques have been developed to more sensitively quantitate bone mass. These include radiogrammetry (RG) and radiographic photodensitometry (RD), single and dual photon absorptiometry (SPA and DPA), quantitative computed tomography (QCT), and single and dual-energy X-ray absorptiometry (SEXA and DEXA). These techniques provide bone mass quantitation at the spine, wrist, hip and total body skeletal sites that are the principal areas usually involved in osteoporosis. The evaluation of the aetiology, progression, and treatment of osteoporosis has been clearly improved with the use of these methods. It is the intent of this review to discuss the pros and cons of these techniques, in particular their applications to the detection and management of osteoporosis.
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Dual-Energy X-ray Absorptiometry
Densitometry
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