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DXA scans to determine hip structural analysis: a better tool to predict fracture risk?



DOI:10.1038/bonekey.2013.203

Fracture risk in patients with osteoporosis is routinely determined by performing a dual-energy X-ray absorptiometry (DXA) scan of the proximal femur to determine bone mineral density, but the method has its limitations. In this study, Ohnaru et al. investigated the potential of a DXA-based hip structural analysis (DXA-HSA) in postmenopausal women in Japan.

The participants were 184 women aged between 51 and 88 years who had passed through the menopause and who had received a hip or knee replacement because of osteoporosis. They were assessed preoperatively by CT scanning to obtain a hip structural analysis, and this was compared with the DXA-HSA data.

Correlation between the two data sets was moderate to high (r=0.60–0.90, P<0.001) in the narrow neck and intertrochanteric regions of the hip. High correlation was seen between the HSA indices and measurements of fracture load; in fact the correlation was significantly greater between DXA-HSA and fracture load compared with CT-HSA and fracture load.

Editor’s comment: The results of the present study suggest that the geometry of the proximal femoral cross section can be reasonably well characterized using DXA; using the routine CT scan with a 2.5-mm slice thickness would provide little additional information over DXA-HSA.


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