title: Low bone mass and fractures on foot radiographs: missed opportunities to evaluate for osteoporosis: a pilot study.
abstract: BACKGROUND
  Osteoporosis is often unrecognized, even in the presence of radiologic evidence of vertebral or nonvertebral fragility fractures.
  
  
  METHODS
  Ninety patients aged 50 years and older with radiographs of the foot taken at Howard University Hospital between 2003 and 2005 were randomly selected. In phase 1, standard radiograph reports were reviewed for evidence of osteopenia, fractures, or both. In phase 2, risk factors for osteoporosis and dual energy x-ray absorptiometry scans were obtained.
  
  
  RESULTS
  In phase 1, radiologists reported all of the fractures for all 90 participants; however, osteopenia was reported in only 54.7% of these. In phase 2, for 50% of the participants with radiographic evidence of osteopenia, fractures, or both, there was no evidence that the clinicians evaluated risk factors for low bone mass or requested a dual energy x-ray absorptiometry scan. Of participants who had radiographic evidence of osteopenia, osteoporosis, or both, 83.3% met the criteria for dual energy x-ray absorptiometry scans.
  
  
  CONCLUSIONS
  Osteopenia or fracture observed on radiographs of the foot are predictive of low bone mass but are often not evaluated.
authors.affiliation: Department of Internal Medicine, Howard University, College of Medicine, Washington, DC 20060, USA.
authors.forename: Marisha T
authors.initials: MT
authors.lastname: Newton
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Archer
authors.forename: Michangelo
authors.initials: M
authors.lastname: Scruggs
authors.forename: Kirk
authors.initials: K
authors.lastname: Geter
authors.forename: Hiba
authors.initials: H
authors.lastname: Al-Dabagh
authors.forename: Errol
authors.initials: E
authors.lastname: Lloyd
authors.forename: Maria
authors.initials: M
authors.lastname: Nwokike
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011897:Random Allocation; D012307:Risk Factors