Osteoporosis X-ray
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American Roentgen Ray Society Images of Osteoporosis X-ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
X-ray may be helpful in the diagnosis of osteoporosis. The main finding on x-ray suggestive of osteoporosis is bone mass loss, identified with decreased bony trabecula in primary stages and then decreased cortical thickness. The most common bones monitored for osteoporosis evidences are femoral neck, lumbar vertebrae, and calcaneus. Plain radiography needs at least 30-50% of bone loss to demonstrate decreased bone density; therefore, it is not a very sensitive modality.
Osteoporosis X-ray
Plain X-ray
- X-ray may be helpful in the diagnosis of osteoporosis. The main finding on x-ray suggestive of osteoporosis is bone mass loss, identified with decreased bony trabecula in primary stages and then decreased cortical thickness. The most common bones monitored for osteoporosis evidences are femoral neck, lumbar vertebrae, and calcaneus.
- Plain radiography needs at least 30-50% of bone loss to demonstrate decreased bone density; therefore, it is not a very sensitive modality.
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Lumbar vertebrae
- The major findings correlated to osteoporosis in lumbar vertebrae are include:
- Wedge shape of vertebrae (decreasing anterior aspect of the body)
- Picture frame vertebrae (decreased cortical bone in periphery)
- Ghost vertebrae (decreased trabecular bone in the body)
- Vertebra plana (severe compression fracture)[1]
Femoral neck
- Singh's index: categorization of femoral neck bone mineral density upon visual scale of the trabecular bone existence on x-ray.
- The Singh's categories include:
- Grade 1: thin principle compression trabeculae
- Grade 2: principle compression trabeculae
- Grade 3: thin principle tensile trabeculae, with discontinuity
- Grade 4: thin principle tensile trabeculae, with continuity
- Grade 5: thin principle tensile and compression trabeculae
- Grade 6: normal appearance
- Reduced density of trabecular bone in the area, which is described by means of Singh's index (grades 3, 2, and 1), could reflect the diagnosis of osteoporosis[2]
Tubular bones
- Osteoporosis in these bones, especially metacarpals and metatarsals, appeared as loss of cortical thickness. However, cortical thickness of less than 25% of entire bone demonstrate osteoporosis.[1]
Dual energy X-ray absorptiometery (DEXA, DXA)
- The most important modality for measuring bone mineral density (BMD), that every osteoporosis diagnostic and therapeutic decision are based on, is dual energy X-ray absorptiometry (DEXA).[3] DEXA is a 2-dimensional image of a 3-demensional subject, mainly depends on size of the bone which is studied; therefore, it would explain the variety of BMD upon sex, body weight, and also ethnicity.[4]
- Considering the effect of bone size on 2-dimensional image of DEXA, the measured BMD is not reflecting the exact BMD; however, the DEXA fracture prediction would be better than 3-dimansional images, because small bones fractured easily than large bones.[5]
- DEXA is the choice modality because of the following factors:
- Short duration of procedure
- High validity in BMD measurement (accuracy)
- High reliability in BMD measurement (reproducible)
- High range of application (different bone sites)[6]
- There are many factors influencing the osteoporosis diagnosis, such as trabecular bone architecture; however, DEXA is the best predictor of osteoporosis and osteoporotic fractures by means of central BMD surveys.[7]
- For adults, it has to be always two sites of BMD measurement, Lumbar spine and femoral neck; in case each of them is impossible to evaluate, forearm will be substituted.[8]
- For children (less than 20 years old), femoral maturity level may be different among population, leading to lack of unique reference measure; thus, just one site of measurement (i.e., lumbar spine) is considered.[9]
- Upon the world health organization (WHO) report in 1994, using T-score (standard deviations (SD) below or above the average of young Caucasian women), BMD measures are divided into three groups, include:
- T-score greater than -1.0 SD assumed as normal BMD
- T-score between -1.0 and -2.5 SD assumed as osteopenia
- T-score less than -2.5 SD assumed as osteoporosis[10]
- Z-score is same as the T-score, but the target population is matched for age, sex, race, and also in some studies, weight.
- Using DEXA in men, almost always show higher BMD levels. But regarding the effect of bone size on DEXA measured BMD levels, it seems that higher BMD levels may be due to larger bones in men. Surprisingly, after matching the BMD levels, it is concluded that volumetric BMD is even lower in men. However, their fracture risk is same as women's risk; thus, the reference range of BMD for women assume for men, too.[11]
- Regarding the vast advantages of DEXA (low radiation exposure, high availability, and tremendous information related to fracture risk), it seems that DEXA will remain the masterpiece of fracture risk assessment and also osteoporosis diagnosis.[12]
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References
- ↑ 1.0 1.1 "Osteoporosis | Radiology Reference Article | Radiopaedia.org".
- ↑ "Singh index | Radiology Reference Article | Radiopaedia.org".
- ↑ Messina C, Monaco CG, Ulivieri FM, Sardanelli F, Sconfienza LM (2016). "Dual-energy X-ray absorptiometry body composition in patients with secondary osteoporosis". Eur J Radiol. 85 (8): 1493–8. doi:10.1016/j.ejrad.2016.03.018. PMID 27048946.
- ↑ Seeman E (1998). "Growth in bone mass and size--are racial and gender differences in bone mineral density more apparent than real?". J. Clin. Endocrinol. Metab. 83 (5): 1414–9. doi:10.1210/jcem.83.5.4844. PMID 9589631.
- ↑ Black DM, Bouxsein ML, Marshall LM, Cummings SR, Lang TF, Cauley JA, Ensrud KE, Nielson CM, Orwoll ES (2008). "Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using QCT". J. Bone Miner. Res. 23 (8): 1326–33. doi:10.1359/jbmr.080316. PMC 2680175. PMID 18348697.
- ↑ Cummings SR, Bates D, Black DM (2002). "Clinical use of bone densitometry: scientific review". JAMA. 288 (15): 1889–97. PMID 12377088.
- ↑ Lorente-Ramos R, Azpeitia-Armán J, Muñoz-Hernández A, García-Gómez JM, Díez-Martínez P, Grande-Bárez M (2011). "Dual-energy x-ray absorptiometry in the diagnosis of osteoporosis: a practical guide". AJR Am J Roentgenol. 196 (4): 897–904. doi:10.2214/AJR.10.5416. PMID 21427343.
- ↑ Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008). "Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference". J Clin Densitom. 11 (1): 75–91. doi:10.1016/j.jocd.2007.12.007. PMID 18442754.
- ↑ Baim S, Leonard MB, Bianchi ML, Hans DB, Kalkwarf HJ, Langman CB, Rauch F (2008). "Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Pediatric Position Development Conference". J Clin Densitom. 11 (1): 6–21. doi:10.1016/j.jocd.2007.12.002. PMID 18442749.
- ↑ "WHO IRIS: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis : report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]".
- ↑ Srinivasan B, Kopperdahl DL, Amin S, Atkinson EJ, Camp J, Robb RA, Riggs BL, Orwoll ES, Melton LJ, Keaveny TM, Khosla S (2012). "Relationship of femoral neck areal bone mineral density to volumetric bone mineral density, bone size, and femoral strength in men and women". Osteoporos Int. 23 (1): 155–62. doi:10.1007/s00198-011-1822-8. PMC 3640410. PMID 22057550.
- ↑ Jain RK, Vokes T (2017). "Dual-energy X-ray Absorptiometry". J Clin Densitom. doi:10.1016/j.jocd.2017.06.014. PMID 28716497.