Comparison between metacarpal bone measurements by computarized radiogrammetry and total body DEXA in normal and osteoporotic women

Sex and External Size Specific Limitations in Assessing Bone Health From Adult Hand Radiographs

Morphological parameters measured for the second metacarpal from hand radiographs are used clinically for assessing bone health during growth and aging. Understanding how these morphological parameters relate to metacarpal strength and strength at other anatomical sites is critical for providing informed decision-making regarding treatment strategies and effectiveness. The goals of this study were to evaluate the extent to which 11 morphological parameters, nine of which were measured from hand radiographs, relate to experimentally measured whole-bone strength assessed at multiple anatomical sites and to test whether these associations differed between men and women. Bone morphology and strength were assessed for the second and third metacarpals, radial diaphysis, femoral diaphysis, and proximal femur for 28 white male donors (18-89 years old) and 35 white female donors (36-89+ years old). The only morphological parameter to show a significant correlation with strength without a sex-specific effect was cortical area. Dimensionless morphological parameters derived from hand radiographs correlated significantly with strength for females, but few did for males. Males and females showed a significant association between the circularity of the metacarpal cross-section and the outer width measured in the mediolateral direction. This cross-sectional shape variation contributed to systematic bias in estimating strength using cortical area and assuming a circular cross-section. This was confirmed by the observation that use of elliptical formulas reduced the systematic bias associated with using circular approximations for morphology. Thus, cortical area was the best predictor of strength without a sex-specific difference in the correlation but was not without limitations owing to out-of-plane shape variations. The dependence of cross-sectional shape on the outer bone width measured from a hand radiograph may provide a way to further improve bone health assessments and informed decision making for optimizing strength-building and fracture-prevention treatment strategies. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Hand bone segmentation in radioabsorptiometry images for computerised bone mass assessment

From hand radiographs, the measurement of the bone density of hand bones is automatically performed, using units relative to an aluminium wedge, in order to know the absorption of the ray light intensity respect to a known substance. By means of a point distribution model, the variation modes of a statistical model of the phalanx are determined, and the boundaries of such bones localised, aiming to obtain their average grey level. The goal is to obtain an accurate and reliable computerised radiographic X-ray absorptiometry system for automatic bone mass assessment that can be easily applied to the population. The developed system has been tested and compared to other known methods with a high level of correlation.

The metacarpal index revisited: a brief overview

Metacarpal index (MCI) is combined cortical thickness (both sides)) normalized with regard to outer bone diameter of the measuring site, the midshaft of the second metacarpal, or the three midmetacarpals of both hands. MCI is reduced with age, particularly in postmenopausal women. It correlates with axial bone mass in group studies. Measurement of the MCI in its modern version, digital X-ray radiogrammetry (DXR), requires only a plain analog radiograph, a PC, a film scanner, and reliable software. MCI can be used diagnostically and longitudinally for monitoring changes. MCI measured with DXR has few problems regarding accuracy and precision errors, and MCI is presently regaining lost territories among tests for quantification of bone mass and bone strength. It can be measured inexpensively and swiftly. MCI and other geometrical variables of bone can be measured on old radiographs, thus enabling estimation of cortical bone loss from the time of earlier recordings.

[Cortical bone mass and risk factors for osteoporosis among postmenopausal women in our environment]

OBJECTIVE

To evaluate the relevance of the so called risk factors for osteoporosis among women.

MATERIALS AND METHODS

A total of 150 consecutive postmenopausal women who had been enrolled in the gynecology outpatient clinics of the Health Areas affiliated to the Alcalá de Henares University Hospital. Bone mass of these women was calculated as index of metacarpal cortical area/total area (CA/TA) (mm2), measured by radiogrammetry.

RESULTS

With the ANOVA test, a late menarchial age and a shorter reproductive life induced a lower bone mass (p < 0.0005 and < 0.05, respectively); also, a history of bone fractures without previous relevant trauma (p < 0.05) was obtained. By correlational studies, there was a negative significance between CA/TA index and chronological age, menarchial age, menopausal age and number of fractures (r = -0.20 to -0.30; p < 0.05 to < 0.0001) and a positive significance with years of reproductive life (r = 0.17; p < 0.05). These values virtually remain unchanged when with partial correlation are weight adjusted, but with the multiple regression model, the CA/TA index is negatively significant only with menopause years (p < 0.005). Taking the average of the metacarpal CA/TA index as value, a sensitivity of 50% and an specificity of 78% were obtained to indicate fractures and a negative predictive value of 92%.

