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Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk-a study in 5,420 women and 2,837 men
Karolinska University Hospital, Stockholm, Sweden .
Linköping University, Center for Medical Image Science and Visualization (CMIV). Sectra Imtec AB, Linköping, Sweden .ORCID iD: 0000-0002-3486-796X
Sectra Imtec AB, Linkoping, Sweden .
Karolinska Institutet, Stockholm, Sweden .
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2013 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 23, no 5, 1383-1391 p.Article in journal (Refereed) Published
Abstract [en]

To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. less thanbrgreater than less thanbrgreater thanA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age a parts per thousand yen 40 years, no prior hip fracture and observation time andgt; 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. less thanbrgreater than less thanbrgreater than8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. less thanbrgreater than less thanbrgreater thanDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. less thanbrgreater than less thanbrgreater thanKey Points less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. less thanbrgreater than less thanbrgreater thanOsteoporosis can potentially be identified in patients with suspected wrist fractures. less thanbrgreater than less thanbrgreater thanDXR can potentially be used for selective osteoporosis screening.

Place, publisher, year, edition, pages
Springer Verlag (Germany) , 2013. Vol. 23, no 5, 1383-1391 p.
Keyword [en]
Osteoporosis, Hip fracture, Digital X-ray radiogrammetry, Cohort, BMD
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-103399DOI: 10.1007/s00330-012-2706-9ISI: 000317427500029OAI: oai:DiVA.org:liu-103399DiVA: diva2:689080
Note

Funding Agencies|Stockholm County Council||Karolinska Institutet||

Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
Open this publication in new window or tab >>Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion.

In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million.

Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA.

Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1433
Keyword
Osteoporosis, rheumatoid arthritis, digital X-ray radiogrammetry, joint space width, bone densitometry
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-113680 (URN)10.3384/diss.diva-113680 (DOI)978-91-7519-170-6 (ISBN)
Public defence
2015-03-13, Wrannesalen, CMIV, Campus US, Linköpings universitet, Linköping, 13:00 (English)
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Available from: 2015-01-28 Created: 2015-01-28 Last updated: 2015-03-26Bibliographically approved

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