Hand bone density assessment method to prevent hip fractures

Researchers from Karolinska Institutet in Sweden have discovered that a technique to measure bone density called digital X-ray radiogrammetry (DXR) used on standard hand radiographs can help in the identification of patients with a higher risk of hip fracture.

Each year, approximately 1.7 million hip fractures occur worldwide (about 18,000 in Sweden), mainly in elderly people and women with osteoporosis. A hip fracture can be particularly serious for the elderly; it often entails lengthy rehabilitation and leaves many patients unable to lead an independent life. Moreover, between 10 and 20 per cent of sufferers die from complications. Apart from the human suffering they cause, hip fractures are also very costly to the healthcare services in the amount of care they demand.

"If we can identify people with osteoporosis and treat them with drugs, we can reduce the risk of hip fracture," says principal investigator, Associate Professor Torkel Brismar of Karolinska Institutet's Department of Clinical Sciences, Intervention and Technology. "Our research shows that DXR is a technique that lends itself well to this, maybe at general health check-ups, or screenings, for example, or when people seek treatment for a suspected hand or wrist fracture."

In a paper published in European Radiology, the Karolinska Institutet scientists have detailed their analysis of 18,824 left-hand radiographs from over 8,000 patients using DXR. They correlated measurements of bone cortex porosity and thickness with whether patients suffered a hip fracture following the X-ray.

Those who suffered a post-X-ray hip fracture had significantly lower bone density than those who had not had a hip fracture. This result also held up when adjusted for age. The researchers have shown that DXR is at least as effective as dual-energy X-ray absorptiometry (DXA), the standard method of measuring bone density. This opens up the possibility of DXR being used in the future for osteoporosis examinations. In fact, several pilot projects are already underway to determine if DXR screening of bone density can indeed be used to prevent hip fractures.