CONCLUSION

These results indicate the greater importance of menarchial age, of reproductive life years and therefore of menopausal years, as determinants of postmenopausal bone mass and show a very acceptable specificity of the CA/TA index as predictive for bone fracture.

Estimation of wrist fracture load using phalangeal speed of sound: an in vitro study

This study aimed to evaluate the ability of speed of sound (SOS) measured at the phalanges to estimate simulated wrist fracture load and stress. SOS was measured along the proximal phalanges of the second, third and fourth fingers using an ultrasound (US) system operating in axial transmission mode. The bone mineral density (BMD) of the radius and the phalanges was also measured with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA), and the combined cortical thickness (CCT) of the phalanges was measured from hand radiographs. After the measurements were completed, the radius was excised from the cadaver, embedded in polymethylmethacrylate and tested to failure on a servohydraulic testing machine. The configuration of the radius was chosen to simulate a fall onto the hand. Linear regression analysis showed a highly significant correlation between SOS (r = 0.76-0.94, p < 0.001), CCT (r = 0.86-0.90, p < 0.001) and BMD (r = 0.92-0.96, p < 0.0001) in the three proximal phalanges measured. SOS, BMD and CCT were significant predictors of fracture load (r = 0.60-0.69, p < 0.03) and stress (r = 0.65-0.77, p < 0.02). Cortical area and bone mineral content (BMC) of the radius were consistently higher predictors of fracture load (r = 0.76-0.82, p < 0.01 for area and r = 0.78-0.88, p < 0.01 for BMC) than BMD. The correlation of BMC and area was poorer with fracture stress. In a step-wise regression analysis using both phalangeal BMD and SOS, only SOS remained a significant predictor of fracture stress. In forward stepwise regression analysis, both cortical area and SOS were entered into the regression model to estimate fracture load. Only SOS remained significant in the model for estimating fracture stress. Phalangeal BMD was only entered in the combined model with the cortical area at the 4% site (r = 0.84, p = 0.002). Phalangeal SOS is a useful parameter in the assessment of bone status of the radius.

Digital X-ray radiogrammetry: a new appendicular bone densitometric method with high precision

The precision of any given method for measurement of bone mineral density (BMD) is important in relation to the interpretation of repeated measurements over time, e.g. to monitor the course of suspected osteoporosis or follow the effect of therapy. In the present study a new bone densitometer using the digital X-ray radiogrammetry (DXR) method (Pronosco X-posure Systemtrade mark) is investigated with respect to its short-term precision. The study was carried out on two groups of females, one consisting of 20 women between the ages of 30 and 40, and the other of 20 post-menopausal women above the age of 64. The mean age of the premenopausal women was 35.2 years and the mean DXR BMD was 0.578 g cm-2. The mean age of the post-menopausal women was 68.2 years and the mean DXR BMD was 0.489 g cm-2. The short-term precision of the two groups was evaluated using the coefficient of variation (CV%) and corresponding 90% confidence intervals. The coefficient of variation in the premenopausal group was 0.68% with a 90% confidence interval of 0. 57%-0.83%. The coefficient of variation in the postmenopausal group was 0.61% with a 90% confidence interval of 0.52-0.75%. It can be concluded from the present study that the short-term in vivo precision error of the DXR method is low in both pre- and post-menopausal women. When the results of the study are compared to data reported in the literature, the performance of the DXR method seems to be at least equivalent with peripheral DXA.

Vertebral and metacarpal morphometry as indicators of nutritional improvement

Because of the importance of nutrition in the development of bone mass, we studied the nutritional state, and bone state by means of metacarpal radiogrammetric measurements and vertebral morphometry in a group of 40 premenopausal women born between 1960 and 1970, mean age 29 +/- 5 years, and in another group of 40 postmenopausal women born between 1934 and 1944, mean age 55 +/- 4 years. Both groups were considered normal, the main characteristic distinguishing them being that the women born between 1934 and 1944 grew up in a period of widespread malnutrition in Spain and the women born between 1960 and 1970 grew up in a period of normal nutrition. Protein, carbohydrate and fat intake in these two periods differed significantly (p < 0.0001 in the three cases by Fischer's exact test). The values of the metacarpal measurements, anterior height of the dorsal vertebrae from T-4 to T-12, and posterior height from L-1 to L-4 between the premenopausal and postmenopausal groups of women were significantly different (p < 0.001) (Anova test). These findings show the importance of nutrition in the development of bone mass during childhood.

