The American Association for Hand Surgery (AAHS) had their 2017 annual meeting last week in Waikoloa, Hawaii. A research study that I have been working on with colleagues at Stanford University was presented, and was fortunate enough to have been selected as the winner of the meeting’s “Outstanding Paper” award.
The goal of the study was to try and find an easy way for hand surgeons to diagnose osteoporosis in their office. This study was also just recently accepted for publication into the Journal of Hand Surgery – the premier journal for publishing new findings in the field of hand surgery.
Schreiber JJ, Kamal RN, Yao J. “Simple Assessment of Global Bone Density and Osteoporosis Screening Utilizing Standard Radiographs of the Hand”.
Osteoporosis can lead to very serious fractures of the hip, spine and other bones. In patients with osteoporosis, these fractures can occur very easily, and can result from minor trauma like falling from a chair or tripping while walking. Osteoporosis and associated fractures, unfortunately, are quite prevalent and costly. In the United States alone, there are over 2 million fractures annually attributed to osteoporosis, which place a major financial burden on the health care system – with costs exceeding $20 billion annually (1). Fortunately, if osteoporosis is caught early, it can be treated and this fracture risk can be greatly reduced.
Typically, osteoporosis is diagnosed based on results from a DXA scan – a bone density scan. In our new study, we asked if there was information on simple hand and wrist x-rays that could tell us as much about bone quality as the DXA scan – which is more expensive, less available, and involves more radiation exposure than simple x-rays. We found that a simple measurement of the thickness of the “cortical bone” of the second metacarpal in the hand correlated very strongly with DXA scores. In the figures below, this is the percentage resulting from (A-B)/A. We found that a cortical percentage of less than 50% was over 90% accurate in diagnosing osteoporosis. Patients with the second metacarpal cortical percentage below this threshold were over 11 times more likely to have osteoporosis.
We are currently working on an App for the iPhone, which would allow anyone to take a picture of a hand or wrist x-ray with your camera phone, and calculate your cortical thickness and chance of having osteoporosis. This would help doctors to screen for poor bone quality in the office, and identify individuals who may benefit from treatment. This could potentially prevent fractures – something that could decrease individual suffering and lead to significant health care dollar savings.
1) Bunta AD. It is time for everyone to own the bone. Osteoporos Int. 2011;22 Suppl 3:477-482.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.