title: The role of hip and chest radiographs in osteoporotic evaluation among south Indian women population: a comparative scenario with DXA.
abstract: BACKGROUND
  Osteoporosis is recognized as a worldwide skeletal disorder problem. In India, the older as well as postmenopausal women population suffering from osteoporotic fractures has been a common issue. Bone mineral density measurements gauged by dual-energy X-ray absorptiometry (DXA) are used in the diagnosis of osteoporosis.
  
  
  OBJECTIVE
  (1) To evaluate osteoporosis in south Indian women by radiogrammetric method in a comparative perspective with DXA. (2) To assess the capability of KJH; Anburajan's Empirical formula in the prediction of total hip bone mineral density (T.BMD) with estimated Hologic T.BMD.
  
  
  METHODS
  In this cross-sectional design, 56 south Indian women were evaluated. These women were randomly selected from a health camp. The patients with secondary bone diseases were excluded. The standard protocol was followed in acquiring BMD of the right proximal femur by DPX Prodigy (DXA Scanner, GE-Lunar Corp., USA). The measured Lunar Total hip BMD was converted into estimated Hologic Total hip BMD. In addition, the studied population underwent chest and hip radiographic measurements. Combined cortical thickness of clavicle has been used in KJH; Anburajan's Empirical formula to predict T.BMD and compared with estimated Hologic T.BMD by DXA.
  
  
  RESULTS
  The correlation coefficients exhibited high significance. The combined cortical thickness of clavicle and femur shaft of total studied population was strongly correlated with DXA femur T.BMD measurements (r = 0.87, P < 0.01 and r = 0.45, P < 0.01) and it is also having strong correlation with low bone mass group (r = 0.87, P < 0.01 and r = 0.67, P < 0.01) KJH; Anburajan's Empirical formula shows significant correlation with estimated Hologic T.BMD (r = 0.88, P < 0.01) in total studied population. The empirical formula was identified as better tool for predicting osteoporosis in total population and old-aged population with a sensitivity (88.8 and 95.6 %), specificity (89.6 and 90.9 %), positive predictive value (88.8 and 95.6 %) and negative predictive value (89.6 and 90.9 %), respectively.
  
  
  CONCLUSIONS
  The results suggest that combined cortical thickness of clavicle and femur shaft using radiogrammetric method is significantly correlated with DXA. Moreover, KJH; Anburajan's Empirical formula is useful and better index than other simple radiogrammetry measurements in the evaluation of osteoporosis from the economical and widely available digital radiographs.
authors.affiliation: Department of Biomedical Engineering, SRM University, Kattankulathur, Chennai, 603203, Tamil Nadu, India, joy_ashok2003@yahoo.co.in.
authors.forename: D Ashok
authors.initials: DA
authors.lastname: Kumar
authors.forename: M
authors.initials: M
authors.lastname: Anburajan
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002968:Clavicle; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005269:Femur; D006615:Hip; D006801:Humans; D007194:India; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013909:Thorax
references.citation: Osteoporos Int. 2006 Dec;17(12):1726-33
references.pmid: 16983459
references.citation: Osteoporos Int. 2001;12(6):438-44
references.pmid: 11446558
references.citation: World Health Organ Tech Rep Ser. 1994;843:1-129
references.pmid: 7941614
references.citation: Age Ageing. 2006 Sep;35 Suppl 2:ii27-ii31
references.pmid: 16926200
references.citation: J Bone Miner Res. 2006 Apr;21(4):495-500
references.pmid: 16598367
references.citation: J Bone Miner Res. 2006 Jan;21(1):124-31
references.pmid: 16355281
references.citation: Best Pract Res Clin Rheumatol. 2002 Dec;16(5):795-806
references.pmid: 12473274
references.citation: Am J Clin Nutr. 2000 Aug;72(2):472-5
references.pmid: 10919943
references.citation: Osteoporos Int. 2005 Nov;16(11):1330-8
references.pmid: 15928804
references.citation: Br Med J. 1969 Feb 15;1(5641):409-11
references.pmid: 5763959
references.citation: J Bone Miner Res. 1994 Aug;9(8):1137-41
references.pmid: 7976495
references.citation: Arch Intern Med. 1989 Nov;149(11):2445-8
references.pmid: 2818106
references.citation: J Bone Miner Res. 1994 May;9(5):671-7
references.pmid: 8053396
references.citation: Osteoporos Int. 2004 Apr;15(4):274-80
references.pmid: 14760516
references.citation: J Bone Miner Res. 2009 Mar;24(3):468-74
references.pmid: 19016592
references.citation: J Orthop Res. 2000 May;18(3):443-8
references.pmid: 10937632
references.citation: Bone. 2013 Jan;52(1):393-9
references.pmid: 23103928
references.citation: Bone. 2007 Jul;41(1):129-37
references.pmid: 17442649
references.citation: J Shoulder Elbow Surg. 2013 Jun;22(6):732-8
references.pmid: 23183030
references.citation: J Bone Miner Res. 1999 Oct;14(10):1714-20
references.pmid: 10491219
references.citation: J Bone Miner Res. 2000 Apr;15(4):710-20
references.pmid: 10780863
references.citation: J Nutr. 2006 Jun;136(6):1453-6
references.pmid: 16702302
references.citation: J Assoc Physicians India. 1998 Nov;46(11):965-7
references.pmid: 11229226
references.citation: Osteoporos Int. 1995 May;5(3):167-73
references.pmid: 7655177
references.citation: QJM. 2004 Sep;97(9):569-74
references.pmid: 15317925
references.citation: Lancet. 2005 Jul 9-15;366(9480):129-35
references.pmid: 16005335
references.citation: Bone. 1996 Apr;18(4):327-30
references.pmid: 8726389
references.citation: J Bone Miner Res. 2008 Feb;23(2):205-14
references.pmid: 17937534
references.citation: Comput Biol Med. 2013 Nov;43(11):1910-9
references.pmid: 24209936
references.citation: J Bone Miner Res. 1994 Jul;9(7):1071-6
references.pmid: 7942154
references.citation: J Bone Miner Res. 1997 Sep;12(9):1463-70
references.pmid: 9286763
references.citation: J Orthop Res. 1994 Mar;12(2):211-8
references.pmid: 8164094
references.citation: Osteoporos Int. 2009 Mar;20(3):363-70
references.pmid: 18633665
references.citation: Osteoporos Int. 1999;10(5):384-91
references.pmid: 10591836
references.citation: J Bone Miner Res. 1993 Oct;8(10):1211-7
references.pmid: 8256658
references.citation: N Engl J Med. 1995 Mar 23;332(12):767-73
references.pmid: 7862179
references.citation: J Assoc Physicians India. 1994 Mar;42(3):209-11
references.pmid: 7860510
references.citation: Radiographics. 2011 Sep-Oct;31(5):1343-64
references.pmid: 21918048
references.citation: J Clin Endocrinol Metab. 2005 Dec;90(12):6508-15
references.pmid: 16189253
references.citation: Osteoporos Int. 2000 Sep;11(8):714-20
references.pmid: 27517712
references.citation: Clin Radiol. 1960 Jul;11:166-74
references.pmid: 14408427
references.citation: J Bone Miner Res. 2004 Dec;19(12):1945-54
references.pmid: 15537436
references.citation: Am J Roentgenol Radium Ther Nucl Med. 1963 Jun;89:1287-95
references.pmid: 13934419