Bone status after long-term anticonvulsant therapy in epileptic patients: evaluation using quantitative ultrasound of calcaneus and phalanges

The bone status of 25 epileptic female patients on long-term (mean 19 y) anticonvulsant therapy was investigated using quantitative ultrasound of the calcaneus (Lunar Achilles) and phalanges (Igea DBM Sonic 1200). Comparisons were made with a control group of 43 normal healthy women. Radiogrammetric measurements of the second metacarpal bone were also made in the epileptic patients. While all of the ultrasonic parameters were reduced in the epileptic group, differences only achieved statistical significance for speed of sound (SOS) at the phalanges. Phalangeal SOS correlated significantly with cortical thickness of the second metacarpal bone (r = 0.44, p < 0.05). The data suggest that long-term anticonvulsant therapy is associated with significant cortical bone loss. Quantitative ultrasound may have a role in monitoring bone loss in epileptic patients and in guiding suitable preventive therapy.

New evidence that serum beta(2)-microglobulin behaves as a biological marker of bone remodelling in women

Having observed that serum beta(2)-microglobulin concentration correlates with serum tartrate-resistant acid phosphatase (TRAP) concentration in postmenopausal osteoporosis, and that metacarpal endosteal diameter is dependent on bone resorption, we correlated the two biochemical parameters with the radiographic parameter to determine if beta(2)-microglobulin behaves like a biological marker of bone remodelling. In 105 women (mean age 68 +/- 4 years) consisting of 60 normal postmenopausal women and 55 osteoporotic postmenopausal women, there was a significant positive correlation between metacarpal endosteal diameter and these two biochemical values (r = 0.66 with beta(2)-microglobulin and r = 0.68 with TRAP in the osteoporotic postmenopausal women; r = 0.48 with beta(2)-microglobulin and r = 0.56 with TRAP in the normal postmenopausal women; P < 0.001 for all comparisons). All three measurements were significantly higher (P < 0.001) in the osteoporotic postmenopausal women than in the normal postmenopausal women. These findings show that serum beta(2)-microglobulin behaves like a biological marker of remodelling.

Bone mass in Parkinson's disease: a study with three methods

Recent reports suggest the presence of osteopenia in a high percentage of patients with Parkinson's disease (PD). These data contrast with previous reports of our group, perhaps due to the different methods used. We studied bone mass in 52 PD patients (28 males, 24 females) and in 80 age- and sex-matched controls (40 males, 40 females) who had no other disease that could affect bone mass. We measured the totally body bone mineral content (TBBMC) and the ultrasound bone velocity (UBV) of transmission in phalanx, and performed metacarpal radiogrammetry with computerized radiography (CCT). We also measured serum levels of total alkaline phosphatase and tartrate-resistant acid phosphatase, which were significantly increased in PD patients compared with controls (P < 0.0001). TBBMC was significantly lower in males (P < 0.05) and females (P < 0.05) with PD with respect to their controls. CCT did not differ significantly between the study groups. UBV was significantly lower in males with PD (P < 0.005), but similar in female PD and controls. These data suggest that the changes reported in bone mass in PD patients can depend on the sex and the study methods. We only found severe osteopenia in one male (3.6%) and five females (20.8%) with PD according to z-score. Only in women was no relationship found between TBBMC and severity of PD.

Behavior of bone mass measurements. Dual energy x-ray absorptiometry total body bone mineral content, ultrasound bone velocity, and computed metacarpal radiogrammetry, with age, gonadal status, and weight in healthy women

RATIONALE AND OBJECTIVES

Bone mass as measured by dual energy x-ray absorptiometry varies with body weight. The authors studied the behavior of bone mass measurements made by ultrasound bone velocity and metacarpal radiogrammetry in relation to body weight.

METHODS

Eighty healthy women were studied: 40 post-menopausal and 40 premenopausal (mean age 60 +/- 6 and 38 +/- 8 years, respectively). The authors performed in every subject the following studies: a radiograph of the nondominant hand for metacarpal cortical thickness, a study of the 2nd to 5th proximal phalanges for ultrasound bone velocity, and total bone mineral content by dual energy x-ray absorptiometry.

RESULTS

The measurements obtained with the three methods correlated significantly with each other (P < 0.0001). The only parameter related significantly with weight were total bone mineral content (P < 0.0001). In the premenopausal women, age did not correlate with any measurement. In the postmenopausal women, age correlated significantly with the three measured parameters (P < 0.0058 to P < 0.0001).

CONCLUSIONS

Weight did not influence ultrasound bone velocity and metacarpal cortical thickness measurements.