Reliability of the Radiologic Measurement Methods for Assessment of Osteoporosis Using the Digital Hip Radiograph

Ho Hyun Yun; Ju-Won Yi; Deuk-Soo Lim; Sung Chul Park; Seong Rok Oh

doi:10.5371/jkhs.2011.23.2.142

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Yun, Yi, Lim, Park, and Oh: Reliability of the Radiologic Measurement Methods for Assessment of Osteoporosis Using the Digital Hip Radiograph

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(2): 142-150.

Published online: 30 June 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.2.142

Reliability of the Radiologic Measurement Methods for Assessment of Osteoporosis Using the Digital Hip Radiograph

Ho Hyun Yun, MD, Ju-Won Yi, MD^*, Deuk-Soo Lim, MD, Sung Chul Park, MD, Seong Rok Oh, MD

Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.

^*Department of Orthopedic Surgery, College of Medicine, Ewha Womans University, Seoul, Korea.

Address reprint request to Ho Hyun Yun, MD. Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Gangdong-gu, Seoul 134-791, Korea. TEL: +82-2-2226-1114, FAX: +82-2-2226-1910, yun8813@paran.com

Received 15 January 2011 Revised 7 June 2011 Accepted 8 June 2011

Abstract

Purpose

We evaluated the usefulness of radiographic parameters for osteoporosis by analyzing the results of radiographic parameters determined by digital hip radiographs and bone mineral density T-scores, as assessed by Dual Energy X-ray Absorptiometry (DEXA).

Materials and Methods

The authors reviewed 100 subjects in the hip fracture group and 50 in the non-fracture control group. Digital hip radiographs were assessed to determine the values of Singh index, Canal-to-Calcar Ratio, and Cortical Thickness Index (CTI). Bone mineral density was assessed by DEXA.

Results

Intraclass Correlation Coefficient (ICC) results of the CTI were above 0.8 in the fracture group. Compared to the control group, the fracture group showed higher ICCs. Interobserver ICCs were especially lower in the control group. There were statistically significant correlations between CTI and DEXA (r=0.50~0.58, p<0.05). In the analysis of ROC curves, a mean threshold for CTI set a value of 0.54 (0.53~0.55), and mean sensitivity and specificity were 75.5% (69~79%) and 67.8% (65~78%), respectively.

Conclusion

CTI showed reasonable reliability and correlation with DEXA results. CTI was a useful radiographic parameter to alert the surgeon to recommend referral for osteoporosis evaluation in elderly hip fracture patients.

Keywords: Hip, Hip fracture, Osteoporosis, Radiographic parameter, Digital radiograph

Figures and Tables

Fig. 1

Measurement of calcar-to-canal ratio by FW/CW on anteroposterior radiograph of the hip.

Fig. 2

Cortical thickness index measurement on anteroposterior radiograph of the hip. Cortical thickness index is equal to femoral diaphysis with minus intramedullary width divided by diaphysis width.

Fig. 3

Receiver Operation Characteristic Curves of the cortical thickness index results.

Table 1

Intra- and Interobserver Reliability Evaluated by ICC with 95% CI

^*CCR; Canal-to-Calcar Ratio, ^†CTI; Cortical Thickness Index, ^‡ICC; Intraclass Correlation Coefficient, ^§CI; Confidence Interval

Table 2

Intra- and Interobserver Reliability Evaluated by Kappa with 95% CI

^*SI; Singh Index, ^†OP; Osteoporosis based on Singh Index,

^‡Dorr; Dorr Classification of Femoral Geometry according to Canal-to-Calcar Ratio, ^§CI; Confidence Interval

Table 3

Correlation of CTI and CCR Evaluated by Spearman Correlation Test with P value

^*CCR; Canal-to-Calcar Ratio, ^†CTI; Cortical Thickness Index

Table 4

Correlation of Radiologic Parameters with DEXA Result

^*CCR; Canal-to-Calcar Ratio, ^†CTI; Cortical Thickness Index, ^‡OP; Osteoporosis based on Singh Index,

^§Dorr; Dorr Classification of Femoral Geometry according to Canal-to-Calcar Ratio, ^∥CI; Confidence Iinterval

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