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The use of digital X-ray radiogrammetry and peripheral dual energy X-ray absorptiometry in patients attending fracture clinic after distal forearm fracture

Lookup NU author(s): Michael Reed, Emeritus Professor Roger Francis, Professor Andrew McCaskie


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Despite the fact that 50% of postmenopausal women with Colles' fracture have evidence of osteoporosis, the vast majority of women with forearm fractures are neither investigated nor treated for osteoporosis. Digital X-ray radiogrammetry (DXR) provides an attractive option in patients with distal forearm fracture, as it requires no additional X-rays over and above those performed as part of clinical management. We have compared DXR analysis of nonstandardised plain films taken routinely in accident and emergency with peripheral dual energy X-ray absorptiometry (pDXA) in a group presenting with distal forearm fracture. Women presenting with a fracture of the distal forearm underwent pDXA measurements of the calcaneus. Plain X-rays performed at the time of presentation were taken to allow adequate fracture treatment. No additional radiographer training or standardisation of films was performed. The DXR technique relies upon visualisation of the metacarpal shafts and this was not visualised on 123 of 201 (61%) films. The AP plain film was thus assessed using DXR for BMD in the remaining 78 patients with a mean age of 70.6 years (SE = 1.3). Mean BMD for DXR was 0.46 g/cm(2) (SE = 0.01) and for pDXA was 0.40 g/cm(2) (SE = 0.01). The correlation between BMD measured using the two techniques was 0.55 (P < 0.001). Although DXR measurements could not be performed in all patients, this proportion could easily be increased by routinely including the metacarpal shaft region in X-rays obtained after suspected distal forearm fracture. The correlation between the pDXA and DXR results is comparable with those reported between DXA measurements at the forearm, spine and hip. Our study suggests that DXR may provide a feasible method for the assessment of future fracture risk. The potential advantage of DXR over calcaneal pDXA measurements is that standard forearm X-ray obtained as part of fracture management could be used. (C) 2004 Elsevier Inc. All rights reserved.

Publication metadata

Author(s): Reed MR, Murray JRD, Abdy SE, Francis RM, McCaskie AW

Publication type: Article

Publication status: Published

Journal: Bone

Year: 2004

Volume: 34

Issue: 4

Pages: 716-719

ISSN (print): 8756-3282

ISSN (electronic): 1873-2763

Publisher: Elsevier


DOI: 10.1016/j.bone.2003.12.004


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