title: Computed tomography derived bone density measurement in the diabetic foot.
abstract: BACKGROUND
  The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in populations at risk of foot bone pathology such as in those with long term diabetes. With research and development, computed tomography may prove to be a useful tool for this assessment. The aim of this study was to establish the reliability of a novel method of foot bone density measurement in people with diabetes using computed tomography.
  
  
  METHODS
  Ten feet in people with diabetes were scanned with computed tomography twice with repositioning. Bone density (in Hounsfield units) was assessed in the trabecular and cortical bone in all tarsals and metatarsals. Reliability was assessed with intra-class correlation coefficients (95% confidence intervals), limits of agreement and standard error of measurement.
  
  
  RESULTS
  The reliability of the trabecular density of most bones was excellent with intra-class correlation coefficients ranging from 0.68 to 0.91. Additionally, cortical bone density showed fair to good reliability at the talus (0.52), calcaneus (0.59), navicular (0.70), cuboid (0.69), intermediate cuneiform (0.46) and first metatarsal (0.61).
  
  
  CONCLUSIONS
  The study established the reliability of a practical method of assessing the trabecular and cortical foot bone density using computed tomography scanning. This methodology may be useful in the investigation of foot bone disease occurring in diabetes and its early diagnosis, intervention and assessment of treatment efficacy. Further development of this method is warranted.
authors.affiliation: University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW 2258 Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Barwick
authors.affiliation: University of Newcastle, University Dr, Callaghan, NSW 2308 Australia.
authors.forename: John
authors.initials: J
authors.lastname: Tessier
authors.affiliation: Hunter Imaging Group, 48 Thomas Street, Cardiff, NSW 2285 Australia.
authors.forename: James
authors.initials: J
authors.lastname: Mirow
authors.affiliation: University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW 2258 Australia.
authors.forename: Xanne Janse
authors.initials: XJ
authors.lastname: de Jonge
authors.affiliation: University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW 2258 Australia.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Chuter
mesh_terms: D000368:Aged; D015519:Bone Density; D000071556:Cancellous Bone / Q000000981:diagnostic imaging*; D000071538:Cortical Bone / Q000000981:diagnostic imaging*; D017719:Diabetic Foot / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D013639:Tarsal Bones / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Bone; Diabetes; Foot; Reliability