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- Wilczek, M, et al.
(författare)
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Predicting hip fracture risk with hand or wrist radiographs using digital X-ray Radiogrammetry
- 2012
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Ingår i: Bone. - : Elsevier. - 8756-3282 .- 1873-2763. ; 50:Supplement 1, s. S65-S65
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Background: More than 50% of patients diagnosed with osteoporosis after a fracture have had at least one previous fracture. Despite an established relationship between bone mineral density (BMD) and fracture risk, as well as proven effective pharmacological treatment, there is still no routine for screening for osteoporosis. Digital X-ray Radiogrammetry (DXR) analysis provides a simple way to obtain a BMD measurement. However, there is a need for larger studies evaluating the relationship between BMD obtained through DXR and future fracture risk. If such a relationship is strong enough, it should be possible to find osteoporotic patients already at the time of the first fracture by analyzing hand X-ray images with DXR. Aim: To evaluate if conventional radiographs can be used to estimate future hip fracture risk with DXR analysis. Method and materials: After receiving approval from the local ethical committee, all radiographs depicting the left hand were collected from three emergency hospitals in Stockholm, Sweden (n = 45,538). Radiographs with insufficiently depicted metacarpal bone, foreign material such as fixation pins, unacceptable positioning of the metacarpals or fractures in the measurement regions, were manually excluded. 18,824 radiographs from 15,072 unique patients were considered suitable for DXR analysis. These patients were matched with the death and inpatient registers found at the Swedish National Board of Health and Welfare. Exclusion criteria were age < 40 years (n = 6,611) and prior hip fracture (n = 199). ICD-10 codes were used to identify hip fractures, including only patients coded for both diagnosis and adequate intervention. Results: 5420 women and 2842 men met the inclusion criteria. Average observation time was 3 years and 3 months, resulting in a total observation time of 27,072 person years. In total 122 patients had a hip fracture after their radiograph of the hand or wrist. Patients who suffered from a hip fracture had a significantly lower BMD than that of non-fractured patients when adjusted for age (0.53 g/cm2, SD 0.08 versus 0.42 g/cm2, SD 0.05 in females and 0.63 g/cm2, SD 0.07 versus 0.54 g/cm2, SD 0.09 in males; p < 0.0001, both). The age-adjusted RR/SD for hip fracture was 2.52 in females and 2.08 in males. The AUC was 0.89 in female and 0.84 in male. Conclusion: DXR analysis of wrist and hand radiographs obtained at emergency hospitals in Sweden predicts hip fracture risk in women and men.
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