title: Modified calcaneal index: a new screening tool for osteoporosis based on plain radiographs of the calcaneum.
abstract: OBJECTIVE
  To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius.
  
  
  METHODS
  Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed.
  
  
  RESULTS
  The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was significant (hip BMD, r=0.31; distal radius BMD, r=0.28; calcaneal speed of sound, r=0.20; broadband ultrasound attenuation, r=0.36) [p<0.005]. There were significant differences in hip BMD, distal radial BMD, calcaneal speed of sound, and broadband ultrasound attenuation between the 3 grades of the modified calcaneal index (Kruskal-Wallis 1-way ANOVA; p<0.0001).
  
  
  CONCLUSIONS
  The modified calcaneal index can be used to measure bone structure and skeletal strength and is a suitable screening tool for osteoporosis in places where advanced approaches to bone-status assessment are not available.
authors.affiliation: Sushrut Hospital, Research Centre and PGI Orthopaedics, Ramdaspeth, Nagpur, India. ketanpande@yahoo.com
authors.forename: K C
authors.initials: KC
authors.lastname: Pande
authors.forename: S K
authors.initials: SK
authors.lastname: Pande
authors.forename: D
authors.initials: D
authors.lastname: de Takats
authors.forename: E V
authors.initials: EV
authors.lastname: McCloskey
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D015588:Observer Variation; D010024:Osteoporosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011884:Radius / Q000000981:diagnostic imaging; D014463:Ultrasonography