Wednesday, June 26, 2013

Plain x-ray of proximal humerus can reveal osteoporosis

Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis.

You have to see this site on osteoporosis put up by our friend Susan Ott

It is important that patients be evaluated for the possibility of osteoporosis. First of all, this condition needs to be managed to lower the risk of fractures of the spine, hip, and wrist. Second, with specific reference to shoulder (and elbow) arthroplasty, osteoporosis increases the risk of periprosthetic fractures of the humerus. This is especially the case for tightly fitted humeral components, cemented humeral components and reverse total shoulders. 

These authors studied 108 patients that had both shoulder radiographs and DXA scans. They describe two methods for evaluating cortical bone thickness and they evaluated the relationship between cortical bone thickness and femoral and lumbar DXA. 

They found that cortical bone thickness measurements at the proximal humerus strongly correlated with DXA femur measurements and moderately correlated with DXA lumbar measurements.

They propose that an average proximal humeral cortical thickness of 6 mm was a potential threshold value for predicting osteoporosis, with a sensitivity of 93%, specificity of 52%, and negative predictive value of 95%.

Virtually all of our patients get an AP x-ray of the shoulder. These authors are telling us to pay attention to the cortical thickness of the proximal humerus and to consider the diagnosis of osteoporosis when the bone is thin.

We've previously published on the relationship of shoulder fractures to osteoporosis

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