Qualitative Evaluation of Digital Hand X-rays is Not a Reliable Method to Assess Bone Mineral Density

Miller, AndrewJ. and Jones, Christopher and Liss, Frederick and Abboudi, Jack and Kirkpatrick, William and Beredjiklian, Pedro (2017) Qualitative Evaluation of Digital Hand X-rays is Not a Reliable Method to Assess Bone Mineral Density. The Archives of Bone and Joint Surgery, 5 (1). pp. 10-13.

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Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.Methods: We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.Results: Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63, 0.42 and 0.54 respectively.Conclusion: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays.Â

Item Type: Article
Subjects: WE Musculoskeletal system
WN Radiology . Diagnostic Imaging
WO Surgery
Divisions: Journals > Archives of Bone & Joint Surgery
Depositing User: abjs abjs
Date Deposited: 24 Sep 2017 16:54
Last Modified: 24 Sep 2017 16:54
URI: http://eprints.mums.ac.ir/id/eprint/3624

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