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Digital X-rays of wrist bones predict hip fracture risk



DOI:10.1038/bonekey.2013.36

A large observational study was carried out in Sweden on patients admitted to three emergency hospitals over a period of 8 years. Radiographs obtained using digital X-ray radiogrammetry (DXR) were analysed to estimate bone mineral density (BMD) at the metacarpal bone in the wrist. Patients were followed up in in-patient registers and national death registers to see if BMD levels at the wrist correlated with later incidence of hip fracture.

Of the 8257 patients followed up for an average of 3 years and 3 months (65.6% female and 34.4% male), 122 had a post-radiograph hip fracture. Men and women in the fracture group were significantly older and had a significantly lower BMD, as previously measured by DXR at their wrist. The age-adjusted hazard ratio for hip fracture per standard deviation change in DXR T-score was 2.52 (women) and 2.08 (men).

Editor’s comment: DXR analysis of metacarpal bones has again been shown to predict hip fracture risk. However, despite the authors’ belief that DXR can be used for screening of patients with a predisposition to fragility fractures, this study raises two concerns. First, it still uses radiation and, second, since the patients included in the study were admitted to emergency hospitals, the risk of bias is high (participants may have been at higher risk of fractures than a general population).


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