The validity of plain lumber vertebral X-Rays in diagnosing osteoporosis in elderly-An age-based approach
Background: The diagnosis of osteoporosis relies on the quantitative assessment of BMD, which is currently considered the best predictor of osteoporotic fractures. Early diagnosis is the key for appropriate osteoporosis management. Although common, osteoporosis can be clinically silent, and without prevention and screening, the costs of osteoporotic fracture–related morbidity and mortality will burden healthcare systems, especially in developing countries.
Objective: To assessed the validity of plain radiography in diagnosing osteoporosis in elderly women.
Methods: A retrospective, cross-sectional, observational hospital-based study conducted at the Department of Ortho-Surgery, Patuakhali Medical College Hospital, Patuakhali, Bangladesh from June 2019 to July 2022. One hundred Seventy (170) female patients between the ages of 40 to 83 years were referred to the orthopedic department in PKMCH. These women were found to have features of osteopenia in lumber vertebrae plain radiography. The participants then categorized into two groups. Group A (n=101) are those who are younger than 65 years and group B (n=69) are those who are 65 years and older. The two groups underwent a quantitative ultrasound bone densitometry. Correlations between plain radiography parameters and QUS were calculated. Osteoporosis was diagnosed by QUS T-score ≤ –2.5 at the lumber vertebra.
Results: Total 170 patients were included. The mean age of the participants was 63.5±6 years old with the minimum age was 40 years and the maximum age was 83 years. The most common population aged more than 63 years old, group A who are less than 65 years of age were 101 participants (59.4%), while those 65 years and old were 69 (40.6%). The participants in both groups have showed features of osteopenia in their plain lumbar vertebral X-rays. By QUS; in group A: 2 patients (1.9%) were found to have a normal bone mineral density (T score = >-1 SD), 47 patients (46.5%) were osteopenic (T score between -1 and -2.5 SD), while 52 patients (51.4%) were osteoporotic (T score = <-2.5 SD), in group B: 3 patients (4.3%) were found to have a normal bone mineral density (T score =>-1 SD), 3 patients (4.3%) were osteopenic (T score between -1 and -2.5 SD), while 63 patients (91.3%) were osteoporotic (T score =<-2.5 SD). Also when we performed Fisher’s Exact test we found a significant difference in the validity of X rays as compared to QUS bone densitometry between the two groups, in Group A. The difference between X-ray and quantitative ultrasound bone densitometry was significant (p = 0.000000006 at p > 0.05), and was not significant in Group B (p = 0.491 at p >0.05).
Conclusion: Plain radiography can provide reliable method for diagnosis of osteoporosis in women with a higher risk for fragility fractures (≥65 years) especially in primary healthcare and sittings with limited resources.
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