title: Radiographic texture analysis of densitometer-generated calcaneus images differentiates postmenopausal women with and without fractures.
abstract: BACKGROUND
  Bone fragility is determined by bone mass, measured as bone mineral density (BMD), and by trabecular structure, which cannot be easily measured using currently available noninvasive methods. In previous studies, radiographic texture analysis (RTA) performed on the radiographic images of the spine, proximal femur, and os calcis differentiated subjects with and without osteoporotic fractures. The present cross-sectional study was undertaken to determine whether such differentiation could also be made using high-resolution os calcis images obtained on a peripheral densitometer.
  
  
  METHODS
  In 170 postmenopausal women (42 with and 128 without prevalent vertebral fractures) who had no secondary causes of osteoporosis and were not receiving treatment for osteoporosis, BMD of the lumbar spine, proximal femur, and os calcis was measured using dual energy x-ray absorptiometry. Vertebral fractures were diagnosed on densitometric spine images. RTA, including Fourier-based and fractal analyses, was performed on densitometric images of os calcis.
  
  
  RESULTS
  BMD at all three sites and all texture features was significantly different in subjects with and without fractures, with the most significant differences observed for the femoral neck and total hip measurements and for the RTA feature Minkowski fractal (p<0.001). In univariate logistic regression analysis, Minkowski fractal predicted the presence of vertebral fractures as well as femoral neck BMD (p<0.001). In multivariate logistic regression analysis, both femoral neck BMD and Minkowski fractal yielded significant predictive effects (p=0.001), and when age was added to the model, the effect of RTA remained significant (p=0.002), suggesting that RTA reflects an aspect of bone fragility that is not captured by age or BMD. Finally, when RTA was compared in 42 fracture patients and 42 nonfracture patients matched for age and BMD, the RTA features were significantly different between the groups (p=0.003 to p=0.04), although BMD and age were not.
  
  
  CONCLUSIONS
  This study suggests that RTA of densitometer-generated calcaneus images provides an estimate of bone fragility independent of and complementary to BMD measurement and age.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Vokes
authors.forename: M L
authors.initials: ML
authors.lastname: Giger
authors.forename: M R
authors.initials: MR
authors.lastname: Chinander
authors.forename: T G
authors.initials: TG
authors.lastname: Karrison
authors.forename: M J
authors.initials: MJ
authors.lastname: Favus
authors.forename: L B
authors.initials: LB
authors.lastname: Dixon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D017709:Fractals; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011859:Radiography