Scientific article
Correlation Between Distal Radial Cortical Thickness and Bone Mineral Density

https://doi.org/10.1016/j.jhsa.2014.12.015Get rights and content

Purpose

To determine interobserver reliability in measuring the cortical thickness of distal radiuses on posteroanterior radiographs obtained at the time of injury and to determine whether there is a correlation between distal radius cortical thickness and hip and lumbar spine scores on dual-energy x-ray absorptiometry (DXA).

Methods

Four orthopedic surgeons at 2 academic institutions who were blinded to the study protocol reviewed standard posteroanterior wrist radiographs of 80 women over age 50 years with distal radius fractures with DXA data obtained within the past 2 years. Radial bicortical widths were measured at 50 and 70 mm proximal to the distal ulnar articular surface, and mean bicortical thickness was calculated from radiographs of the injured wrist. Average bicortical width was compared with each patient’s femoral and lumbar spine bone density measures. Data were analyzed using Pearson correlation coefficients and simple linear regression. Inter-rater reliability was evaluated using intra-class correlation coefficients.

Results

The inter-rater reliability for average bicortical thickness had a high intra-class correlation coefficient value of 0.91. Average bicortical thickness showed a statistically significant positive relationship with femoral bone density. Average bicortical thickness was statistically correlated with femoral bone density values, with a 1-mm increase in average bicortical thickness associated with a 0.05 g/cm2-increase in femoral density. Average bicortical thickness was not associated with lumbar bone density.

Conclusions

Bicortical thickness of the distal radius was positively correlated with femoral bone density but not with lumbar spine density. This may reflect similarity in quality and loading properties of the femur and radius as appendicular bones, compared with the axial spine. Identification of thinned distal radial cortices in association with distal radius fracture is a simple qualitative observation that should prompt further evaluation with DXA and medical management of bone insufficiency.

Type of study/level of evidence

Diagnostic II.

Section snippets

Materials and Methods

After we obtained institutional review board approval, we analyzed a subset of data collected as part of a cross-sectional study of postmenopausal women with distal radius fractures conducted at 2 academic institutions. Between 2011 and 2013, DXA scans were obtained for 80 consecutive women over age 50 years who had sustained distal radius fractures. This group had a mean age of 66 years (range, 50–94 y); 81% were Caucasian, 9% were black, 8% were Hispanic, and 2% were classified as other

Results

For the entire cohort, mean femoral bone density was 0.84 ± 0.14 g/cm2 and mean lumbar spine density was 1.00 ± 0.15 g/cm2. For cortical thickness measures, mean CBT was 5.75 ± 1.07 mm and mean GT1 and GT2 were 0.40 ± 0.08 and 0.42 ± 0.08, respectively.

Analysis using linear regression showed that BCT (r = 0.39; P < .01), distal GT1 (r = 0.44; P < .01), and average GT2 (r = 0.44; P < .01) were moderately associated with femoral bone density values (Fig. 2). Conversely, BCT (r = –0.05; P = .7), GT

Discussion

This study demonstrated that cortical bone density measured on standard PA wrist radiographs correlated with femoral bone mineral density on DXA. Patients with a diagnosis of osteoporosis based on DXA had a significantly thinner BCT, which supports the correlation between cortical thickness and bone density. Bicortical thickness of the proximal humerus and hand has been previously correlated with osteoporosis as detected by DXA7, 14 and has been suggested as a screening tool to determine which

Acknowledgments

Funding for this work was received from the American Foundation for Surgery of the Hand and the Orthopaedic Research and Education Foundation (RJOS/DePuy/OREF grant). The authors acknowledge the assistance of Katy Coyle, RN, Mark Cote, PhD, Lindsay Herder, BS, and Mary Bouxsein, PhD.

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