Reliability Of Radiological Indices In Comparison With Dual Energy X-Ray Absorptiometry In Diagnosis Of Osteoporosis –A One Year Hospital Based Comparative Study

Abstract

INTRODUCTION: The term osteoporosis stands for Osteo- bone and poros- structure with tiny holes. It is a process wherein, the microstructure , quality and the mineral density of the bone is compromised or lost. This change occurs in a tranquillity, progressively and symptomless until the fracture occurs. It is a regularly noticed disorder of the osseous skeletal system occurring in the geriatric age and is often unrecognised or undiagnosed. It projects a dominant issue related to health in the community in developing country like ours –India. Osteoporosis results in serious complications like hip and spinal bone fractures. Hip fractures usually have an atypical presentations like subtrochantric fractures , peri-prosthetic fractures and require surgical fixation whereas vertebral involvement present as chronic back ache , wedge compression fracture , deformity (Hunch back ) etc. Hence diagnosis and early treatment of osteoporosis is of utmost importance. DEXA Scan is the best, unambiguous and meticulous modality to measure the bone mineral density known by far till date1. The fracture risk can be assessed by clinical evaluation of risk factors and by evaluation of mass of bone by physical techniques.The present study compares the reliability of radiological indices versus gold standard DEXA scan in the diagnosis of Osteoporosis. So that the radiological indices can be used to diagnose osteoporosis in the peripheral setup in a cost effective manner. AIMS AND OBJECTIVES: 1. To assess the reliability of radiological indices in comparison with DEXAscan in diagnosis of osteoporosis 2. Cost effectiveness of radiological indices in diagnosing osteoporosis. MATERIALS AND METHODS: A one year comparative study was conducted in the Department of Orthopaedics, KLEsDr.Prabhakar Kore Hospital and MRC, Belagavi. 80 patients presenting to OPD / IPD of Department of Orthopaedics, fulfilling the inclusion and exclusion criteria were enrolled in the study. After getting an written informed consent, the patients were subjected to DEXA scan and a plain radiograph of either of the hip joint with full length femur in AP and Lateral views. Subsequently, the Singh’s Index, CTI(AP and Lateral) , CCR were measured and compared with the standard DEXA scan. RESULTSand Conclusion: The obtained data was statistically analysed using SPSS software. The mean, Standard deviation, correlation between DEXA scan and Radiological Indices by Spearman’s co-efficent, Level of agreement(Kappa) were calculated. A cut off of 0.43 for both CTI (AP & Lateral) and 0.50 for CCR was deduced. There was a Significant correlation seen with DEXA scores using Spearman’s Rank Co-efficient(p<0.0001) and a Substantial level of agreement using Kappa statistics. With greater Sensitivity and specificity,positive predictive value CTI(lateral) is more reliable compared to other indices in this study. Though there was a Significant correlation of Singh’s Index with DexaScores, due to its limitations of reproducibility, observer bias , technical limitations with the Radiography , and application to a larger population , it is concluded that Singh Index is not reliable in diagnosis of Osteoporosis.Radiological indices are both Reliable and cost effective in the diagnosis of Osteoporosis