Abstract
ObjectiveTo evaluate the predictive ability of digital X-ray radiogrammetry (DXR) for fracture in women attending general mammography screening. Study designIn a nested case-control study, women aged between 40 and 75 years, who attended the regional mammography screening program, had their bone mass assessed with DXR and provided information regarding clinical risk factors for osteoporosis. Follow-up was done through cross-referencing with National Patient Registers. Associations between DXR, clinical risk factors and fracture risk were examined. Receiver operating characteristics curves for DXR T-score and different fracture types were plotted, and their respective AUC calculated. Main outcome measuresFractures (hip, major osteoporotic and any clinical facture). Fracture diagnoses were retrieved from National Patient Registers. Results14,841 women had their bone mass examined in conjunction with mammography. Of these women, 10,967 returned fully completed questionnaires regarding clinical risk factors. In total 605 fractures (including 355 major osteoporotic fractures and 18 hip fractures) occurred during the follow-up period (median follow-up time was 3.3 years). Women with fractures were older and had lower DXR T-score compared with those without. DXR T-score correlated with fracture risk. HR/SD T-score decrease was 2.15 (CI 1.55–3.00) for hip, 1.47 (CI 1.36–1.59) for major osteoporotic and 1.33 (CI 1.26–1.42) for any clinical fracture. The AUCs for the different fracture types were 0.79 (hip), 0.69 (major osteoporotic) and 0.65 (any clinical). ConclusionsDXR T-score is negatively correlated with risk of fracture in a general female population. This indicates a potential use of DXR in population-based screening for osteoporosis.
Highlights
Fractures after low energy trauma account for substantial morbidity, increased mortality and health care cost
The aim of this study was to assess the predictive performance of digital X-ray radiogrammetry (DXR) with regard to fractures in a population of women called for regular mammography screening
Cox proportional hazard models were used to assess the association of DXR and fractures, where the hazard ratios (HR) and 95% CI were calculated
Summary
Fractures after low energy trauma (fragility fractures) account for substantial morbidity, increased mortality and health care cost. In order to maximize their potential, they should be initiated early, before fractures occur This suggests a need for early identification of individuals at risk. The Fracture Risk Assessment Tool (FRAX) is the most prevalent and can be used with or without bone mineral density (BMD) measurements [2]. Some methods such as quantitative ultrasound have been developed and opportunistic detec tion through e.g. standard abdominal and thoracic computed tomogra phy have been investigated in an attempt to increase diagnostic availability [4,5]. The aim of this study was to assess the predictive performance of DXR with regard to fractures in a population of women called for regular mammography screening
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